FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 357:1075-1082 September 13, 2007 Number 11 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Mittleman, M. A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Exposure to air pollution from traffic is associated with adverse cardiovascular events. The mechanisms for this association are unknown. We conducted a controlled exposure to dilute diesel exhaust in patients with stable coronary heart disease to determine the direct effect of air pollution on myocardial, vascular, and fibrinolytic function.

Methods In a double-blind, randomized, crossover study, 20 men with prior myocardial infarction were exposed, in two separate sessions, to dilute diesel exhaust (300 µg per cubic meter) or filtered air for 1 hour during periods of rest and moderate exercise in a controlled-exposure facility. During the exposure, myocardial ischemia was quantified by ST-segment analysis using continuous 12-lead electrocardiography. Six hours after exposure, vasomotor and fibrinolytic function were assessed by means of intraarterial agonist infusions.

Results During both exposure sessions, the heart rate increased with exercise (P<0.001); the increase was similar during exposure to diesel exhaust and exposure to filtered air (P=0.67). Exercise-induced ST-segment depression was present in all patients, but there was a greater increase in the ischemic burden during exposure to diesel exhaust (–22±4 vs. –8±6 millivolt seconds, P<0.001). Exposure to diesel exhaust did not aggravate preexisting vasomotor dysfunction, but it did reduce the acute release of endothelial tissue plasminogen activator (P=0.009; 35% decrease in the area under the curve).

Conclusions Brief exposure to dilute diesel exhaust promotes myocardial ischemia and inhibits endogenous fibrinolytic capacity in men with stable coronary heart disease. Our findings point to ischemic and thrombotic mechanisms that may explain in part the observation that exposure to combustion-derived air pollution is associated with adverse cardiovascular events. (ClinicalTrials.gov number, NCT00437138 [ClinicalTrials.gov] .)

Source Information

From the Centre for Cardiovascular Science (N.L.M., E.V., S.D.R., N.A.B., D.E.N.) and ELEGI Colt Laboratory, Center for Inflammation Research (K.D.) — both at Edinburgh University, Edinburgh; and the Department of Respiratory Medicine and Allergy (H.T., T.S., A.B.) and the Department of Medicine (M.C.G., S.S.), Umeå University, Umeå, Sweden.

Drs. Mills and Törnqvist contributed equally to this article.

Address reprint requests to Dr. Mills at the Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Bldg., Edinburgh EH16 4SB, United Kingdom, or at nick.mills{at}ed.ac.uk.

Full Text of this Article

This article has been cited by other articles:

• Folino, A. F., Scapellato, M. L., Canova, C., Maestrelli, P., Bertorelli, G., Simonato, L., Iliceto, S., Lotti, M. (2009). Individual exposure to particulate matter and the short-term arrhythmic and autonomic profiles in patients with myocardial infarction. Eur Heart J 30: 1614-1620 [Abstract] [Full Text]  
• Naota, M., Shimada, A., Morita, T., Inoue, K., Takano, H. (2009). Translocation Pathway of the Intratracheally Instilled C60 Fullerene from the Lung into the Blood Circulation in the Mouse: Possible Association of Diffusion and Caveolae-mediated Pinocytosis. Toxicol Pathol 37: 456-462 [Abstract] [Full Text]  
• Barclay, J L, Miller, B G, Dick, S, Dennekamp, M, Ford, I, Hillis, G S, Ayres, J G, Seaton, A (2009). A panel study of air pollution in subjects with heart failure: negative results in treated patients. Occup. Environ. Med. 66: 325-334 [Abstract] [Full Text]  
• Akinaga, L. M. Y., Lichtenfels, A. J., Carvalho-Oliveira, R., Caldini, E. G., Dolhnikoff, M., Silva, L. F. F., De Siqueira Bueno, H. M., Pereira, L. A. A., Saldiva, P. H. N., Garcia, M. L. B. (2009). Effects of Chronic Exposure to Air Pollution from Sao Paulo City on Coronary of Swiss Mice, from Birth to Adulthood. Toxicol Pathol 37: 306-314 [Abstract] [Full Text]  
• Lund, A. K., Lucero, J., Lucas, S., Madden, M. C., McDonald, J. D., Seagrave, J.-C., Knuckles, T. L., Campen, M. J. (2009). Vehicular Emissions Induce Vascular MMP-9 Expression and Activity Associated With Endothelin-1-Mediated Pathways. Arterioscler. Thromb. Vasc. Bio. 29: 511-517 [Abstract] [Full Text]  
• Soberanes, S., Urich, D., Baker, C. M., Burgess, Z., Chiarella, S. E., Bell, E. L., Ghio, A. J., De Vizcaya-Ruiz, A., Liu, J., Ridge, K. M., Kamp, D. W., Chandel, N. S., Schumacker, P. T., Mutlu, G. M., Budinger, G. R. S. (2009). Mitochondrial Complex III-generated Oxidants Activate ASK1 and JNK to Induce Alveolar Epithelial Cell Death following Exposure to Particulate Matter Air Pollution. J. Biol. Chem. 284: 2176-2186 [Abstract] [Full Text]  
• von Klot, S., Mittleman, M. A., Peters, A. (2009). Physical exertion and triggering of myocardial infarction: reply. Eur Heart J 0: ehn551v1-1 [Full Text]  
• Lucking, A. J., Lundback, M., Mills, N. L., Faratian, D., Barath, S. L., Pourazar, J., Cassee, F. R., Donaldson, K., Boon, N. A., Badimon, J. J., Sandstrom, T., Blomberg, A., Newby, D. E. (2008). Diesel exhaust inhalation increases thrombus formation in man. Eur Heart J 29: 3043-3051 [Abstract] [Full Text]  
• Ljungman, P. L.S., Berglind, N., Holmgren, C., Gadler, F., Edvardsson, N., Pershagen, G., Rosenqvist, M., Sjogren, B., Bellander, T. (2008). Rapid effects of air pollution on ventricular arrhythmias. Eur Heart J 29: 2894-2901 [Abstract] [Full Text]  
• Chan, M. Y., Andreotti, F., Becker, R. C. (2008). Hypercoagulable States in Cardiovascular Disease. Circulation 118: 2286-2297 [Full Text]  
• Lanki, T, Hoek, G, Timonen, K L, Peters, A, Tiittanen, P, Vanninen, E, Pekkanen, J (2008). Hourly variation in fine particle exposure is associated with transiently increased risk of ST segment depression. Occup. Environ. Med. 65: 782-786 [Abstract] [Full Text]  
• Bigert, C, Alderling, M, Svartengren, M, Plato, N, de Faire, U, Gustavsson, P (2008). Blood markers of inflammation and coagulation and exposure to airborne particles in employees in the Stockholm underground. Occup. Environ. Med. 65: 655-658 [Abstract] [Full Text]  
• Chuang, K. J., Coull, B. A., Zanobetti, A., Suh, H., Schwartz, J., Stone, P. H., Litonjua, A., Speizer, F. E., Gold, D. R. (2008). Particulate Air Pollution as a Risk Factor for ST-Segment Depression in Patients With Coronary Artery Disease. Circulation 118: 1314-1320 [Abstract] [Full Text]  
• Simkhovich, B. Z., Kleinman, M. T., Kloner, R. A. (2008). Air Pollution and Cardiovascular Injury: Epidemiology, Toxicology, and Mechanisms. J Am Coll Cardiol 52: 719-726 [Abstract] [Full Text]  
• Argacha, J.-F., Adamopoulos, D., Gujic, M., Fontaine, D., Amyai, N., Berkenboom, G., van de Borne, P. (2008). Acute Effects of Passive Smoking on Peripheral Vascular Function. Hypertension 51: 1506-1511 [Abstract] [Full Text]  
• Nawrot, T. S., Alfaro-Moreno, E., Nemery, B. (2008). Update in Occupational and Environmental Respiratory Disease 2007. Am. J. Respir. Crit. Care Med. 177: 696-700 [Full Text]  
• Mills, N. L., Oberdorster, G., Newby, D. E. (2008). Reducing Exposure to Airborne Particles: A Novel Strategy to Improve Cardiovascular Health. Am. J. Respir. Crit. Care Med. 177: 366-367 [Full Text]  
• Krivoshto, I. N., Richards, J. R., Albertson, T. E., Derlet, R. W. (2008). The Toxicity of Diesel Exhaust: Implications for Primary Care. J Am Board Fam Med 21: 55-62 [Abstract] [Full Text]  
• (2007). "Bad Air" Days. JWatch Emergency Med. 2007: 5-5 [Full Text]  
• Mittleman, M. A. (2007). Air Pollution, Exercise, and Cardiovascular Risk. NEJM 357: 1147-1149 [Full Text]  
• (2007). Diesel Exhaust and Cardiovascular Events. Journal Watch Cardiology 2007: 1-1 [Full Text]