Cardiopulmonary Impact of Particulate Air Pollution in High- Risk Populations: JACC State-of-the-Art-Review

Fine particulate air pollution <2.5 mm in diameter (PM2.5) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM2.5 as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM2.5 can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy, health benefits, risks, burden, costs) of the various protective interventions, in particular among real-world susceptible and vulnerable populations. This paper summarizes the discussions and conclusions from an expert workshop, Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High Risk Populations, held on May 29 to 30, 2019, and convened by the National Institutes of Health, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention.

Impact/Purpose

This manuscript summarizes the perspectives of experts from cardiovascular medicine, epidemiology, indoor air quality, environmental measurement and exposure science on the topic of reducing the cardiopulmonary impact of air pollution in high risk populations. People who have existing respiratory and cardiovascular disease are at heightened risk of health effects, including premature death, from exposure to particulate matter air pollution. Given that cardiovascular disease is the highest cause of death in the US, actions that can lower these health risks are a very high priority. Doctors and other health professionals are eager for evidence that shows how advice they might give their patients will reduce in lower risks. Experts at this workshop debated whether it was feasible at this stage to conduct a clinical trial of interventions that patients could take (such as use of portable air cleaners) that could improve their health or reduce their risks. They discussed issues such as who constitutes a high risk population; what size population would be needed for the study; how would you measure the actual use of the air cleaners; what type of study design could actually work and what types of preliminary research would be needed before knowledge was adequate to conduct a clinical trial. This manuscript summarizes the issues raised and points of views expressed at this workshop about research that could answer these important questions.

Citation

Newman, J., D. Bhatt, S. Rajagopalan, J. Balmes, M. Brauer, P. Breysse, A. Brown, M. Carnethon, W. Cascio, G. Collman, L. Fine, N. Hansel, A. Hernandez, J. Hochman, M. Jerrett, B. Joubert, J. Kaufman, A. Malik, G. Mensah, D. Newby, J. Peel, J. Siegel, D. Siscovick, B. Thompson, J. Zhang, AND R. Brook. Cardiopulmonary Impact of Particulate Air Pollution in High- Risk Populations: JACC State-of-the-Art-Review. W B Saunders Company, Philadelphia, PA, 76(24):2878–94, (2020). [DOI: 10.1016/j.jacc.2020.10.020]

• PubMed Central

DOI: Cardiopulmonary Impact of Particulate Air Pollution in High- Risk Populations: JACC State-of-the-Art-Review