Number of total mortality, cardiovascular mortality and Chronic Obstructive Pulmonary Disease due to exposure with Nitrogen dioxide in Tehran during 2005-2014

<p>Over the last few decades, the evidence on the adverse effects on the health of air pollution has been raised. Mortality is the most important health effect of ambient air pollution. We studied the relation between mortality and criteria pollutant air in Tehran, one of the highly industrialized, densely populated area and most polluted cities of the reign, during 2005-2014. For this purpose, we applied the approach proposed by the World Health Organization using the AirQ 2.2.3 model. Hourly concentrations of pollutants were taken from the Tehran environmental protection agency and Air Quality Control Company. In this model, the attributable proportion of health outcome, the annual number of excess cases of mortality for all causes were estimated. According to results, the number of total mortality caused by exposure to O3, NO2, SO2, PM10, PM2.5 in the past decade was 8042, 15141, 8136, 17776 and 20015 cases, respectively. The number of cumulative total mortality was 53110 cases in ten years. Furthermore, the number of cumulative cardiovascular and respiratory mortality 33887 and 8168 cases was estimated in last decade. A large number of residents of Tehran have died as a result of exposure to air pollutants; therefore for control and management of air pollution, appropriate actions on health and the environment should be performed.</p>

Elevated blood pressure (known as hypertension) increases with age, and most rapidly over age 60. Systolic hypertension is more strongly associated with cardiovascular disease than diastolic hypertension, and occurs more commonly in older people. It is important to know the benefits and harms of antihypertensive treatment of hypertension in this age group. To quantify antihypertensive drug effect on overall mortality, cardiovascular mortality and morbidity and withdrawal due to adverse effects in people 60 years and older with mild to moderate systolic or diastolic hypertension. Updated search of electronic database of EMBASE, CENTRAL, MEDLINE until Dec 2008; previous search of two Japanese databases (1973-1995) and WHO-ISH Collaboration register (August 1997); references from reviews, trials and previously published meta-analyses; and experts. Randomized controlled trials of at least one year duration in hypertensive elders (at least 60 years old) comparing antihypertensive drug therapy with placebo or no treatment and providing morbidity and mortality data. Outcomes assessed were total mortality (including cardiovascular, coronary heart disease and cerebrovascular mortality); total cardiovascular morbidity and mortality (representing combined coronary heart disease and cerebrovascular morbidity and mortality); and withdrawal due to adverse events. Fifteen trials (24,055 subjects >/= 60 years) with moderate to severe hypertension were identified. These trials mostly evaluated first-line thiazide diuretic therapy for a mean duration of treatment of 4.5 years. Treatment reduced total mortality, RR 0.90 (0.84, 0.97); event rates per 1000 participants reduced from 116 to 104. Treatment also reduced total cardiovascular morbidity and mortality, RR 0.72 (0.68, 0.77); event rates per 1000 participants reduced from 149 to 106. In the three trials restricted to persons with isolated systolic hypertension the benefit was similar. In very elderly patients >/= 80 years the reduction in total cardiovascular mortality and morbidity was similar RR 0.75 [0.65, 0.87] however, there was no reduction in total mortality, RR 1.01 [0.90, 1.13]. Withdrawals due to adverse effects were increased with treatment, RR 1.71 [1.45, 2.00]. Treating healthy persons (60 years or older) with moderate to severe systolic and/or diastolic hypertension reduces all cause mortality and cardiovascular morbidity and mortality. The decrease in all cause mortality was limited to persons 60 to 80 years of age.

Background: Air pollution in large cities is one of the main difficulties that have harmful effects on humans and the environment and cause various diseases including cardiovascular disease. So, present study with aim of Estimation of Cardiovascular Death, Attributed to CO Exposure in Tehran Megacity in during a five-year period (2010-2014) by using AirQ Model were performed. Materials and Methods: This Study was a descriptive–analytic at first, hourly data of pollutants were taken from the environmental protection agency Tehran and Air Quality Control Company and validated according to the WHO guidelines. Required statistical parameters calculated for health effect quantifying and finally processed data converted to input and requirements AirQ model data and health effects quantifying were performed using this model. The final results on deaths due to cardiovascular disease were presented in tables and graphs format. Results: Results showed annual average concentration of CO in Tehran in 2010-2014 are 49, 31, 11,12,21,76 mg/ m3 respectively. In addition, the number of cardiovascular deaths in 2011-2015 is 52,37,29,31,42 respectively Conclusion: According to the results, CO as well as other pollutants can adversely affect human health. Due to high levels of air pollution and its related health consequences, particularly cardiovascular disease, should take appropriate measures to reduce air pollution.

Evolution of all-causes and cardiovascular mortality in the age-group 75-84 years in Europe during the period 1970-1996; a comparison with worldwide changes.

Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is still unknown. By utilizing a large population-based database, we assessed the threshold of SUA that increases the risk of total mortality and cardiovascular mortality (CVM). The URRAH study (Uric Acid Right for Heart Health) is a multicentre retrospective, observational study, which collected data from several large population-based longitudinal studies in Italy and subjects recruited in the hypertension clinics of the Italian Society of Hypertension. Total mortality was defined as mortality for any cause, CVM as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. A total of 22 714 subjects were included in the analysis. Multivariate Cox regression analyses identified an independent association between SUA and total mortality (hazard ratio, 1.53 [95% CI, 1.21-1.93]) or CVM (hazard ratio, 2.08 [95% CI, 1.146-2.97]; P<0.001). Cutoff values of SUA able to discriminate total mortality (4.7 mg/dL [95% CI, 4.3-5.1 mg/dL]) and CVM status (5.6 mg/dL [95% CI, 4.99-6.21 mg/dL]) were identified. The information on SUA levels provided a significant net reclassification improvement of 0.26 and of 0.27 over the Heart Score risk chart for total mortality and CVM, respectively (P<0.001). Sex-specific cutoff values for total mortality and CVM were also identified and validated. In conclusion, SUA levels increasing the risk of total mortality and CVM are significantly lower than those used for the definition of hyperuricemia in clinical practice. Our data provide evidence of a cardiovascular SUA threshold that might contribute in clinical practice to improve identification of patients at higher risk of CVM.

In Helsinki, Finland, from 1987 to 1993, the authors studied the associations between daily concentrations of sulphur dioxide, nitrogen dioxide, ozone, total suspended particulates, and particulates with aerodynamic diameters less than 10 microm (PM10), and the daily number of deaths from all causes and from cardiovascular causes. Investigators used Poisson regressions to conduct analyses in two age groups, and they controlled for temperature, relative humidity, day of the week, month, year, long-term trend, holidays, and influenza epidemics. The PM10 levels were associated significantly with all-cause and cardiovascular mortality among persons under the age of 65 y of age. In the less-than-65-y age group, sulfur dioxide and ozone were also associated significantly with cardiovascular mortality. The effect of ozone was independent of the PM10 effect, whereas sulfur dioxide became nonsignificant when modeled with PM10. An increase of 10 microg/m3 in PM10 resulted in increases in total mortality and cardiovascular mortality of 3.5% (95% confidence interval=1.0, 5.8) and 4.1% (95% confidence interval=0.4, 10.3), respectively. A 20 microg/m3 increase in ozone was associated with a 9.9% (95% confidence interval=1.1, 19.5) increase in cardiovascular mortality; however, ozone results were inconsistent. Moreover, in addition to their separate effects, high concentrations of PM10, ozone, and nitrogen dioxide had a further harmful additive effect. Typically, PM10 was a better indicator of particulate pollution than total suspended particulates. The authors' findings suggest that (a) even low levels of particulates are related to an increase in cardiovascular mortality; (b) ozone--even in low concentrations--is associated, independently, with cardiovascular mortality; and (c) PM10, ozone, and nitrogen dioxide--the essential components of summertime pollution--have harmful interactions at high concentrations.

To evaluate risk factors and prognosis of subjects who had developed a new Q/QS pattern on the resting electrocardiogram (ECG) in relation to history of myocardial infarction (MI). Cross-sectional and prospective population-based cohort study. Uppsala, Sweden. In 1970-73, all 50-year-old men in Uppsala, were invited to participate in a health survey aimed at identifying risk factors for cardiovascular disease. The present study included the 1221 subjects who also were re-examined at age 70. Subjects with a new Q/QS pattern on the resting ECG at age 70 were characterized by impaired insulin secretion compared with those without Q/QS, and a higher prevalence of diabetes compared with the control group. In Cox proportional hazard analysis a new Q/QS pattern at age 70 was a significant predictor of cardiovascular mortality (hazard ratio : 1.67, 95% CI: 1.22-2.26) and total mortality (hazard ratio: 1.31, 95% CI: 1.04-1.62) (after age 70) during 9.4 years follow-up, also when adjusted for other risk factors and MI diagnosis. The finding of a new Q/QS pattern on the resting ECG, regardless of history of MI was associated with impaired insulin secretion and was an independent predictor of total and cardiovascular mortality. Therefore, these subjects must be given a high priority to preventive measures against both coronary heart disease and diabetes.

Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease, development of end-stage renal disease, and all-cause mortality. It affects around 10% of the population worldwide. The prevalence of hypertension in people with CKD ranges from 22% in stage 1 to 80% in stage 4. Elevated arterial blood pressure is one of the major independent risk factors for adverse cardiovascular events. Thereby, reducing blood pressure to below standard targets may be beneficial but could also increase the risk of adverse events. The optimal blood pressure target in people with hypertension and CKD remains unknown. Primary: to compare the effects of standard and lower-than-standard blood pressure targets for hypertension in people with chronic kidney disease on mortality and morbidity outcomes. Secondary: to assess the magnitude of reductions in systolic and diastolic blood pressure, the proportion of participants reaching blood pressure targets, and the number of drugs necessary to achieve the assigned target. We used standard, extensive Cochrane search methods. We searched the Cochrane Hypertension Specialized Register, CENTRAL, MEDLINE, Embase, one other database, and two trial registers up to 8 February 2023. We also contacted authors of relevant papers regarding further published and unpublished work. We applied no language restrictions. We included randomized controlled trials (RCTs) in people with hypertension and CKD that provided at least twelve months' follow-up. Eligible interventions compared lower targets for systolic/diastolic blood pressure (130/80 mmHg or lower) to standard targets for blood pressure (140 to 160/90 to 100 mmHg or lower). Participants were adults with CKD and elevated blood pressure documented in a standard way on at least two occasions, or already receiving treatment for elevated blood pressure. We used standard Cochrane methods. Our critical outcomes were: total mortality, total serious adverse events, total cardiovascular events, cardiovascular mortality, and progression to end-stage renal disease. Important outcomes were: participant withdrawals due to adverse effects, and number of participants with a doubling of serum creatinine level or at least a 50% reduction in the glomerular filtration rate (GFR) at the end of the study. We used GRADE to assess the certainty of the evidence for the critical outcomes. This review received no funding. We included six RCTs that contributed data for meta-analysis, involving 7348 participants overall (range 840 to 4733 people per study). The mean follow-up was 3.6 years (range 1.0 to 8.0 years). Three studies were publicly funded, two were privately funded, and one had both public and private funding. All RCTs provided individual participant data. None of the included studies blinded participants or clinicians because of the need to titrate antihypertensive drugs to reach a specific blood pressure target. However, an independent committee blinded to group allocation assessed clinical events in all studies. Critical outcomes. Compared with standard blood pressure targets, lower targets likely result in little to no difference in total mortality (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.76 to 1.06; 6 studies, 7348 participants), total serious adverse events (RR 1.01, 95% CI 0.94 to 1.08; 6 studies, 7348 participants), and total cardiovascular events (RR 1.00, 95% CI 0.87 to 1.15; 5 studies, 6508 participants), all with moderate-certainty evidence. Compared with standard blood pressure targets, lower targets may result in little to no difference in cardiovascular mortality (RR 0.90, 95% CI 0.70 to 1.16; 6 studies, 7348 participants) and progression to end-stage renal disease (RR 0.94, 95% CI 0.80 to 1.11; 4 studies, 4788 participants), both with low-certainty evidence. Important outcomes. We found little to no differences in: participant withdrawals due to adverse effects; and the number of participants with a doubling of serum creatinine level, or at least a 50% reduction in GFR at the end of the study. Exploratory outcomes. Compared to the standard blood pressure target groups, participants in the lower target groups achieved lower systolic and diastolic blood pressure values after one year, and required a higher number of antihypertensive drugs at the end of the studies. A higher proportion of participants in the standard blood pressure target groups achieved the targets they were assigned than did participants in the intensive target groups. Compared to a standard blood pressure target, lower blood pressure targets probably result in little to no difference in total mortality, total serious adverse events, and total cardiovascular events, and may result in little to no difference in total cardiovascular mortality or in the progression to end-stage renal disease in people with hypertension and CKD. However, the evidence underpinning these conclusions has several limitations. All studies were open design, blood pressure measurement was performed at a medical office, and there was scant information about adverse events. Future research should include high-quality adverse event data, report results for people with different levels of proteinuria, and consider out-of-office blood pressure monitoring. Several studies are ongoing, and may provide new evidence for this topic in the near future.

Two-way effect modifications of air pollution and air temperature on total natural and cardiovascular mortality in eight European urban areas

This study aimed to evaluate the impact of both cumulative and non-cumulative exposure to air pollutants on hospitalizations due to Coronavirus Disease 2019 (COVID-19) in Tehran. A time-stratified case-crossover approach was employed to estimate the relative risks and assess the attributable fraction and attributable number of COVID-19 hospitalizations associated with air pollution exposure. Data on hospitalizations were collected from a teaching hospital in Tehran between March 20, 2020, and September 20, 2022, and were categorized by gender and age. Air pollution data including fine particulate matter (particles with a diameter less than 2.5 micrometers), nitrogen dioxide, sulfur dioxide, coarse particulate matter (particles with a diameter less than 10 micrometers), ozone, and carbon monoxide were obtained from the Environmental Protection and Air Quality Control Organization of Tehran. Quasi-Poisson conditional regression and distributed lag non-linear models were applied to estimate the relative risk of hospitalizations associated with pollutant exposure. The findings indicate a significant association between exposure to fine particulate matter, nitrogen dioxide, and ozone with increased COVID-19 hospitalizations. The estimated relative risks for hospitalizations were 1.36 (95% confidence interval: 1.15-1.62), 1.17 (95% confidence interval: 1.07-1.29), and 1.37 (95% confidence interval, 1.19-1.58), respectively. No significant association was observed between coarse particulate matter exposure and hospitalizations. The number of hospitalizations attributed to ozone (6,000 cases) and nitrogen dioxide (3,300 cases) exceeded those associated with other pollutants. This study highlights the impact of air pollution on increased hospitalization risk for COVID-19. These findings underscore the urgent need for health authorities to implement stringent air quality regulations and pollution control measures to mitigate the adverse health effects of air pollution.

Aim: The association between atrial fibrillation (AF) and risk of stroke mortality among men and women without traditional cerebrocardiovascular risk factors (TCVRFs) is unclear. This study aimed to determine whether AF was a risk factor for stroke and total cardiovascular disease mortality among individuals without TCVRFs.Methods: A total of 90,629 Japanese subjects from the Ibaraki Prefectural Health Study aged 40–79 years, with and without TCVRFs, were studied from 1993 to 2013. Hazard ratios (HRs) were calculated using the Cox proportional hazard regression model stratified by sex and the presence of TCVRFs. Covariates were age, systolic blood pressure, anti-hypertensive medication use, and serum total cholesterol levels. A standard 12-lead electrocardiogram at rest was used to screen AF. Cause-specific mortality was classified according to the International Classification of Disease code.Results: Compared with participants without AF, multivariable-adjusted hazard ratios (with 95% confidence intervals) for stroke mortality among participants without TCVRFs were 4.3 (1.1–17.8) and 15.0 (5.5–40.8) for men and women with AF, respectively. HRs for total cardiovascular disease mortality were 6.2 (2.8–14.2) for men and 10.7 (4.8–24.1) for women. For participants with TCVRFs, multivariable-adjusted HRs for stroke mortality were 3.1 (2.2–4.6) and 4.3 (2.6–7.3), whereas HRs for total cardiovascular disease mortality were 2.9 (2.2–3.8) and 3.5 (2.4–5.1) for men and women, respectively.Conclusions: AF was found to be an independent risk factor for stroke and total cardiovascular mortality even in individuals without other TCVRFs.

Although the growths of ambient pollutants have been attracting public concern, the characteristic of the associations between air pollutants and mortality remains elusive. Time series analysis with a generalized additive model was performed to estimate the associations between ambient air pollutants and mortality outcomes in Shenzhen City for the period of 2012-2014. The results showed that nitrogen dioxide (NO2)-induced excess risks (ER) of total non-accidental mortality and cardiovascular mortality were significantly increased (6.05% (95% CI 3.38%, 8.78%); 6.88% (95% CI 2.98%, 10.93%), respectively) in interquartile range (IQR) increase analysis. Also, these associations were strengthened after adjusting for other pollutants. Moreover, similar associations were estimated for sulfur dioxide (SO2), particulate matter with an aerodynamic diameter of <10μm (PM10), and total non-accidental mortality. There were significant higher ERs of associations between PM10 and mortality for men than women; while there were significant higher ERs of associations between PM10/NO2 and mortality for elders (65 or elder) than youngers (64 or younger). Season analyses showed that associations between NO2 and total non-accidental mortality were more pronounced in hot seasons than in warm seasons. Taken together, NO2 was positively associated with total non-accidental mortality and cardiovascular mortality in Shenzhen even when the concentrations were below the ambient air quality standard. Policy measures should aim at reducing residents' exposure to anthropogenic NO2 emissions.

This poster details the results of a study funded in late 1999 by the SPIRT scheme which examined the short-term health effects of air pollution in Brisbane, Queensland, Australia, for the period 1996-1999. The study used a protocol similar to that used in Europe (Air Pollution and Health: A European Approach-APHEA) to examine the associations between health outcomes, such as daily mortality and daily hospital admissions counts, and air pollutants. The poster details the results for the Brisbane region for the acute health impacts of a range of pollutants-fine particles (as measured by nephelometery), PM10, nitrogen dioxide, ozone, sulfur dioxide, and carbon monoxide-on daily mortality (total, cardiovascular, respiratory), daily cardiovascular hospital admissions, and daily respiratory hospital admissions. Fine particles (as measured by nephelometery) and PM10 have a statistically significant impact on total mortality (all ages), and total cardiovascular mortality (all ages), as well as on total respiratory admissions for the elderly (>65 years). Carbon monoxide and PM10 have a statistically significant impact on IHD admissions (>65 years). Carbon monoxide, nitrogen dioxide and PM10 have a statistically significant impact on cardiac admissions (>65 years). Fine particles and ozone have a statistically significant impact on respiratory admissions in the elderly (especially COPD, asthma, pneumonia and acute bronchitis). The statistical methods used is generalised additive models (GAM) using the S Plus statistical package and loess smoothing. The results for all methods are presented and for lag periods of 0-3 days for all pollutants.

Serum uromodulin and risk for cardiovascular morbidity and mortality in the community-based KORA F4 study

Impacto de la contaminación atmosférica sobre la mortalidad y las urgencias por enfermedad pulmonar obstructiva crónica y asma en Barcelona