JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

VOL. 65, NO. 21, 2015

ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 0735-1097/$36.00

PUBLISHED BY ELSEVIER INC.

http://dx.doi.org/10.1016/j.jacc.2015.04.010

EDITORIAL COMMENT

Personalizing Your Airspace and Your Health* Sanjay Rajagopalan, MD,y Robert D. Brook, MDz

I

ndoor and outdoor air pollution rank as the

and point to an increase in the proportion of

fourth and ninth leading causes of global

patients in East Asia living above the World Health

morbidity and mortality in the most recent

Organization (WHO) interim Target-1 of 35 mg/m 3

Global Burden of Disease (GBD) report and collec-

(increased from 51% in 1998 to 2000 to 70% in

tively outrank other major risk factors in terms of

2010 to 2012) (5). In stark contrast in North America,

importance (1). The fine particulate matter 48 h, among 35 healthy young

ficantly

university students in Shanghai, China. The chosen

measured indoor PM2.5 levels across both exposure

location is a strength of the study, being conducted in

scenarios, lending further credence to a prob-

a very polluted part of the world, with average levels

able causal exposure–health response relationship.

of 103 mg/m 3. Active air filtration proved capable of

Though changes in gaseous pollutants did not likely

reducing indoor PM2.5 concentration by just more

confound the main results, as they were thought not

linearly

associated

with

the

directly

than one-half, from 96.2 to 41.3 mg/m 3. After 48 h of

to be altered by filtration, their levels were not

“cleaner air” exposure, systolic and diastolic blood

evaluated.

pressure fell, whereas a few of the measured metrics

concomitant reduction in these copollutants could

of inflammation (MCP-1, interleukin-1b, myeloper-

provide further or differing health benefits. The spe-

oxidase) and platelet activation (sCD40L) were

cific sources (e.g., traffic, coal-fired power plants),

It

thus

remains

unclear

whether

a

significantly reduced. Several other biomarkers also

particle sizes (fine vs. ultrafine ranges), and compo-

trended towards improvement, but were not signifi-

nents (organic/elemental carbon, sulfates, metals)

cantly changed. Fractional exhaled nitric oxide, an

most strongly linked to the health effects also were

established marker of respiratory inflammation, was

not reported.

reduced, but lung function measured by spirometry

Although improvement in outdoor air quality ul-

did not change, possibly owing to the short-term

timately will be needed to change indoor air quality

nature of the intervention. Added to the results

in the cities of China and India, when rapid changes

from a few previous studies, these new findings

in outdoor air quality occur, as it did during the

bolster the evidence that improving indoor air filtra-

Beijing Olympics (PM 2.5 levels 101 and 84 m g/m 3

tion may be a practical “personalized” method to

before and after, averaging 69 m g/m 3 during the

reduce overall PM2.5 exposure and mitigate adverse

games), several biomarkers of inflammation throm-

health effects. The observed improvement in out-

bosis, as well as blood pressure, improved (11). The

comes, despite particulate levels remaining high

good news is that air quality regulations, when

during air filtration (41.3 mg/m 3) supports the pre-

enforced, can substantially reduce prevailing out-

vailing understanding of a log-linear dose–response

door air pollution concentrations and improve soci-

relationship between exposure and health effects,

etal life expectancy rates (12). In the meantime,

whereby any lowering of pollution can translate into

personalized

benefits with larger absolute benefits, the higher the

ventions to lower exposures (e.g., filters in homes

level of air pollution (2). The population was homo-

and cars) may be needed in order to optimally protect

geneous, taking no potentially confounding medica-

citizens in these areas (13).

behavioral

and

small-scale

inter-

tions, and residing within 2 nearby buildings, thus making for a clean study design. Assuming the

REPRINT REQUESTS AND CORRESPONDENCE: Dr.

participants complied with the protocol, potential

Sanjay Rajagopalan, Health Science Facility II, Divi-

confounding effects of lifestyle changes (e.g., diet,

sion of Cardiovascular Medicine, University of Mary-

activity), unmeasured environmental factors (e.g.,

land School of Medicine, 20 Penn Street, Baltimore,

traffic, noise, temperature), and PM2.5 exposure mis-

Maryland

classification(s) were all likely minimized. Most of

umaryland.edu.

21201.

E-mail:

srajagopalan@medicine.

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5. Van Donkelaar A, Martin RV, Brauer M, Boys BL. Use of satellite observations for long-term exposure assessment of global concentrations of fine particulate matter. Environ. Health Perspect 2015; 123:135–43. 6. Bräuner EV, Forchhammer L, Møller P, et al. Indoor particles affect vascular function in the aged: an air filtration-based intervention

8. Karottki DG, Spilak M, Frederiksen M, et al. An indoor air filtration study in homes of elderly: cardiovascular and respiratory effects of exposure to particulate matter. Environ Health 2013; 12:116. 9. Weichenthal S, Mallach G, Kulka R, et al. A randomized double-blind crossover study of

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Air Pollution Prevention

indoor air filtration and acute changes in cardiorespiratory health in a First Nations community. Indoor Air 2013;23:175–84. 10. Chen R, Zhao A, Chen H, et al. Cardiopulmonary benefits of reducing indoor particles of outdoor origin: a randomized, double-blind crossover trial of air purifiers. J Am Coll Cardiol 2015;65: 2279–87.

11. Rich DQ, Kipen HM, Huang W, et al. Association between changes in air pollution levels during the Beijing Olympics and biomarkers of inflammation and thrombosis in healthy young adults. JAMA

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2012;307:2068–78. 12. Pope CA 3rd, Ezzati M, Dockery DW. Fineparticulate air pollution and life expectancy in the United States. N Engl J Med 2009;360:376–86.

KEY WORDS air pollution, cardiovascular, environment, indoor air quality, inflammation

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