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Environmental Cardiology

Environmental Cardiology

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   C  r  e   d   i   t
Environews
Focus
 
Environmental Health Perspectives
VOLUME
112
|
NUMBER
15
|
November 2004
 A 881
Cardiovascular disease (CVD) is the lead-ing killer in many developed countries,and is soon expected to be the leadingkiller in all countries. A number of factorshave raised CVD to this unsavory stature,among them lack of exercise, poor diet,and smoking. But evidence has slowly been building to indicate that exposuresto chemicals and other environmentalsubstances also can have a profoundimpact on heart health. The link betweenenvironmental agents and CVD was onceconsidered tenuous by much of the med-ical and scientific establishment. But after watching the evidence accumulate overthe years, with a surge in the past fiveyears, more and more scientists, doctors,and organizations are acknowledging theimportance of a field that some are callingenvironmental cardiology.One group that is beginning to embraceenvironmental cardiology is the AmericanHeart Association (AHA), an 80-year-oldorganization that has traditionally focusedon risk factors such as poor diet and lack of exercise as some of the most importantcontributors to CVD. In the 1 June 2004issue of 
Circulation 
, an expert panel of 11researchers and physicians published an AHA Scientific Statement that concludedthat air pollutants, one of the major envi-ronmental exposure sources under investi-gation by environmental cardiologists,pose a “serious public health problem” forCVD. This is the first official AHA acknowledgment of such links.The group’s decision was based on thebreadth and depth of the accumulatinginformation. “There was no single majorstudy that prompted the writing of thispaper,” says Sidney Smith, past presidentof the AHA and a professor of medicine atthe University of North Carolina at ChapelHill. “It was the gathering body of evi-dence that connected air pollution withcardiovascular diseases, extending wellbeyond cigarette smoke.”The AHA paper was a very positivedevelopment in the eyes of some of theresearchers who have been involved in
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Focus
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Environmental Cardiology
 
the field for many years. “That’s pretty amazing,” says C. Arden Pope III, an envi-ronmental epidemiologist at Brigham Young University. “It’s taken the researchout of the fringes and made it part of themainstream.”
Less than two months after the release of the AHA statement, the U.S. Environ-mental Protection Agency (EPA) gave a clueto how seriously it takes this issue, awardingthe largest scientific research grant in its his-tory, $30 million, to study links between airpollution and CVD. The research team willbe headed by associate environmental andoccupational health professor Joel Kaufmanof the University of Washington, andincludes scientists from nine other universi-ties and medical centers.
 A few other government agencies, suchas the National Heart, Lung, and BloodInstitute (NHLBI), have also begun toaddress the links between environmentalagents and CVD, as have advocacy organi-zations such as the American Lung Association and the Natural ResourcesDefense Council. And the NIEHS, one of the original players in the environmentalcardiology arena, has ramped up its effortsto explore this area of research.There is still a ways to go before environ-mental cardiology is fully embraced as a med-ical paradigm. Many major public healthorganizations, such as the World HealthOrganization (WHO) and the Centers forDisease Control and Prevention (CDC),have yet to fold this concept into their pre-vention efforts in any significant way. Andthere is very little trickle-down into the typi-cal doctor–patient relationship.Nonetheless, environmen-tal cardiology shows signs of increasingly becoming a fac-tor in research, public policy discussion, and pollutant reg-ulation, as its presence spreadsinto journals, conferences,textbooks, e-mail discussiongroups, and continuing med-ical education courses. EvenThe Weather Channel is get-ting into the act with a new feature that advises viewers ondaily levels of pollutants thatcan affect heart health.
 A Heavy Burden forHearts Worldwide
The most basic facts aboutCVD haven’t been availablefor very long. The early decades of the 1900s, whenphysicians were just beginningto form groups to addressheart diseases, were a time of “almost unbelievable ignorance” about theseconditions, according to the AHA website.That has changed, spurred in large partby the huge impact CVD has on people.Heart conditions such as heart attack andcongestive heart failure are the leadingkiller in the United States, and stroke isthird, according to the CDC’s
Deaths: Preliminary Data for 2002 
, released inFebruary 2004. Combined, these two cate-gories of CVD alone account for about35% of all U.S. deaths, compared to 23%for cancers. Other serious health problemsthat fall into the CVD classificationinclude aortic aneurysms, high blood pres-sure, and congenital cardiovascular defects.CVD deaths had been declining sharply in the United States over the past few decades, but that curve has flattened out inrecent years. Death rates for heart diseases(responsible for nearly 696,000 U.S. deathsin 2002) declined about 3% from 2001 to2002, as did death rates for stroke (respon-sible for about 163,000 U.S. deaths in2002). But death rates attributed to highblood pressure (responsible for about20,000 U.S. deaths in 2002) rose about3%, continuing a steady rise over the prior20 years.Other industrialized nations have seensimilar patterns. The WHO says that CVDaccounts for about one-third of globaldeaths, killing about 16.7 million peopleeach year. Patterns in developing countriesare quickly emulating those in developedcountries, thanks to the imported westernlifestyle and reductions in infectious diseasedeaths and other acute causes of death. The WHO estimates that CVD will be the lead-ing killer in developing countries by 2010.But there are huge variations fromcountry to country. In 36 countries trackedby the AHA, CVD death rates differ dra-matically, with rates in some of the most-affected countries, such as the RussianFederation, Bulgaria, and Romania, morethan five times higher than in some of theleast-affected countries, such as France, Japan, and Australia. Variations in factorssuch as diet, exercise, smoking, health carequality and availability, and pollution like-ly play a role in these differences. Within a country, there also can behuge variations. In the United States, theCVD rate in the least-affected state,Minnesota, is less than 60% the rate in themost-affected state, Mississippi, accordingto the AHA’s
Heart Disease and Stroke Statistics—2004 Update 
. And the gap hasbeen widening. Minnesota had a 27%decline from 1990 to 2000, whileMississippi saw a 12% decline.Race and ethnicity are significant risk determinants. Black women in the UnitedStates are 2.5 times as likely as Asian andPacific Islander women to die of diseases of the heart, and a similar ratio of 2.25 to 1holds for black men, according to CDCstatistics published in
Women and Heart Disease 
and
Men and Heart Disease 
. Deathrates for American Indian, Alaska Native,Hispanic, and white men and women fallin between these two extremes.Similar disparities exist for stroke, withthe death rate for black men and womenmore than twice that of the least-affectedgroups—Hispanics, Amer-ican Indians, and AlaskaNatives—according to theCDC’s 2003 publication
 Atlas of Stroke Mortality: Racial, Ethnic, and Geo-  graphic Disparities in the United States 
.The elderly tend to bemost vulnerable to CVD,and the problem is expectedto worsen in many countriesas populations age. But sud-den cardiac-related deathshave increased dramatically among people under age 35,according to the CDC’s 2003report
 A Public Health Action Plan to Prevent Heart Disease and Stroke 
. And CVD is thethird-leading cause of deathfor children under 15,according to the AHA.Deaths aren’t the only consideration. Chronic dis-eases, which the CDC says
 A 882
VOLUME
112
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NUMBER
15
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November 2004
Environmental Health Perspectives
Focus
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Environmental Cardiology
Leading Causes of Death for All Males and Females
United States,2001A Total CVDD Chronic Lower Respiratory DiseasesB CancerE Diabetes MellitusC AccidentsF Alzheimer Disease
Source:
AHA.Heart Disease and Stroke Statistics—2004 Update.Dallas,TX:American Heart Association;2003.
0100200300400500FEDBAEDCBA
    D   e   a   t    h   s    i   n    T    h   o   u   s   a   n    d   s
MalesFemales
432,245287,07566,06059,69732,841498,863266,69363,31638,53138,090

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