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Exposicion Al Ruido y Enfermedad Cardiovascular
Exposicion Al Ruido y Enfermedad Cardiovascular
Introduction
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raditional cardiovascular (CV) disease (CVD) risk factors, such
as obesity, hypercholesterolemia, smoking, hypertension, diabe-
tes mellitus (DM), and obstructive sleep apnea, have been exten-
sively studied. More research is now being conducted into nontraditional
risk factors, such as noise exposure, and the impact of these environmen-
tal risk factors on CV health. With the growing urbanization worldwide,
noise pollution naturally increased as the development of transportations,
including airports, railways, and road traffic, all contributed to an increase
in environmental noise exposure. Noise is considered as an environmen-
tal stressor reducing well-being and quality of life, disturbing inter-indi-
vidual communications, mental concentration, and induces emotional
responses, corresponding to noise annoyance. It has been documented
that elevated noise exposure is associated with non auditory effects
including worsening mental health, cognitive impairments, adverse
birth outcomes, sleep disorders, and increased annoyance.1 In the last
decades, compelling evidence has indicated that traffic noise was also
associated with CVD, through multiple pathways.2 It has been shown
that mental health disorders such as depression and anxiety have a nega-
tive impact on the development of CVD and CVD outcomes.3 Likewise,
reduced sleep quality and/or duration has been reported to increase sym-
pathetic nervous system activity, which can predispose to conditions
Epidemiological Studies
Noise pollution can take various forms, and the first type of noise pol-
lution we sought to examine was noise pollution related to road traffic.
Road traffic noise is the main source of transportation noise-associated
health effects and a 2020 UE estimation indicate that about 20% of Euro-
peans are exposed to a burden of road traffic noise exceeding the thresh-
old harmful to health (55dB[A]).6 A recent study conducted in the UK by
Huang and colleagues sought to examine the association between road
traffic noise and primary hypertension incidence. They found that long
term exposure to road traffic noise was associated with an increased inci-
dence of primary hypertension, and this effect was heightened in areas
with higher air pollution.7 The additional finding of increased incidence
in higher pollution areas speaks to the role of fine particulate matter in
the development of CVD, a risk factor that we have showed to have a sig-
nificant impact on the development of CVD and CVD mortality.8 Simi-
larly, Bustaffa and colleagues showed, using a retrospective cohort study
in the city of Pisa, that increasing exposure to road traffic was associated
with increased CVD mortality in women, particularly in the highest
exposed areas.9 This relationship was not seen in men, so the authors
argued there may be some biological differences at play. Similarly, Lim
and colleagues, in the Danish Cohort Nursing Study, showed that long-
term exposure to road traffic noise levels greater than 56 dB may result in
increased occurrence of myocardial infarction (MI).10 However, the sex-
specific impact of traffic exposure remains controversial. Recent data
from a retrospective study from a French urban zone indicate that after
adjustment, noise exposure at the home address remained a predictor of
atherothrombotic risk, with LAeq (daily equivalent A-weighted noise
level),24 h (OR [95% CI]: 1.162 [1.011 1.337]) and with Lnight (night
equivalent A-weighted noise level) (OR [95% CI]: 1.159
[1.019 1.317]). The relationship with transportation Lnight was signifi-
cant only for men (OR [95% CI]: 1.260 [1.078 1.472]) but not for
women (OR [95% CI]: 0.959 [0.763 1.205]).11
Limitations
Our review has certain limitations. First, while most studies controlled
for variables like sex, age, and other basic demographic factors, the
response rates were variable and thus some component of selection bias
could have occurred. Second, most of these studies took place in urban-
ized areas, but some areas differ in regard to population, quality of living,
socioeconomic status, health, environmental exposure, and genetic fac-
tors and these could impact the observed results regarding noise pollution
and CVD. Third, more research needs to be conducted to elucidate
whether noise pollution is an independent risk factor for CVD, or if it
operates on the underlying predisposition for individuals with CVD risk
factors or those genetically predisposed to develop CVD. Finally, the
inter-relationship of air pollution and noise pollution needs further inves-
tigation and strategies to target reduction in both these factors need to be
developed.
Central Illustration
Author’s access
All authors had access to the data and a role in writing the manuscript.