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Published ahead of print on November 17, 2005, doi:10.1164/rccm.200507-1123OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 4, February 2006, 432-441

A more recent version of this article appeared on February 15, 2006
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Submitted on July 21, 2005
Accepted on November 11, 2005

Air Pollution and Markers of Inflammation and Coagulation in Patients with Coronary Heart Disease

Regina Ruckerl1*, Angela Ibald-Mulli1, Wolfgang Koenig2, Alexandra Henneberger1, Gabriele Woelke3, Josef Cyrys1, Joachim Heinrich4, Victor Marder5, Mark Frampton6, H. Erich Wichmann7, and Annette Peters4

1 Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany; IBE Department of Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany, 2 Department of Internal Medicine II, Cardiology, University of Ulm Medical Center, Ulm, Germany, 3 Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany, 4 Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany; Focus-Network Aerosols and Health, GSF-National Research Center for Environment and Health, Neuherberg, Germany, 5 Department of Medicine and Dentistry - Vascular Medicine, Rochester School of Medicine and Dentistry, Rochester, NY, USA, 6 Department of Medicine and Dentistry - Pulmonary and Critical Care Unit, Rochester School of Medicine and Dentistry, Rochester, NY, USA, 7 Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany; IBE Department of Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany; Focus-Network Aerosols and Health, GSF-National Research Center for Environment and Health, Neuherberg, Germany

* To whom correspondence should be addressed. E-mail: rueckerl{at}gsf.de.

Rationale Ambient air pollution has been shown to be associated with cardiovascular morbidity and mortality. Objectives A prospective panel study was conducted to study the early physiological reactions characterized by blood biomarkers of inflammation, endothelial dysfunction and coagulation in response to daily changes in air pollution in Erfurt, Germany. Methods Blood parameters were repeatedly measured in 57 male patients with coronary heart disease during winter 2000/2001. Fixed effects linear and logistic regression models were applied, adjusting for trend, weekday and meteorological parameters. Measurements Hourly data on ultrafine particles (number concentration of particles from 0.01 to 0.1 µm, UFP), mass concentration of particles less than 10 and 2.5 µm in diameter (PM10, PM2.5), elemental and organic carbon, gaseous pollutants and meteorological data were collected at central monitoring sites. Main Results Increased levels of C-reactive protein above the 90th percentile were observed for an increase in air pollution concentrations of one interquartile range. The effect was strongest for accumulation mode particles, with a delay of two days (OR:3.2, CI:1.7;6.0). Results were consistent for UFP and PM10 which also showed a two day delayed response (OR:2.3; CI:1.3;3.8 and 2.2;CI:1.2;3.8 respectively). However not all of the blood markers for endothelial dysfunction and coagulation increased consistently in association with air pollutants. Conclusion These results suggest that inflammation as well as parts of the coagulation pathway may contribute to the association between particulate air pollution and coronary events.
Key words: Acute-Phase Reaction, Air Pollution, Blood coagulation, Cardiovascular Diseases, C-reactive protein




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