Mitigating the Effects of Environmental Stress on the Heart

By Tamara Thomas - Last Updated: February 6, 2023

According to a story published in Cardiology, environmental stressors like air pollution and extreme temperatures have multiple harmful effects on the heart and increase the relative risk of acute cardiovascular events within a few days of exposure.

Researchers at Cardiology emphasize the negative effect of wildfire smoke and extreme heat on the heart and what can and should be done to attenuate the effects of environmental stress on the heart.

“While we face the existential crisis of climate change, most people don’t realize that of the many deleterious effects of air pollution, cardiovascular disease is number one. It’s not diseases of the lung or cancer, but in fact ischemic heart disease and stroke that top the list,” says Jamal S. Rana, MD, Ph.D., FACC, Chief of Cardiology at Kaiser Permanente’s Oakland Medical Center and governor of the American College of Cardiology’s Northern California Chapter.

According to a review by Sanjay Rajagopalan, MD, and colleagues published in the Journal of the American College of Cardiology, short-term exposure to elevated levels of particulate matter in the air increases the relative risk of acute cardiovascular events by 1-3% within a few days. Longer-term exposure increases this risk by about 10%.

The editors, however, believed that the strict regulation in the U.S. has effectively reduced the levels of pollutants, thus reducing the risk of pollution-related cardiovascular disease.

“For the sources of air pollution that we can control, we’ve actually seen great progress in North America. It’s one of the few places in the world where we’ve seen reductions in the health impacts of air pollution. Western Europe has also seen some reductions, but not as dramatic as in North America. Most of the rest of the world, though, is going in the other direction,” says Michael Brauer, a professor in the School of Population and Public Health at the University of British Columbia and an affiliate professor at the Institute for Health Metrics and Evaluation at the University of Washington.

Beyond air pollution, burning fossil fuels creates more extreme weather conditions and contributes to dramatic spikes in air pollution, dangerous heat waves, and wildfires which can all be deadly.

“Due to the warmer climate, we’re pretty well locked into a future of more wildfires, more frequent wildfires, a longer wildfire season, and more severe wildfires that are very difficult, if not impossible, to suppress,” says Brauer. Ironically, he adds, the wildfires are helping to increase awareness of air pollution.

There have also been reports of deaths due to heat stroke, with deaths from cardiovascular and cerebrovascular diseases being important contributors to overall heat-related deaths.

The researchers at Cardiology also noted that age is a significant determinant in heat-related mortality, with older adults bearing the brunt of the increase in heat-related mortality. According to researchers, older adults are more likely to have limitations that make managing extreme heat events difficult such as lower evaporative cooling efficiency. In addition,, older adults have weaker contractile force in response to heat.

The researchers recommend the need for patient- and community-level activities in addition to a societal response to help mitigate this risk.

“Importantly, health care providers should screen older patients regularly to assess their level of vulnerability to weather-related events and provide personal risk mitigation strategies,” says Rana. One simple solution on bad air days is face masks. “It’s hard to say there are any silver linings to COVID, but certainly people are more accepting and attuned to wearing N95 masks on bad air days than they were before.”

Brauer also advises clinicians to give vulnerable patients personal management plans to ensure they can receive their clinical care and medications if an event displaces them. He also added that personal protection equipment and HEPA filters are needed.

Stacey E. Alexeeff, PhD, a research scientist and statistician at the Kaiser Permanente Northern California Division of Research, also added that clinicians should routinely address wearing a mask or other measures when exposure is high with patients as well as diet, exercise, and medication.

Source: American College of Cardiology

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