Air pollution-related hospitalization for chest pain, heart attack differed by seasons

Research Highlights:

• Smoke from summertime wildfires that created short-term spikes in fine particulate matter air pollution was significantly associated with same-day hospitalization for unstable chest pain in Utah.
• In contrast, during the wintertime, when pollution from human sources, such as vehicle exhaust, is more concentrated, data indicates people waited about two weeks before seeking treatment for unstable chest pain.
• In addition, people sought same-day treatment for heart attacks during the wintertime exposure to air pollution, while in the summertime, there was no significant increase in same-day hospitalizations for heart attack.

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 6, 2023

DALLAS, Nov. 6, 2023 — Short-term increases in fine particulate air pollution (PM2.5) during the summer and winter months in a mountain valley region of Utah were associated with increased health care visits for heart attack and unstable chest pain; however, the risk for each cardiac event differed by season, according to a preliminary study to be presented at the American Heart Association’s Scientific Sessions 2023. The meeting, to be held Nov. 11-13, in Philadelphia, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

This study compared hospital visits for heart attack and unstable chest pain in a mountain valley of Utah during spikes in PM2.5 due to summertime wildfire smoke versus rising levels of PM2.5 during winter inversions — a weather phenomenon where a mix of cold and warm fronts trap air pollution from motor vehicles, factory emissions and other human sources.

“Summertime wildfire smoke does not cause the PM2.5 to rise as much as pollution from human sources during the winter inversions. However, the biological response to the particulate matter that is produced by wildfire smoke has been shown to be different from the response of PM2.5 produced by other sources, such as cars and businesses,” said lead study author Benjamin D. Horne, Ph.D., M.P.H., FAHA, director of cardiovascular and genetic epidemiology for Intermountain Health at the Intermountain Medical Center Heart Institute in Salt Lake City, Utah.

Previous research has linked air pollution with seeking same-day treatment for sudden, life-threatening heart conditions. This study examined heart attack and unstable chest pain separately.

“With a heart attack, you feel crushing chest pain, have difficulty breathing and symptoms where you call for an ambulance and go to the hospital right away,“ Horne explained. “With unstable chest pain, people experience pain when they are at rest or doing low-intensity physical activity. They can still function and may stay home for a week or so thinking about it. When symptoms don’t go away, they decide to seek medical attention, sometimes up to two weeks after symptoms began.”

“Interestingly, in the summertime when PM2.5 rose, the data indicates people did not feel the need for hospitalization for heart attacks, but there was an immediate awareness of the need for hospitalization for unstable chest pain,” he said.

PM2.5 levels were measured at air quality monitoring stations along a valley region in Utah known as the Wasatch Front. PM2.5 spikes in both seasons were then cross-referenced with health records for people admitted to hospitals in the region. The analysis evaluated pollution on the day of admission as well as pollution two weeks prior to hospitalization. These data were compared to days in the same month when people were not admitted to the hospital.

Study details:

• The study evaluated health records for nearly 22,000 adults (average age of 66 years; 31% female; 89% white adults) who were treated for heart attack or unstable chest pain between 1999 and 2022 at 11 hospitals throughout Utah’s Wasatch Front region.
• The Wasatch Front is an area in Utah bordered on both sides by mountains and includes the cities of Salt Lake City, Ogden and Provo.
• Through its design, the study controlled for other individual-specific factors such as smoking and other long term health conditions such as high blood pressure and Type 2 diabetes.

In a 2020 scientific statement and a 2020 policy statement, the American Heart Association details the latest science about air pollution exposure and the individual, industrial and policy measures to reduce the negative impact of poor air quality on cardiovascular health.

“Air pollution is widely recognized as a significant contributor to cardiovascular disease and death and one we can modify by reducing exposure. Reversing the negative impacts of poor air quality on cardiovascular health is essential,” said Joel D. Kaufman, M.D., M.P.H., FAHA, a professor of environmental and occupational health sciences, professor of epidemiology and professor of medicine – general internal medicine at the University of Washington in Seattle, and chair of the writing group for the Association’s 2020 policy statement “Guidance to Reduce Cardiovascular Burden of Ambient Air Pollutants.”

While this study observed risks associated with hospital visits for heart attack and unstable chest pain during spikes of air pollution, individual data on pollution exposure was not available, which limits the interpretation of the findings.

Co-authors, disclosures and funding sources are listed in the abstract. The study was conducted in collaboration with Horne’s colleagues at Stanford University and Harvard University. The National Institutes of Health funded this study.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The

SDGs, Targets, and Indicators Analysis

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 11: Sustainable Cities and Communities
• SDG 13: Climate Action

The article discusses the impact of air pollution on cardiovascular health, specifically heart attacks and unstable chest pain. This connects to SDG 3, which focuses on promoting good health and well-being for all. Additionally, the article mentions the sources of air pollution, such as vehicle exhaust and factory emissions, which are related to SDG 11, which aims to make cities and human settlements inclusive, safe, resilient, and sustainable. Finally, the article highlights the role of wildfire smoke in increasing air pollution, linking it to SDG 13, which addresses climate action and the need to take urgent action to combat climate change and its impacts.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3.9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination.
• SDG 11.6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management.
• SDG 13.1: Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.

Based on the article’s content, the specific targets that can be identified are reducing deaths and illnesses from air pollution (SDG 3.9), improving air quality in cities (SDG 11.6), and strengthening resilience to climate-related hazards (SDG 13.1).

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions specific indicators that can be used to measure progress towards the identified targets. These indicators include:

• Air Quality Index (AQI): The article refers to different levels of air quality index, such as orange-level and green-level, which can be used to measure air pollution levels.
• Hospitalizations for heart attacks and unstable chest pain: The article discusses the increase in hospitalizations for these conditions during periods of elevated air pollution, which can be used as an indicator of the health impacts of air pollution.

These indicators can be used to measure progress towards reducing deaths and illnesses from air pollution, improving air quality in cities, and strengthening resilience to climate-related hazards.

Table: SDGs, Targets, and Indicators

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Source: newsroom.heart.org

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