The contribution of PM 2.5 to cardiovascular disease in China
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REVIEW ARTICLE
The contribution of PM2.5 to cardiovascular disease in China Shuqi Zhang 1 & Michael N. Routledge 2,3 Received: 18 April 2020 / Accepted: 1 July 2020 # The Author(s) 2020
Abstract China is experiencing rapid urbanization and industrialization with correspondingly high levels of air pollution. Although the harm of PM2.5 has been long reported, it is only quite recently that there is increasing concern in China for its possible adverse health effects on cardiovascular disease. We reviewed the epidemiologic evidence of potential health effects of PM2.5 on cardiovascular disease reported from recent studies in China (2013 onwards). There is clear evidence for the contribution of PM2.5 to cardiovascular outcomes, including mortality, ischemic heart disease, and stroke from studies based in various regions in China. This evidence adds to the global evidence that PM2.5 contributes to adverse cardiovascular health risk and highlights the need for improved air quality in China. Keywords PM2.5 . Air pollution . Cardiovascular mortality . Ischemic heart disease . Stroke . China
Introduction Cardiovascular disease (CVD) is a group of diseases of multifactorial origin that involve damage to the heart and/or vascular system. Contributing factors include hypertension, dyslipidemia, diabetes, and obesity (GBD 2017 Risk Factor Collaborators 2018; Cercato and Fonseca 2019). Cigarette smoking is another major contributor, as a result of damage to the vasculature that results from the regular inhalation of a cocktail of noxious chemicals, including those in gaseous form and those carried on particulate matter (Conklin et al. 2019). It is not surprising, therefore, that inhaled particulates from other sources, including industrial emissions, heating fuels, and traffic exhaust emissions, can also contribute to risk. There is growing evidence for an association between longterm exposure to fine particulate matter and cardiovascular Responsible Editor: Lotfi Aleya * Michael N. Routledge [email protected] Shuqi Zhang [email protected] 1
School of Public Health, Fudan University, Shanghai 200032, China
2
Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
3
School of Food and Biological Engineering, Jiangsu University, Zhenjiang, China
mortality (Requia et al. 2018; Rajagopalan et al. 2018; Yuan et al. 2019). In addition, people with existing cardiovascular disease, from whatever origin, are at risk of acute and potentially fatal cardiovascular events such as heart attack and stroke. A common factor in such events is the formation or rupture of a blood clot that can block blood vessels leading to the death of heart muscle or neural cells (Robertson and Miller 2018). Consequently, it is important to understand the role of air borne particulates in both the long-term and short-term effects on populations undergoing high levels of exposure as well as considering that some people are particularly susceptible to short-term peaks in exposure. The aging population and accel
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