Association between short-term exposure to ambient air pollution and heart failure: An updated systematic review and meta-analysis of more than 7 million participants

Front Public Health. 2023 Jan 23:10:948765. doi: 10.3389/fpubh.2022.948765. eCollection 2022.

Abstract

Introduction: Exposure to air pollution has been linked to the mortality of heart failure. In this study, we sought to update the existing systematic review and meta-analysis, published in 2013, to further assess the association between air pollution and acute decompensated heart failure, including hospitalization and heart failure mortality.

Methods: PubMed, Web of Science, EMBASE, and OVID databases were systematically searched till April 2022. We enrolled the studies regarding air pollution exposure and heart failure and extracted the original data to combine and obtain an overall risk estimate for each pollutant.

Results: We analyzed 51 studies and 7,555,442 patients. Our results indicated that heart failure hospitalization or death was associated with increases in carbon monoxide (3.46% per 1 part per million; 95% CI 1.0233-1.046, P < 0.001), sulfur dioxide (2.20% per 10 parts per billion; 95% CI 1.0106-1.0335, P < 0.001), nitrogen dioxide (2.07% per 10 parts per billion; 95% CI 1.0106-1.0335, P < 0.001), and ozone (0.95% per 10 parts per billion; 95% CI 1.0024-1.0166, P < 0.001) concentrations. Increases in particulate matter concentration were related to heart failure hospitalization or death (PM2.5 1.29% per 10 μg/m3, 95% CI 1.0093-1.0165, P < 0.001; PM10 1.30% per 10 μg/m3, 95% CI 1.0102-1.0157, P < 0.001).

Conclusion: The increase in the concentration of all pollutants, including gases (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone) and particulate matter [(PM2.5), (PM10)], is positively correlated with hospitalization rates and mortality of heart failure.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021256241.

Keywords: air pollution; gas pollutant; heart failure; meta-analysis; particulate matter.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants* / adverse effects
  • Air Pollutants* / analysis
  • Air Pollution* / adverse effects
  • Air Pollution* / analysis
  • Carbon Monoxide / adverse effects
  • Carbon Monoxide / analysis
  • Environmental Exposure / adverse effects
  • Heart Failure* / epidemiology
  • Humans
  • Nitrogen Dioxide / analysis
  • Ozone*
  • Particulate Matter / adverse effects
  • Particulate Matter / analysis
  • Sulfur Dioxide / adverse effects
  • Sulfur Dioxide / analysis

Substances

  • Carbon Monoxide
  • Air Pollutants
  • Particulate Matter
  • Ozone
  • Sulfur Dioxide
  • Nitrogen Dioxide

Grants and funding

This study was funded by the National Natural Science Foundation of China under grant no. 81700243, the subject of Jiangsu Province Hospital of Traditional Chinese Medicine under grant no. Y2020CX42, and the graduate training innovation project of Jiangsu Province (grant nos. SJCX21_0780 and KYCX21_1714).