Heart Failure and Air Pollution

MedicalResearch.com Interview with:
Dr Anoop Shah MBChB
Cardiology Research fellow
Centre of Cardiovascular sciences
Chancellors Building
University Of Edinburgh
Little France Edinburgh

MedicalResearch.com: What are the main findings of the study?

Answer: Many studies have shown the effect of air pollution on cardiac mortality and myocardial infarction. Less studies have shown a similar effect on patients with heart failure. We therefore systemically reviewed and pooled data across 12 countries involving over 4 million patients with heart failure. We showed that air pollution has a close temporal association with either being hospitalized or dying from heart failure. Most of the effects of air pollution on patients with heart failure were acute. Most of the data that we analyzed came from developed countries across Europe and the USA. There was a significant paucity of data from rapidly urbanizing nations such as India and China.

MedicalResearch.com: Were any of the findings unexpected?

Answer: We showed a clear and consistent relationship with both gaseous and particulate pollution and heart failure hospitalization or heart failure mortality. Although many individual studies have shown this in different populations, the pooled estimates indicate that air pollution at a population level is a serious and important trigger for acute cardiac decompensation in individuals who already have heart failure.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: The American Heart Association has issued specific advice to elderly and high risk groups regarding exposure to air pollution. We would echo that advice – patients should limit exposure to air pollution especially on smoggy days and avoid times when there is high traffic congestion on the roads.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: There are a number of unanswered issues. Primarily we still do not know the exact mechanisms of how air pollution affects patients with heart failure although there are many hypothetical mechanisms that have been suggested. We need to better understand these mechanisms. In addition we also need to study ways of reducing personal exposure to air pollution in high risk groups and if this reduction translates to better clinical and functional outcomes.


Global association of air pollution and heart failure: a systematic review and meta-analysis
Anoop SV Shah MBChB,Jeremy P Langrish MBChB,Harish Nair PhD,David A McAllister MD,Amanda L Hunter MBChB,Prof Ken Donaldson DSc,Prof David E Newby BM,Dr Nicholas L Mills MBChB
The Lancet – 21 September 2013 ( Vol. 382, Issue 9897, Pages 1039-1048 )
DOI: 10.1016/S0140-6736(13)60898-3