Search tips
Search criteria 


Logo of envhperEnvironmental Health PerspectivesBrowse ArticlesAbout EHPGeneral InformationAuthorsMediaProgramsPartnerships
Environ Health Perspect. 2001 June; 109(Suppl 3): 405–409.
PMCID: PMC1240558
Research Article

Air pollution and blood markers of cardiovascular risk.


Recent studies have linked air pollution to tens of thousands of premature cardiovascular deaths per year. The mechanisms of such associations remain unclear. In this study we examine the association between blood markers of cardiovascular risk and air pollution in a national sample of the U.S. population. Air pollution concentrations were merged to subjects in the Third National Health and Nutrition Examination Survey (NHANES III) in the United States, and the association with fibrinogen levels and counts of platelets and white blood cells were examined. The subjects in NHANES III are a representative sample of the U.S. population. Regressions controlled for age, race, sex, body mass index, current smoking, and number of cigarettes per day. The complex survey design was dealt with using mixed models with a random sampling site effect. In single-pollutant models, PM(10) (particulate matter with a mass median aerodynamic diameter less than 10 microm) was associated with all three outcomes (p< 0.05): Sulfur dioxide (SO(2)) was significantly associated only with white cell counts, nitrogen dioxide (NO(2)) with platelet counts and fibrinogen, and ozone with none of the outcomes. In two-pollutant models, PM(10) remained a significant predictor of white cell counts controlling for SO(2) but not vice versa. PM(10) was marginally significant in a model for platelet counts with NO(2), and the sign of the NO(2) coefficient was reversed. These results were stable with control for indoor exposures (wood stoves, environmental tobacco smoke, gas stoves, fireplaces), dietary risk factors (saturated fat, alcohol, caffeine intake, n-3 fatty acids), and serum cholesterol. The magnitude of the effects are modest [e.g., 13 microg/dL fibrinogen for an interquartile range (IQR) change in PM(subscript)10(/subscript), 95% confidence interval (CI) 4.6-22.1 mg/dL]. However, the odds ratio of being in the top 10% of fibrinogen for the same IQR change was 1.77 (95% CI 1.26-2.49). These effects provide considerable biologic plausibility to the mortality studies. PM(10), but not gaseous air pollutants, is associated with blood markers of cardiovascular risk, and this may explain epidemiologic associations with early deaths.

Full Text

The Full Text of this article is available as a PDF (1.7M).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Katsouyanni K, Touloumi G, Spix C, Schwartz J, Balducci F, Medina S, Rossi G, Wojtyniak B, Sunyer J, Bacharova L, et al. Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Air Pollution and Health: a European Approach. BMJ. 1997 Jun 7;314(7095):1658–1663. [PMC free article] [PubMed]
  • Borja-Aburto VH, Loomis DP, Bangdiwala SI, Shy CM, Rascon-Pacheco RA. Ozone, suspended particulates, and daily mortality in Mexico City. Am J Epidemiol. 1997 Feb 1;145(3):258–268. [PubMed]
  • Schwartz J, Dockery DW. Increased mortality in Philadelphia associated with daily air pollution concentrations. Am Rev Respir Dis. 1992 Mar;145(3):600–604. [PubMed]
  • Peterson EW, Howland J. Predicting radon testing among university employees. J Air Waste Manag Assoc. 1996 Jan;46(1):2–11. [PubMed]
  • Schwartz J, Morris R. Air pollution and hospital admissions for cardiovascular disease in Detroit, Michigan. Am J Epidemiol. 1995 Jul 1;142(1):23–35. [PubMed]
  • Schwartz J. Air pollution and hospital admissions for heart disease in eight U.S. counties. Epidemiology. 1999 Jan;10(1):17–22. [PubMed]
  • Burnett RT, Dales R, Krewski D, Vincent R, Dann T, Brook JR. Associations between ambient particulate sulfate and admissions to Ontario hospitals for cardiac and respiratory diseases. Am J Epidemiol. 1995 Jul 1;142(1):15–22. [PubMed]
  • Schwartz J. What are people dying of on high air pollution days? Environ Res. 1994 Jan;64(1):26–35. [PubMed]
  • Schwartz J. Assessing confounding, effect modification, and thresholds in the association between ambient particles and daily deaths. Environ Health Perspect. 2000 Jun;108(6):563–568. [PMC free article] [PubMed]
  • Watkinson WP, Campen MJ, Costa DL. Cardiac arrhythmia induction after exposure to residual oil fly ash particles in a rodent model of pulmonary hypertension. Toxicol Sci. 1998 Feb;41(2):209–216. [PubMed]
  • Pope CA, 3rd, Verrier RL, Lovett EG, Larson AC, Raizenne ME, Kanner RE, Schwartz J, Villegas GM, Gold DR, Dockery DW. Heart rate variability associated with particulate air pollution. Am Heart J. 1999 Nov;138(5 Pt 1):890–899. [PubMed]
  • Liao D, Creason J, Shy C, Williams R, Watts R, Zweidinger R. Daily variation of particulate air pollution and poor cardiac autonomic control in the elderly. Environ Health Perspect. 1999 Jul;107(7):521–525. [PMC free article] [PubMed]
  • Gold DR, Litonjua A, Schwartz J, Lovett E, Larson A, Nearing B, Allen G, Verrier M, Cherry R, Verrier R. Ambient pollution and heart rate variability. Circulation. 2000 Mar 21;101(11):1267–1273. [PubMed]
  • Peters A, Liu E, Verrier RL, Schwartz J, Gold DR, Mittleman M, Baliff J, Oh JA, Allen G, Monahan K, et al. Air pollution and incidence of cardiac arrhythmia. Epidemiology. 2000 Jan;11(1):11–17. [PubMed]
  • Pope CA3rd, Dockery DW, Kanner RE, Villegas GM, Schwartz J. Oxygen saturation, pulse rate, and particulate air pollution: A daily time-series panel study. Am J Respir Crit Care Med. 1999 Feb;159(2):365–372. [PubMed]
  • Peters A, Perz S, Döring A, Stieber J, Koenig W, Wichmann HE. Increases in heart rate during an air pollution episode. Am J Epidemiol. 1999 Nov 15;150(10):1094–1098. [PubMed]
  • Seaton A, MacNee W, Donaldson K, Godden D. Particulate air pollution and acute health effects. Lancet. 1995 Jan 21;345(8943):176–178. [PubMed]
  • Peters A, Döring A, Wichmann HE, Koenig W. Increased plasma viscosity during an air pollution episode: a link to mortality? Lancet. 1997 May 31;349(9065):1582–1587. [PubMed]
  • Gardner SY, Lehmann JR, Costa DL. Oil fly ash-induced elevation of plasma fibrinogen levels in rats. Toxicol Sci. 2000 Jul;56(1):175–180. [PubMed]
  • Ghio AJ, Kim C, Devlin RB. Concentrated ambient air particles induce mild pulmonary inflammation in healthy human volunteers. Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):981–988. [PubMed]
  • Salvi S, Blomberg A, Rudell B, Kelly F, Sandström T, Holgate ST, Frew A. Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers. Am J Respir Crit Care Med. 1999 Mar;159(3):702–709. [PubMed]
  • Gordon T, Nadziejko C, Schlesinger R, Chen LC. Pulmonary and cardiovascular effects of acute exposure to concentrated ambient particulate matter in rats. Toxicol Lett. 1998 Aug;96-97:285–288. [PubMed]
  • Seaton A, Soutar A, Crawford V, Elton R, McNerlan S, Cherrie J, Watt M, Agius R, Stout R. Particulate air pollution and the blood. Thorax. 1999 Nov;54(11):1027–1032. [PMC free article] [PubMed]
  • Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998 May 13;279(18):1477–1482. [PubMed]
  • Benchimol D, Dubroca B, Bernard V, Lavie J, Paviot B, Benchimol H, Couffinhal T, Pillois X, Dartigues J, Bonnet J. Short- and long-term risk factors for sudden death in patients with stable angina. Int J Cardiol. 2000 Nov-Dec;76(2-3):147–156. [PubMed]
  • Lind P, Hedblad B, Stavenow L, Janzon L, Eriksson KF, Lindgärde F. Influence of plasma fibrinogen levels on the incidence of myocardial infarction and death is modified by other inflammation-sensitive proteins: a long-term cohort study. Arterioscler Thromb Vasc Biol. 2001 Mar;21(3):452–458. [PubMed]
  • Rubel C, Fernández GC, Dran G, Bompadre MB, Isturiz MA, Palermo MS. Fibrinogen promotes neutrophil activation and delays apoptosis. J Immunol. 2001 Feb 1;166(3):2002–2010. [PubMed]
  • Schindler C, Ackermann-Liebrich U, Leuenberger P, Monn C, Rapp R, Bolognini G, Bongard JP, Brändli O, Domenighetti G, Karrer W, et al. Associations between lung function and estimated average exposure to NO2 in eight areas of Switzerland. The SAPALDIA Team. Swiss Study of Air Pollution and Lung Diseases in Adults. Epidemiology. 1998 Jul;9(4):405–411. [PubMed]
  • Dockery DW, Pope CA, 3rd, Xu X, Spengler JD, Ware JH, Fay ME, Ferris BG, Jr, Speizer FE. An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993 Dec 9;329(24):1753–1759. [PubMed]
  • Pope CA, 3rd, Thun MJ, Namboodiri MM, Dockery DW, Evans JS, Speizer FE, Heath CW., Jr Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am J Respir Crit Care Med. 1995 Mar;151(3 Pt 1):669–674. [PubMed]
  • Sarnat JA, Koutrakis P, Suh HH. Assessing the relationship between personal particulate and gaseous exposures of senior citizens living in Baltimore, MD. J Air Waste Manag Assoc. 2000 Jul;50(7):1184–1198. [PubMed]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Science