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Circulation. 2000;101:1267-1273

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(Circulation. 2000;101:1267.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Ambient Pollution and Heart Rate Variability

Diane R. Gold, MD, MPH; Augusto Litonjua, MD, MPH; Joel Schwartz, PhD; Eric Lovett, PhD; Andrew Larson, BS; Bruce Nearing, PhD; George Allen, BS; Monique Verrier, BA; Rebecca Cherry, BA; Richard Verrier, PhD

From the Channing Laboratory, Brigham and Women’s Hospital and the Harvard Medical School (D.R.G., A. Litonjua, M.V., R.C.); the Environmental Epidemiology Program and the Environmental Science and Engineering Program, Department of Environmental Health, Harvard School of Public Health (D.R.G., J.S., G.A.); and the Institute of Prevention of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Boston, Mass (E.L., A. Larson, B.N., R.V.); and Marquette Medical Systems, Milwaukee, Wis (A. Larson).

Correspondence to Diane R. Gold, MD, MPH, The Channing Laboratory, Brigham and Women’s Hospital, Harvard Medical Laboratory, 181 Longwood Avenue, Boston, MA 02115-5804. redrg@gauss.bwh.harvard.edu

Background—We investigated associations between ambient pollution levels and cardiovascular function in a repeated measures study including 163 observations on twenty-one 53- to 87-year-old active Boston residents observed up to 12 times from June to September 1997. Particles with aerodynamic diameter <=2.5 µm (PM2.5) were measured continuously using a tapered element oscillating microbalance.

Methods and Results—The protocol involved 25 minutes per week of continuous Holter ECG monitoring, including 5 minutes of rest, 5 minutes of standing, 5 minutes of exercise outdoors, 5 minutes of recovery, and 20 cycles of slow breathing. Heart rate variability (HRV) was assessed through time domain variables: the standard deviation of normal RR intervals (SDNN) and the square root of the mean of the squared differences between adjacent normal RR intervals (r-MSSD). Mean 4-hour PM2.5 levels ranged from 3 to 49 µg/m3; 1-hour ozone levels ranged from 1 to 77 ppb. In multivariate analyses, significantly less HRV (SDNN and r-MSSD) was associated with elevated PM2.5. During slow breathing, a reduction in r-MSSD of 6.1 ms was associated with an interquartile (14.3 µg/m3) increase in PM2.5 during the hour of and the 3 hours previous to the Holter session (P=0.006). During slow breathing, a multiple pollution model was associated with a reduction in r-MSSD of 5.4 ms (P=0.02) and 5.5 ms (P=0.03) for interquartile changes in PM2.5 and ozone, respectively, resulting in a combined effect equivalent to a 33% reduction in the mean r-MSSD.

Conclusions—Particle and ozone exposure may decrease vagal tone, resulting in reduced HRV.


Key Words: nervous system, autonomic • heart rate • epidemiology • electrophysiology • air pollution




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