Abstract 18440: Global Burden of Air Pollution on Heart Failure: A Systematic Review and Meta Analysis

Abstract

Introduction Air pollution is responsible for over a million deaths worldwide each year with predilection towards patients with chronic cardiovascular disease. We undertook the first meta-analysis to determine the association between gaseous and particulate air pollution and heart failure admissions and mortality. Methods Medline, EMBASE, CINAHL, Global health and Web of Science databases up to and including 01/02/2012 were searched for studies investigating the association between gaseous (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate (PM2.5 and PM10) pollution and heart failure admission or mortality. Two independent reviewers extracted study information and risk estimates were meta-analysed and stratified by lag periods (days). Studies measuring air pollution up to and including a lag of seven days were included. Results 1,146 studies were identified in the primary search including a search of all relevant bibliographies. 195 articles were fully reviewed and 35 met the inclusion criteria. Except for ozone, heart failure admission or mortality was positively associated with all pollutants (Figure 1). Across all pollutants stronger associations were seen at Lag 0 with diminishing effect at longer lag times. Conclusion Gaseous and particulate air pollutants have a marked and close temporal association with heart failure admissions and mortality. The causality and biological mechanisms of this association now needs to be explored. Meanwhile, air pollution continues to remain a pervasive public health issue with significant cardiovascular consequences presenting a key target for national and international public health.