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ENVIROMENTAL FACTORS IN IHD IN A SRILANKAN POPULATION byDr Ruvan EkanayakaDr ConstantineDr Hemantha Wickramatillake Dr Nuwan kumara : 

ENVIROMENTAL FACTORS IN IHD IN A SRILANKAN POPULATION byDr Ruvan EkanayakaDr ConstantineDr Hemantha Wickramatillake Dr Nuwan kumara

RATIONALE: : 

RATIONALE: Short- and long-term exposure to air pollution has been associated with increased cardiovascular mortality and morbidity (Pope et al. 2002; Samet et al. 2000; Schwartz 1999), and individuals with underlying cardiovascular disease, including heart failure, arrhythmia, or diabetes, are at greater risk (Bateson and Schwartz 2004; Goldberg et al. 2001; Mann et al. 2002; Zanobetti and Schwartz 2002). Possible mechanisms for these associations include effects on the autonomic nervous system through direct reflexes from airways or through inflammatory response, chemical effects on ion channel function in myocardial cells, ischemic response in the myocardium, and inflammatory responses that trigger endothelial dysfunction, atherosclerosis, and thrombosis (Utell et al. 2002

In 2002The U.K. department of health made the following extrapolations regarding cardiac disease and environmental pollution: : 

In 2002The U.K. department of health made the following extrapolations regarding cardiac disease and environmental pollution: 1 in 50 myocardial infarctions admitted to London hospitals may have been triggered by air pollutants. A reduction in the 24 hour average of particles (of diameter less than 10μg/mm2) could lead to a reduction in cardiac admissions by 8% .

Components of Air Pollution : 

Components of Air Pollution Air pollution is composed of many environmental factors. They include carbon monoxide, nitrates, sulfur dioxide, ozone, lead, secondhand tobacco smoke and particulate matter. Particulate matter, also known as particle pollution, is composed of solid and liquid particles within the air. It can be generated from vehicle emissions, tire fragmentation and road dust, power generation and industrial combustion, smelting and other metal processing, construction and demolition activities, residential wood burning, windblown soil, pollens, molds, forest fires, volcanic emissions and sea spray. These particles vary considerably in size, composition and origin.

London smog of 1952 : 

London smog of 1952

Slide 6: 

Air pollution and cardiovascular disease Haber G – Harefuah. 2007 Oct Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem Cardiovascular atherothrombosis is the most common cause of death globally, with several well-known risk factors. Air pollution is a byproduct of fuel combustion by motor vehicles, power plants and industrial factories. It is composed of gases, fluids and particulate matter (PM) of different sizes, which include basic carbon, organic carbonic molecules and metals such as vanadium, nickel, zinc and iron. These particles are subdivided by their median size, a major contributing factor for their capability to enter the human body through the respiratory system. Most of the epidemiological studies have shown correlation between acute and long-term exposure to air pollution elements and cardiovascular morbidity in general and angina pectoris and acute myocardial infarction specifically. Physiological studies have found different arrhythmias as the etiologic cause of cardiovascular morbidity and mortality following exposure to air pollution. A major finding was a decline in heart rate variability, a phenomenon known as endangering for cardiovascular morbidity and mortality, especially in patients after acute myocardial infarction. To date, several pathways have been proposed, including a hypercoagulable state following an inflammatory response, cardiac nervous autonomic disequilibrium, endothelial dysfunction with blood vessel contraction and direct toxic impact on cardiac muscle. Additional research is needed for clarifying the pathophysiogical pathways by which air pollution affects the cardiovascular system. That might allow forthcoming with preventive measures and correct treatment and hence a decrease in cardiovascular morbidity and mortality. Another important target is dose-outcome correlation curves for safety threshold calculation as a basis for air pollution regulations.

Particulate matter (PM) : 

Particulate matter (PM) Particulate matter (PM) air pollution is associated with an increased risk of cardiovascular morbidity and mortality. Even short-term exposure to PM2.5μg/mm2 over a few hours can trigger myocardial infarctions, cardiac ischemia, arrhythmias, heart failure, stroke, exacerbation of peripheral arterial disease and sudden death. Chronic exposure to moderately elevated levels also enhances the risk for developing a variety of cardiovascular disease, possibly including hypertension and systemic atherosclerosis. The overall weight of evidence is now sufficient to implicate PM exposure as a cause of cardiovascular disease.

Case control study : 

Case control study

OBJECTIVES: : 

OBJECTIVES: To investigate the vascular and systemic effects of air pollution in non smoking humans who are living close to main roads at urban area AND in non smoking humans who are living in villages (BP ,ECG CHANGES,. myocardial infarctions, cardiac ischemia, arrhythmias)

METHODS: Case control study : 

METHODS: Case control study Mapping different pollution levels in urban and village area 1.Particulate matter (PM 2,5) 2.So2 3.NO 4.CO 5.Dust Level

Structure of epidemic pattern : 

Structure of epidemic pattern 1.Cardiac Disease 2.Resparotory Disease 3. Other Disease

Clinical Variability : 

Clinical Variability 1.Heart rate variability 2.Mesuring Ambulatory BP

MEASUREMENTS : 

MEASUREMENTS HS CRP IL 6 Lipid profile FBS

Time duration : 

Time duration 2-3 years

Cost : 

Cost Funds from NSF & other

Future : 

Future Possibility of Long term Project

World without air pollution : 

World without air pollution

THANK YOU : 

THANK YOU