Assessing Cardiovascular Effect of Wildland Fire Smoke Exposure Using Lipid Biomarkers, Vascular Function, Hemodynamics, and Atherosclerotic Progression

项目摘要 在美国，数百万人暴露在野火排放的烟雾中。增加 基于人群的研究证据表明，急性暴露于野火（WF）烟雾会引起急性 呼吸影响。这些研究中的观察结果对WF的心血管效应尚无定论 抽烟然而，这些研究受到相对较高的暴露错误分类可能性及其 检测微小群体水平差异的固有弱点。此外，累积的长期影响 暴露，例如荒地消防员经历的暴露，目前尚不清楚。此外，健康研究 仅限于急性肺反应和非特异性全身终点， 尽管在野外消防员中，心血管事件导致的在职死亡人数最多。的 拟议的研究旨在解决NIOSH的“公共安全”部门和“癌症，生殖， 通过评估职业暴露于WF之间的关联来评估“心血管疾病”跨部门 吸烟和心血管疾病前兆。这项研究的假设是， 暴露在WFF中诱导不良心血管效应，如脂质失调所示， 在血管结构和功能上。具体来说，我们将确定职业暴露于WF烟雾的影响 （1）传统和新的CVD脂质危险因素和（2）血管结构和动脉粥样硬化的测量 进展这些措施的基线和预期变化将在荒地和荒地之间进行比较。 消防员和一组非暴露的紧急医疗技术人员（EMT）。疾病的使用 作为结果的前体将有助于发现与描述可能演变的风险有关的结果， 工作和退休后可以发展的人。 拟议研究的目标与NIOSH的优先校外研究目标“减少 消防员慢性和急性疾病的发病率可能与.燃烧产物有关，” 进行一项以疾病前兆为结果的研究。这项工作将有助于发展 相关的早期疾病检测。总的来说，在拟议的研究成功完成后，我们预计， 确定职业性WF烟雾暴露对CVD发展的贡献。设想的 拟议研究的产出将包括可公开获取的成果和出版物， 直接告知NIOSH的优先目标，以减少野外消防员的暴露和疾病发生率。 这些结果将有助于对WF烟雾暴露进行适当的风险评估， 风险暴露和风险缓解策略，以及测试其有效性的方法。最后，研究结果将 传播并提供给其直接受众，荒地消防社区。无障碍 还将通过针对开放获取出版物的研究结果来加强。

Project Abstract Millions of people are exposed to smoke emissions from wildfires in the United States (U.S.). Increasing evidence from population-based studies indicates that acute exposure to wildland fire (WF) smoke induces acute respiratory effects. Observations made in these studies are inconclusive about the cardiovascular effects of WF smoke. However, these studies are limited by a relatively higher potential for exposure misclassification and their inherent weakness to detect small population level differences. Additionally, longer-term effects of cumulative exposure, such as experienced by wildland firefighters, are currently unknown. Furthermore, health studies among firefighters have been limited to acute pulmonary responses and non-specific systemic end-points, although cardiovascular events cause the largest number of on-the-job deaths among wildland firefighters. The proposed study is designed to address NIOSH’s “Public Safety” sector and “Cancer, Reproductive, and Cardiovascular Diseases” cross-sector by assessing the association between occupational exposure to WF smoke and precursors of cardiovascular disease. The hypothesis of the proposed study is that WF smoke exposure induces adverse cardiovascular effects among WFFs as indicated by lipid dysregulation, and changes in vascular structure and function. Specifically we will determine the effect of occupational exposure to WF smoke on (1) traditional and novel CVD lipid risk factors and (2) measures of vascular structure and atherosclerotic progression. Baseline and prospective changes in these measures will be compared between wildland firefighters and a control non-exposed group of emergency medical technicians (EMTs). The use of disease precursors as outcomes will enable findings that are relevant for characterizing risks that may evolve while still working and those that could develop after retirement. The objective of the proposed study is well aligned with NIOSH’s priority extramural research goal to “reduce the incidence of chronic and acute diseases in firefighters that may be related to … combustion products,” by conducting a study using precursors of disease as outcomes. This work will contribute to the development of relevant early disease detection. Overall, following the successful completion of the proposed study we expect to have determined the contribution of occupational WF smoke exposure to CVD development. The envisaged outputs from the proposed research, which would include publicly accessible results and publications, would directly inform NIOSH’s priority goal to reduce incidence of exposure and illnesses among wildland firefighters. These outputs will contribute to appropriate risk assessment of WF smoke exposure, the development of exposure and risk mitigation strategies, and methods to test their effectiveness. Finally, the study results will be disseminated and made accessible to its immediate audience, the wildland firefighting community. Accessibility will also be enhanced by targeting study results for open access publication.