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

项目摘要 在美国，数以百万计的人暴露在野火排放的烟雾中。渐增 来自基于人群的研究的证据表明，急性暴露在野地火灾(WF)烟雾中会导致急性 对呼吸的影响。这些研究中的观察结果对于白蛋白对心血管的影响没有定论。 烟。然而，这些研究受到相对较高的接触错误分类的可能性和他们的限制 与生俱来的弱点，无法检测到微小的种群水平差异。此外，累积的长期影响 目前尚不清楚野地消防员所经历的接触情况。此外，健康研究 消防员之间的反应仅限于急性肺部反应和非特定的全身终点， 尽管心血管事件是导致荒野消防员在职死亡人数最多的。这个 拟议的研究旨在解决NIOSH的“公共安全”部门和“癌症、生殖和 通过评估职业性接触WF与心血管疾病之间的关系 烟雾和心血管疾病的前兆。拟议研究的假设是WF烟雾 暴露诱导WFFS的不良心血管效应，如血脂失调所示，并改变 在血管结构和功能上。具体地说，我们将确定职业性接触WF烟雾的影响 关于(1)传统和新的心血管疾病血脂危险因素和(2)血管结构和动脉粥样硬化的测量方法 进步。这些措施的基线和预期变化将在荒野之间进行比较 消防员和一组对照的非暴露的紧急医疗技术人员(EMT)。疾病的使用 作为结果的前兆将使发现与表征可能演变的风险相关 工作和那些退休后可能发展的人。 拟议研究的目标与NIOSH的优先校外研究目标很好地保持一致，即“减少 消防员慢性病和急性病的发病率可能与…有关燃烧产物，“由 进行一项使用疾病前兆作为结果的研究。这项工作将有助于 相关疾病的早期发现。总括而言，在成功完成拟议研究后，我们预期 已确定职业性WF烟雾暴露对CVD发生的贡献。设想中的 拟议研究的产出将包括可供公众查阅的结果和出版物， 直接告知NIOSH减少野外消防员暴露和疾病发生率的优先目标。 这些产出将有助于对WF烟雾暴露的适当风险评估，制定 暴露和风险缓解战略，以及测试其有效性的方法。最后，研究结果如下 传播并使其直接受众--荒野消防界--能够接触到它。无障碍 还将通过将研究结果作为开放获取出版物的目标加以加强。

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.