Clean Air- Heart: Clinical trial of an air purifier intervention to reduce indoor particulate matter and improve cardiovascular outcomes in COPD

 描述（由申请人提供）：室外颗粒物（PM）与心血管和呼吸系统疾病相关的发病率和死亡率增加有关。尽管室外污染对心血管结果的影响已经得到了很好的证实，但对室内污染的研究很少，这些研究主要集中在室内生物量的影响上。了解室内空气对心血管的影响至关重要，因为美国人大部分时间（超过85%）都在室内，室内空气质量在个人层面上是可以改变的。慢性阻塞性肺病（COPD）患者是研究的重点，因为他们容易受到空气污染的健康影响，并且心血管疾病发病率和死亡率的风险增加。虽然与生物质相关的室内污染的影响是最近全球努力减少COPD负担的焦点，但有必要研究美国家庭暴露典型浓度的室内污染物的影响。在拟议的研究中，我们利用最近NIEHS R01资助的空气清洁器干预试验的基础设施来解决独特的假设。这项母试验提供了详细的参与者特征，室内污染物测量，空气净化器与假干预，呼吸结果的措施。在目前的提案中，我们增加了与心血管发病率相关的中间结局，包括内皮功能、血压、血管僵硬度、心率变异性、全身炎症和凝血标志物。我们将确定室内PM浓度与心血管结局之间的关联，并确定减少室内PM的空气净化器干预对这些结局的影响。解决本提案中的假设将告知我们对COPD患者的空气净化器干预可能导致的多系统健康益处的理解，包括心血管和呼吸结果。这些发现很有可能通过将室内空气污染干预定义为COPD患者的治疗方法来改变我们对COPD管理的方法。

 DESCRIPTION (provided by applicant): Outdoor particulate matter (PM) has been associated with increased morbidity and mortality related to cardiovascular and respiratory disease. Despite the well-established effects of outdoor pollution on cardiovascular outcomes, there have been very few studies of indoor pollution and these have mostly focused on effects of indoor biomass. It is critical to understand cardiovascular effects of indoor air as people in the United States spend the great majority (over 85%) of their time indoors and indoor air quality is modifiable at the individual level. Individuals with chronic obstructive lung disease (COPD) are a high research priority as they are susceptible to the health effects of air pollution and are at increased risk for cardiovascular morbidity and mortality. While the effects of indoor pollution related to biomass has been a recent focus of worldwide efforts to reduce the burden of COPD, there is a need to study the effects of indoor pollutants at concentrations typical of US household exposures. In the proposed study, we address unique hypotheses by leveraging the infrastructure of a recently NIEHS R01-funded air cleaner intervention trial. This parent trial provides detailed participant characterization, indoor pollutant measurements, an air purifier versus sham intervention, and respiratory outcomes measures. In the current proposal, we add intermediate outcomes that have been linked to cardiovascular morbidity, including endothelial function, blood pressure, vascular stiffness, heart rate variability, markers of systemic inflammation and coagulation. We will determine the association between in-home PM concentrations and cardiovascular outcomes and determine the effect of an air purifier intervention that reduces indoor PM on these outcomes. Addressing the hypotheses in this proposal will inform our understanding of multisystem health benefits that can result from an air purifier intervention for patients with COPD, including cardiovascular in addition to respiratory outcomes. The findings have high potential to shift our approach to COPD management by defining indoor air pollution interventions as a therapy for individuals with COPD.