Reducing Particulate Matter-Associated Cardiovascular Health Effects for Seniors

项目总结/摘要 <2.5 µm的细颗粒物（PM2.5）空气污染是全球第五大死亡风险因素。 仅在美国，每年就有超过8.8万人死于PM2.5，其中最大部分来自 心血管（CV）原因（心肌梗死、中风、心力衰竭）。尽管各地都有改善， 在美国，PM2.5在许多热点地区仍高于世界卫生组织空气质量指南（<10 µg/m3） (e.g.,公路附近）。因此，制定切实有效的个人保护策略至关重要 “易受伤害”（城市/道路附近）和“易受影响”（老年人）人口， PM2.5。 新兴的试验表明，具有高效颗粒的便携式室内空气过滤装置（AFU） 过滤器可以将PM2.5暴露减少30-50%，并改善CV健康终点（例如，血压，血管 函数）。我们最近的临床试验结果证实，即使是低PM2.5水平也会对CV健康构成重大风险 便携式室内空气过滤装置（AFU）是一种很有前途的预防策略。但没有 一项研究探讨了暴露减少和健康改善是否可以持续更长时间， 临床相关的干预期（即，几周），这需要合理地产生减少， 实际CV事件。此外，新的实用（即，更便宜，更可行的真实的- 世界设置）的方法，只在卧室使用一个AFU，专注于减少夜间PM2.5 目前暴露情况未知。 本提案旨在进行一项随机双盲3向交叉干预研究（AFU在2 房间与卧室AFU单独使用与假过滤），在50名居住在低收入老年人住宅的成年人中进行 受到道路污染物的影响。具体目的是：（1）确定长期使用2室AFU是否提供 持续减少PM2.5暴露和持续改善心脏代谢结果;（2） 确定单独减少夜间PM2.5暴露是否能改善心脏代谢结果;以及（3） 证明肾上腺激活作为解释PM2.5诱导的心脏代谢的新机制的关键作用。 变化我们的建议将有助于验证在老年人中使用AFU的新策略的益处。 弱势群体。积极的结果将是形成所需证据基础的关键一步， 促进更广泛的AFU使用;从长远来看，由于其成本低，负担轻，AFU的使用可能会增加- 以帮助保护不同的人群。

Project Summary/Abstract Fine particulate matter <2.5 µm (PM2.5) air pollution is the fifth leading risk factor for mortality worldwide. Over 88 thousand deaths per year are attributable to PM2.5 in the US alone, with the largest portion from cardiovascular (CV) causes (myocardial infarctions, strokes, heart failure). Despite improvements across the US, PM2.5 remains above World Health Organization Air Quality Guidelines (<10 µg/m3) in numerous hot-spots (e.g., near roadways). Therefore, it is critical to develop feasible and effective personal strategies to protect “vulnerable” (urban/near-roadway) and “susceptible” (elderly) populations at risk from the harmful effects of PM2.5. Emerging trials have shown that portable indoor air filtration units (AFUs) with high-efficiency particulate arrestance filters can reduce PM2.5 exposures by 30-50% and improve CV health endpoints (e.g., BP, vascular function). Our recent clinical trial results confirm that even low PM2.5 levels pose significant risks to CV health and that portable indoor air filtration units (AFUs) represent a promising preventative strategy. However, no study has addressed whether exposure reductions and health improvements can be sustained over more clinically relevant periods of intervention (i.e., several weeks) which are required to plausibly yield decreases in actual CV events. In addition, the efficacy of the novel practical (i.e., less expensive and more feasible in real- world settings) approach of using a single AFU only in the bedroom to focus on reducing nocturnal PM2.5 exposure is currently unknown. This proposal seeks to conduct a randomized double-blind 3-way crossover intervention study (AFUs in 2 rooms vs. bedroom AFU use alone vs. sham filtration) in 50 adults living in a low-income senior residence impacted by roadway pollutants. Specific Aims are: (1) determine if long-term, 2-room AFU usage provides sustained reductions in PM2.5 exposure and persistent improvements in cardiometabolic outcomes; (2) determine if nocturnal PM2.5 exposure reduction alone improves cardiometabolic outcomes; and (3) demonstrate the key role of adrenal activation as a novel mechanism explaining PM2.5-induced cardiometabolic changes. Our proposal will help validate the benefits of novel strategies to employ AFUs in an elderly vulnerable population. Positive results would represent a key step in forming the evidence base required to promote more wide-scale AFU use; in the long term, given their low cost and burden, AFU use could be up- scaled to help protect diverse populations.