Reducing Particulate Matter-Associated Cardiovascular Health Effects for Seniors

项目摘要/摘要 细颗粒物和2.5微米(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，其中最大的部分来自 心血管原因(心肌梗塞、中风、心力衰竭)。尽管世界各地的情况有所改善 美国，PM2.5在许多热点地区保持在世界卫生组织空气质量指南(&lt；10微克/立方米)以上 (例如，在道路附近)。因此，制定可行和有效的个人保护战略至关重要。 “脆弱”(城市/临近道路)和“易受影响”(老年人)人口面临着受 PM2.5。 新出现的试验表明，便携式室内空气过滤装置(AFU)具有高效颗粒物 制动过滤器可以将PM2.5暴露减少30%-50%，并改善心血管健康终点(例如，血压、血管 功能)。我们最近的临床试验结果证实，即使是低水平的PM2.5也会对心血管健康构成重大风险 便携式室内空气过滤装置(AFU)代表了一种很有前途的预防策略。然而，没有 研究已经解决了暴露减少和健康改善是否可以持续更多 临床上相关的干预期(即几周)，这是可信地产生减少的 实际的CV事件。此外，新的实用(即，更便宜，在实际中更可行)的效果。 世界环境)仅在卧室使用单个AFU以专注于减少夜间PM2.5的方法 目前还不清楚接触情况。 这项建议寻求进行一项随机双盲3向交叉干预研究(AFU在2 居住在低收入老年住宅的50名成年人的房间与卧室(AFU单独使用与假过滤)的比较 受道路污染物的影响。具体目标是：(1)确定长期使用两个房间的AFU是否提供 PM2.5暴露持续减少，心脏代谢结果持续改善；(2) 确定夜间PM2.5暴露减少是否单独改善心脏代谢结果；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 改变。我们的建议将有助于验证在老年人中使用AFU的新策略的好处 弱势群体。积极的结果将是形成所需证据基础的关键一步 促进更广泛地使用AFU；从长远来看，鉴于AFU的成本和负担较低，AFU的使用可能会增加- 扩大规模，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.