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Air Filters and Heart Disease

January 24, 2011 Written by JP       [Font too small?]

Sometimes knowing too many details can be maddening. If you’ve seen newspaper or television exposes about the astronomical number of germs found on everyday objects (doorknobs, money, restaurant menus, telephones, TV remote controls, etc.) you probably know what I mean. Or perhaps you’ve stumbled across science programs that provide a microscopic view of what’s actually living in the carpeting of average households. Do we really need to know all of this?! I don’t know about you, but I’d rather just know a few practical ways that minimize the risks associated with the colorful microbes and organisms present in the examples above. So rather than frighten you with the details about what’s floating around in the air in our households, I’ll just tell you about a practical way to improve indoor air quality.

By now, we’re all well aware of the damaging effects of second-hand smoke. So too do we understand that outdoor air pollution can wreak havoc on pulmonary function in adults and children alike. But what’s less known is that indoor air pollution contributes to many of the leading causes of mortality in the modern world. What makes this form of pollution all the more insidious is that it can’t been seen like a layer of smog along the skyline. However, it can be seen quite clearly in the medical literature. A growing body of evidence clearly points to a profound effect of “exposure to particulate matter” and cardiovascular-related health conditions and mortality throughout the world. (1,2,3,4,5)

A new publication in the the American Journal of Respiratory and Critical Care Medicine supports a preventive health strategy that I’ve long since endorsed: the use of high efficiency particle air (HEPA) filters to improve indoor air quality. The study in question enrolled 45 healthy adults in a randomized, crossover intervention study. On two-occasions, the participants were exposed to 7-days of filtered or non-filtered air. Various tests pertaining to endothelial function, inflammation and oxidative stress were performed throughout the different stages of the trial. Here’s what the researchers discovered:

  • The HEPA filters reduced indoor fine particulate concentrations by 60% and woodsmoke by 75%.
  • C-reactive protein, an inflammatory marker, decreased by 32.6% during the air filtration period.
  • An indicator of endothelial function (reactive hyperemia index) improved by 9.4% in the HEPA leg of the study.

This particular study employed two types of HEPA filters – a larger, more powerful model (Honeywell 5300) in the primary room of each household and a quieter, smaller version (Honeywell 18150) in the bedrooms. One of the co-authors of the trial, Dr. Ryan Allen, concluded that: “Our results support the hypothesis that systemic inflammation and impaired endothelial function, both predictors of cardiovascular morbidity, can be favorably influenced by a reduction of particle concentration and add to a growing body of evidence linking short-term exposure to particulate matter with a systemic inflammatory response”. (6,7)

How Air Pollution Damages Cardiovascular and Pulmonary Health

Source: Particle and Fibre Toxicology 2009, 6:24 (link)

When I suggest using air filters to my clients, some of them initially express a certain degree of hesitation. The reasons vary from aesthetic issues to cost to excessive noise. There’s not a great deal that I can offer with regard to the appearance of air filters. My best advice is to simply put them away or move them to another room when guests come to visit. The cost of buying and maintaining basic HEPA filters is very modest. I can assure you that drinking purified water costs considerably more annually and may not afford you greater health benefits. The noise issue can be dealt with by using smaller filtration devices or just turning them on only when you’re not home or occupying a room. This isn’t the ideal way to use them, but it still offers some degree of protection. On the other hand, some people actually find the “white noise” produced by HEPA air purifiers rather soothing. Individual reactions to these health devices vary, but there is always a solution for any conceivable reservation one might have. And to my mind, it’s worth finding a way to use HEPA filtration in your household. I’m confident that future studies, such as the one I highlighted today, will continue to reveal valuable health benefits that are mostly unattainable otherwise.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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9 Comments & Updates to “Air Filters and Heart Disease”

  1. Liverock Says:

    Recent research has highlighted the dangers of woodburning stoves as a possible cause of heart disease and cancer.

    http://www.telegraph.co.uk/health/healthnews/8306792/Wood-burning-stoves-can-cause-cancer-and-heart-disease.html

  2. JP Says:

    Thanks for posting the link, Liverock. Important information indeed.

    I try to avoid using any type of heating. It dries the air out terribly. My eyes and skin suffer. Ugh. I prefer bundling up!

    Be well!

    JP

  3. JP Says:

    Update 05/06/15:

    http://ehp.niehs.nih.gov/wp-content/uploads/advpub/2015/5/ehp.1408988.acco.pdf

    Environ Health Perspect. 2015 May 1.

    Dietary Supplementation with Olive Oil or Fish Oil and Vascular Effects of Concentrated Ambient Particulate Matter Exposure in Human Volunteers.

    BACKGROUND: Exposure to ambient particulate matter (PM) induces endothelial dysfunction, a risk factor for cardiovascular disease. Olive oil (OO) and fish oil (FO) supplements have beneficial effects on endothelial function.

    OBJECTIVE: In this study we evaluated the potential efficacy of OO and FO in mitigating endothelial dysfunction and disruption of hemostasis caused by exposure to particulate matter (PM).

    METHODS AND RESULTS: Forty-two participants (58±1 year old) received either 3 gram/day of OO, FO, or no supplements (naïve) for 4 weeks prior to undergoing 2-hr exposures to filtered-air and concentrated ambient particulate matter (CAP) (mean 253±16 µg/m3). Endothelial function was assessed by flow-mediated dilation of the brachial artery (FMD) pre-, immediately post- and 20 hours post-exposure. Levels of endothelin-1 and markers of fibrinolysis and inflammation were also measured. FMD was significantly lower after CAP exposure in the naïve (-19.4%; 95% CI: -36.4, -2.3 per 100 µg/m3 CAP relative to baseline; p = 0.03) and FO groups (-13.7%; 95% CI: -24.5, -2.9; p = 0.01), but not in the OO group (-7.6%; 95% CI: -21.5, 6.3; p = 0.27). Tissue plasminogen activator levels were significant increased immediately after (11.6%; 95% CI: 0.8, 22.2; p = 0.04) and 20 hours after CAP exposure in the OO group. Endothelin-1 levels were significantly increased 20 hours after CAP exposure in the naïve group only (17.1%; 95% CI: 2.2, 32.0; p = 0.03).

    CONCLUSIONS: Short-term exposure to CAP induced vascular endothelial dysfunction. OO supplementation attenuated CAP-induced reduction of FMD and changes in blood markers associated with vasoconstriction and fibrinolysis, suggesting that OO supplementation may be an efficacious intervention to protect against vascular effects of exposure to PM.

    Be well!

    JP

  4. JP Says:

    Updated 09/08/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470563/

    Curr Cardiovasc Risk Rep. 2015 Jun;9(6).

    Understanding Air Pollution and Cardiovascular Diseases: Is It Preventable?

    Fine particulate matter (<2.5 µm, PM2.5) air pollution is a leading risk factor for morbidity and mortality worldwide. The largest portion of adverse health effects is from cardiovascular diseases. In North America, PM2.5 concentrations have shown a steady decline over the past several decades; however, the opposite trend has occurred throughout much of the developing world whereby daily concentrations commonly reach extraordinarily high levels. While air quality regulations can reduce air pollution at a societal level, what individuals can do to reduce their personal exposures remains an active field of investigation. Here, we review the emerging evidence that several interventions (e.g., air filters) and/or behavioral changes can lower PM pollution exposure and as such, may be capable of mitigating the ensuing adverse cardiovascular health consequences. Air pollution remains a worldwide epidemic and a multi-tiered prevention strategy is required in order to optimally protect global public health.

    Be well!

    JP

  5. JP Says:

    Updated 09/08/15:

    http://www.sciencedirect.com/science/article/pii/S0735109715016708

    J Am Coll Cardiol. 2015 Jun 2;65(21):2279-87.

    Cardiopulmonary benefits of reducing indoor particles of outdoor origin: a randomized, double-blind crossover trial of air purifiers.

    BACKGROUND: Indoor exposure to fine particulate matter (PM2.5) from outdoor sources is a major health concern, especially in highly polluted developing countries such as China. Few studies have evaluated the effectiveness of indoor air purification on the improvement of cardiopulmonary health in these areas.

    OBJECTIVES: This study sought to evaluate whether a short-term indoor air purifier intervention improves cardiopulmonary health.

    METHODS: We conducted a randomized, double-blind crossover trial among 35 healthy college students in Shanghai, China, in 2014. These students lived in dormitories that were randomized into 2 groups and alternated the use of true or sham air purifiers for 48 h with a 2-week washout interval. We measured 14 circulating biomarkers of inflammation, coagulation, and vasoconstriction; lung function; blood pressure (BP); and fractional exhaled nitric. We applied linear mixed-effect models to evaluate the effect of the intervention on health outcome variables.

    RESULTS: On average, air purification resulted in a 57% reduction in PM2.5 concentration, from 96.2 to 41.3 μg/m3, within hours of operation. Air purification was significantly associated with decreases in geometric means of several circulating inflammatory and thrombogenic biomarkers, including 17.5% in monocyte chemoattractant protein-1, 68.1% in interleukin-1β, 32.8% in myeloperoxidase, and 64.9% in soluble CD40 ligand. Furthermore, systolic BP, diastolic BP, and fractional exhaled nitrous oxide were significantly decreased by 2.7%, 4.8%, and 17.0% in geometric mean, respectively. The impacts on lung function and vasoconstriction biomarkers were beneficial but not statistically significant.

    CONCLUSIONS: This intervention study demonstrated clear cardiopulmonary benefits of indoor air purification among young, healthy adults in a Chinese city with severe ambient particulate air pollution.

    Be well!

    JP

  6. JP Says:

    Updated 11/27/15:

    http://ehp.niehs.nih.gov/1408988/

    Environ Health Perspect

    Dietary Supplementation with Olive Oil or Fish Oil and Vascular Effects of Concentrated Ambient Particulate Matter Exposure in Human Volunteers

    Background: Exposure to ambient particulate matter (PM) induces endothelial dysfunction, a risk factor for cardiovascular disease. Olive oil (OO) and fish oil (FO) supplements have beneficial effects on endothelial function.

    Objective: In this study we evaluated the potential efficacy of OO and FO in mitigating endothelial dysfunction and disruption of hemostasis caused by exposure to particulate matter (PM).

    Methods and Results: Forty-two participants (58 ± 1 years of age) received either 3 g/day of OO or FO, or no supplements (naive) for 4 weeks prior to undergoing 2-hr exposures to filtered air and concentrated ambient particulate matter (CAP; mean, 253 ± 16 μg/m3). Endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery preexposure, immediately postexposure, and 20 hr postexposure. Levels of endothelin-1 and markers of fibrinolysis and inflammation were also measured. The FMD was significantly lower after CAP exposure in the naive (–19.4%; 95% CI: –36.4, –2.3 per 100 μg/m3 CAP relative to baseline; p = 0.03) and FO groups (–13.7%; 95% CI: –24.5, –2.9; p = 0.01), but not in the OO group (–7.6%; 95% CI: –21.5, 6.3; p = 0.27). Tissue plasminogen activator levels were significantly increased immediately after (11.6%; 95% CI: 0.8, 22.2; p = 0.04) and 20 hr after CAP exposure in the OO group. Endothelin-1 levels were significantly increased 20 hr after CAP exposure in the naive group only (17.1%; 95% CI: 2.2, 32.0; p = 0.03).

    Conclusions: Short-term exposure to CAP induced vascular endothelial dysfunction. OO supplementation attenuated CAP-induced reduction of FMD and changes in blood markers associated with vasoconstriction and fibrinolysis, suggesting that OO supplementation may be an efficacious intervention to protect against vascular effects of exposure to PM.

    Be well!

    JP

  7. JP Says:

    Updated 12/16/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587002/

    Lung India. 2015 Sep-Oct;32(5):473-9.

    Enhancing indoor air quality -The air filter advantage.

    Air pollution has become the world’s single biggest environmental health risk, linked to around 7 million deaths in 2012 according to a recent World Health Organisation (WHO) report. The new data further reveals a stronger link between, indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischemic heart disease, as well as between air pollution and cancer. The role of air pollution in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases, is well known. While both indoor and outdoor pollution affect health, recent statistics on the impact of household indoor pollutants (HAP) is alarming. The WHO factsheet on HAP and health states that 3.8 million premature deaths annually – including stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer are attributed to exposure to household air pollution. Use of air cleaners and filters are one of the suggested strategies to improve indoor air quality. This review discusses the impact of air pollutants with special focus on indoor air pollutants and the benefits of air filters in improving indoor air quality.

    Be well!

    JP

  8. JP Says:

    Updated 09/08/16:

    http://www.sciencedirect.com/science/article/pii/S2213177915006575

    JACC Heart Fail. 2016 Jan;4(1):55-64.

    Respiratory Filter Reduces the Cardiovascular Effects Associated With Diesel Exhaust Exposure: A Randomized, Prospective, Double-Blind, Controlled Study of Heart Failure: The FILTER-HF Trial.

    OBJECTIVES: The goal of this study was to test the effects of a respiratory filter intervention (filter) during controlled pollution exposure.

    BACKGROUND: Air pollution is considered a risk factor for heart failure (HF) decompensation and mortality.

    METHODS: This study was a double-blind, randomized to order, controlled, 3-way crossover, single-center clinical trial. It enrolled 26 patients with HF and 15 control volunteers. Participants were exposed in 3 separate sessions to clean air, unfiltered diesel exhaust exposure (DE), or filtered DE. Endpoints were endothelial function assessed by using the reactive hyperemia index (RHi), arterial stiffness, serum biomarkers, 6-min walking distance, and heart rate variability.

    RESULTS: In patients with HF, DE was associated with a worsening in RHi from 2.17 (interquartile range [IQR]: 1.8 to 2.5) to 1.72 (IQR: 1.5 to 2.2; p = 0.002) and an increase in B-type natriuretic peptide (BNP) from 47.0 pg/ml (IQR: 17.3 to 118.0 pg/ml) to 66.5 pg/ml (IQR: 26.5 to 155.5 pg/ml; p = 0.004). Filtration reduced the particulate concentration (325 ± 31 μg/m(3) vs. 25 ± 6 μg/m(3); p < 0.001); in the group with HF, filter was associated with an improvement in RHi from 1.72 (IQR: 1.5 to 2.2) to 2.06 (IQR: 1.5 to 2.6; p = 0.019) and a decrease in BNP from 66.5 pg/ml (IQR: 26.5 to 155.5 pg/ml) to 44.0 pg/ml (IQR: 20.0 to 110.0 pg/ml; p = 0.015) compared with DE. In both groups, DE decreased the 6-min walking distance and arterial stiffness, although filter did not change these responses. DE had no effect on heart rate variability or exercise testing.

    CONCLUSIONS: To our knowledge, this trial is the first to show that a filter can reduce both endothelial dysfunction and BNP increases in patients with HF during DE. Given these potential benefits, the widespread use of filters in patients with HF exposed to traffic-derived air pollution may have beneficial public health effects and reduce the burden of HF.

    Be well!

    JP

  9. JP Says:

    Updated 04/04/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28367952

    Sci Rep. 2017 Apr 3;7:45322.

    B-vitamin Supplementation Mitigates Effects of Fine Particles on Cardiac Autonomic Dysfunction and Inflammation: A Pilot Human Intervention Trial.

    Ambient fine particle (PM2.5) pollution triggers acute cardiovascular events. Individual-level preventions are proposed to complement regulation in reducing the global burden of PM2.5-induced cardiovascular diseases. We determine whether B vitamin supplementation mitigates PM2.5 effects on cardiac autonomic dysfunction and inflammation in a single-blind placebo-controlled crossover pilot trial. Ten healthy adults received two-hour controlled-exposure-experiment to sham under placebo, PM2.5 (250 μg/m3) under placebo, and PM2.5 (250 μg/m3) under B-vitamin supplementation (2.5 mg/d folic acid, 50 mg/d vitamin B6, and 1 mg/d vitamin B12), respectively. At pre-, post-, 24 h-post-exposure, we measured resting heart rate (HR) and heart rate variability (HRV) with electrocardiogram, and white blood cell (WBC) counts with hematology analyzer. Compared to sham, PM2.5 exposure increased HR (3.8 bpm, 95% CI: 0.3, 7.4; P = 0.04), total WBC count (11.5%, 95% CI: 0.3%, 24.0%; P = 0.04), lymphocyte count (12.9%, 95% CI: 4.4%, 22.1%; P = 0.005), and reduced low-frequency power (57.5%, 95% CI: 2.5%, 81.5%; P = 0.04). B-vitamin supplementation attenuated PM2.5 effect on HR by 150% (P = 0.003), low-frequency power by 90% (P = 0.01), total WBC count by 139% (P = 0.006), and lymphocyte count by 106% (P = 0.02). In healthy adults, two-hour PM2.5 exposure substantially increases HR, reduces HRV, and increases WBC. These effects are reduced by B vitamin supplementation.

    Be well!

    JP

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