This is indicated by a study by the Catholic University-Gemelli Polyclinic in Rome. The cause would be ascribed to a chronic inflammation that alters the endothelium, the inner lining of the vessels
Air pollution suffocates the vessels of the heart and can cause heart attacks, even in a healthy heart. This is indicated by a study coordinated by Rocco Antonio Montone and Filippo Crea, cardiologists of the Agostino Gemelli University Hospital Foundation IRCCS – Universit Cattolica, Rome campus, which demonstrates how polluted air can cause heart attacks even in those with coronary arteries without significant atherosclerosis ( MINOCA, Myocardial Infarction with Non-Obstructive Coronary Arteries), resulting in a prolonged spasm of the vessels. The risk of incurring coronary artery spasm ischemia increases up to 11 times in subjects most heavily exposed to fine particulate pollution (PM2.5), mainly caused by vehicular traffic.
I study
The study was presented at the ongoing European Society of Cardiology (ESC) congress in Barcelona and published simultaneously in the Journal of American College of Cardiology (JACC). We studied the phenomenon – explains Rocco Antonio Montone – on 287 patients of both sexes with an average age of 62 years; 56% of them had chronic myocardial ischemia in the presence of “healthy” coronaries (the so-called INOCA), while 44% had even had a heart attack with healthy coronaries (MINOCA). Their exposure to polluted air was determined on the basis of their home address. All underwent coronary angiography, during which a provocative acetylcholine test was performed. The test was positive (ie acetylcholine caused a spasm of the coronary arteries) in 61% of patients; the positivity of the test was much more frequent among subjects exposed to polluted air, in particular if they are also smokers and dyslipidemics. This study demonstrates for the first time – continues Dr. Montone – an association between long-term exposure to polluted air and the appearance of coronary vasomotor disorders, thus suggesting a possible role of pollution on the appearance of healthy coronary heart attacks; in particular, fine particulate pollution (PM2.5) in our study was related to the spasm of the large coronary arteries. The spasms of the heart vessels – explains Massimiliano Camilli, PhD student at the Institute of Cardiology of the Catholic University of the Sacred Heart, Rome campus – could be due to the fact that long-term exposure to polluted air determines a state of chronic inflammation of the vessels, resulting in dysfunction of the endothelium (the lining layer of the inner wall of the vessels).
The relapses
In the light of the results of this work – concludes Professor Filippo Crea, Professor of Cardiovascular Diseases at the Catholic University of the Sacred Heart, Rome campus and director of the Cardiology Complex Operating Unit of the Agostino Gemelli IRCCS University Polyclinic Foundation – limit exposure to environmental pollution (possibly by reducing emissions) could reduce the residual risk of future cardiovascular events related to ischemic heart disease, both on an atherosclerotic basis and from coronary artery spasm. The use of air purifiers at home and the use of face masks when immersed in the traffic of large cities could therefore already be recommended for individuals at risk., waiting for studies to evaluate the real impact on risk reduction. And of course we reiterate the smoking ban and the need for strict control of risk factors for everyone, but even more so for those exposed to pollution, such as those who live in a big city.
What is the acetylcholine test
In patients with ischemic heart disease without evidence of coronary artery obstruction by atherosclerotic plaques, a provocative test with injection of acetylcholine can be performed during coronary angiography to de-detect the tendency to spasm. This test is essential for reaching a diagnosis of the mechanism responsible for the heart attack and therefore allows for targeted therapy to be undertaken.
What is fine (PM2.5) and coarse (PM10) particulate pollution
Airborne particulate matter is defined as all solid and liquid atmospheric particles suspended in ambient air. PM2.5 (fine particulate matter) refers to particles with an aerodynamic diameter of less than or equal to 2.5 μm which derive from all types of combustion (car engines, power generation plants, wood combustion for domestic heating, forest fires and various industrial processes). Particles with dimensions between 2.5 – 10 μm (including PM10) are called coarse and derive mainly from mechanical processes (grinding, erosion, friction phenomena in road transport such as wear of the brakes, tires and abrasion of the streets). PM10 may also have a natural origin (erosion of rocks, volcanic eruptions, forest fires).
August 29, 2022 (change August 29, 2022 | 14:28)
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