Air Pollution and Cardiovascular Disease: A Statement for Healthcare Professionals From the Expert Panel on Population and Prevention Science of the American Heart Association

Air pollution is a heterogeneous, complex mixture of gases, liquids, and particulate matter. Epidemiological studies have demonstrated a consistent increased risk for cardiovascular events in relation to both short- and long-term exposure to present-day concentrations of ambient particulate matter. Several plausible mechanistic pathways have been described, including enhanced coagulation/thrombosis, a propensity for arrhythmias, acute arterial vasoconstriction, systemic inflammatory responses, and the chronic promotion of atherosclerosis. The purpose of this statement is to provide healthcare professionals and regulatory agencies with a comprehensive review of the literature on air pollution and cardiovascular disease. In addition, the implications of these findings in relation to public health and regulatory policies are addressed. Practical recommendations for healthcare providers and their patients are outlined. In the final section, suggestions for future research are made to address a number of remaining scientific questions.

[1]  Francesca Dominici,et al.  Revised Analyses of the National Morbidity, Mortality, and Air Pollution Study: Mortality Among Residents Of 90 Cities , 2005, Journal of toxicology and environmental health. Part A.

[2]  François Mach,et al.  Inflammation and Atherosclerosis , 2004, Herz.

[3]  Stanton A Glantz,et al.  Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study , 2004, BMJ : British Medical Journal.

[4]  R. Burnett,et al.  Cardiovascular Mortality and Long-Term Exposure to Particulate Air Pollution: Epidemiological Evidence of General Pathophysiological Pathways of Disease , 2003, Circulation.

[5]  J. Townend,et al.  Why cardiologists should be interested in air pollution , 2003, Heart.

[6]  W. Goggins,et al.  Evidence for an Association Between Air Pollution and Daily Stroke Admissions in Kaohsiung, Taiwan , 2003, Stroke.

[7]  E. Boerwinkle,et al.  From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. , 2003, Circulation.

[8]  F. Kelly,et al.  Oxidative stress: its role in air pollution and adverse health effects , 2003, Occupational and environmental medicine.

[9]  J. Schwartz,et al.  The temporal pattern of respiratory and heart disease mortality in response to air pollution. , 2003, Environmental health perspectives.

[10]  F. Dominici,et al.  Airborne particulate matter and mortality: timescale effects in four US cities. , 2003, American journal of epidemiology.

[11]  Daniel Krewski,et al.  Rejoinder: Reanalysis of the Harvard Six Cities Study and American Cancer Society Study of Particulate Air Pollution and Mortality , 2003 .

[12]  F. Lipfert,et al.  Commentary on the HEI Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air Pollution and Mortality , 2003, Journal of toxicology and environmental health. Part A.

[13]  W. Cascio,et al.  Elderly humans exposed to concentrated air pollution particles have decreased heart rate variability , 2003, European Respiratory Journal.

[14]  L. Sheppard,et al.  Exposure to ambient fine particulate matter and primary cardiac arrest among persons with and without clinically recognized heart disease. , 2003, American journal of epidemiology.

[15]  Benoit Nemery,et al.  Diesel Exhaust Particles in Lung Acutely Enhance Experimental Peripheral Thrombosis , 2003, Circulation.

[16]  Amir Lerman,et al.  Endothelial Dysfunction: A Marker of Atherosclerotic Risk , 2003, Arteriosclerosis, thrombosis, and vascular biology.

[17]  W. Cascio,et al.  Exposure to Concentrated Ambient Air Particles Alters Hematologic Indices in Humans , 2003, Inhalation toxicology.

[18]  Günter Oberdörster,et al.  Ultrafine Particle Deposition in Humans During Rest and Exercise , 2003, Inhalation toxicology.

[19]  A. Nel,et al.  Ultrafine particulate pollutants induce oxidative stress and mitochondrial damage. , 2002, Environmental health perspectives.

[20]  Steffen Loft,et al.  Personal PM2.5 exposure and markers of oxidative stress in blood. , 2002, Environmental health perspectives.

[21]  B. Coull,et al.  Inhalation of concentrated ambient air particles exacerbates myocardial ischemia in conscious dogs. , 2002, Environmental health perspectives.

[22]  R. Brook,et al.  Air pollution: The "heart" of the problem , 2003, Current hypertension reports.

[23]  C. Monn,et al.  Reactions of macrophages exposed to particles <10 microm. , 2003, Environmental research.

[24]  Fred Lurmann,et al.  Air pollution and hospital admissions for ischemic heart disease in persons with congestive heart failure or arrhythmia. , 2002, Environmental health perspectives.

[25]  B. Coull,et al.  Concentrated ambient air particles induce vasoconstriction of small pulmonary arteries in rats. , 2002, Environmental health perspectives.

[26]  W. Burch,et al.  Passage of inhaled particles into the blood circulation in humans. , 2002, Circulation.

[27]  D. Dockery,et al.  Effect of air-pollution control on death rates in Dublin, Ireland: an intervention study , 2002, The Lancet.

[28]  Bert Brunekreef,et al.  Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study , 2002, The Lancet.

[29]  Robert Gelein,et al.  EXTRAPULMONARY TRANSLOCATION OF ULTRAFINE CARBON PARTICLES FOLLOWING WHOLE-BODY INHALATION EXPOSURE OF RATS , 2002, Journal of toxicology and environmental health. Part A.

[30]  Benoit Nemery,et al.  Ultrafine particles affect experimental thrombosis in an in vivo hamster model. , 2002, American journal of respiratory and critical care medicine.

[31]  Yun-Chul Hong,et al.  Air Pollution: A New Risk Factor in Ischemic Stroke Mortality , 2002, Stroke.

[32]  Bert Brunekreef,et al.  Particulate Air Pollution and Risk of ST-Segment Depression During Repeated Submaximal Exercise Tests Among Subjects With Coronary Heart Disease: The Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air (ULTRA) Study , 2002, Circulation.

[33]  Brent Coull,et al.  Rapid increases in the steady-state concentration of reactive oxygen species in the lungs and heart after particulate air pollution inhalation. , 2002, Environmental health perspectives.

[34]  James F Sallis,et al.  AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee. , 2002, Circulation.

[35]  Deepak L. Bhatt,et al.  Need to test the arterial inflammation hypothesis. , 2002, Circulation.

[36]  Frances Silverman,et al.  Inhalation of Fine Particulate Air Pollution and Ozone Causes Acute Arterial Vasoconstriction in Healthy Adults , 2002, Circulation.

[37]  B. Coull,et al.  Electrocardiographic changes during exposure to residual oil fly ash (ROFA) particles in a rat model of myocardial infarction. , 2002, Toxicological sciences : an official journal of the Society of Toxicology.

[38]  J. Hogg,et al.  Particulate air pollution induces progression of atherosclerosis. , 2002, Journal of the American College of Cardiology.

[39]  R. Burnett,et al.  Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. , 2002, JAMA.

[40]  UNDERSTANDING THE HEALTH EFFECTS OF COMPONENTS OF THE PARTICULATE MATTER MIX : PROGRESS AND NEXT STEPS , 2002 .

[41]  Peter E. Hilsenrath,et al.  The World Health Report 2000 , 2002 .

[42]  B. Coull,et al.  Composition of Inhaled Urban Air Particles Determines Acute Pulmonary Responses , 2002 .

[43]  G. Shaw,et al.  Ambient air pollution and risk of birth defects in Southern California. , 2002, American journal of epidemiology.

[44]  M. Longnecker,et al.  Environmental contaminants as etiologic factors for diabetes. , 2001, Environmental health perspectives.

[45]  A. Siegbahn,et al.  Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease: effects of an early invasive or noninvasive strategy. , 2001, JAMA.

[46]  M F Hoylaerts,et al.  Passage of intratracheally instilled ultrafine particles from the lung into the systemic circulation in hamster. , 2001, American journal of respiratory and critical care medicine.

[47]  V. Fuster,et al.  AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. , 2001, Circulation.

[48]  V. Fuster,et al.  AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease: 2001 update. A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. , 2001, Journal of the American College of Cardiology.

[49]  W. Pryor,et al.  Role of free radicals in the toxicity of airborne fine particulate matter. , 2001, Chemical research in toxicology.

[50]  J. Hogg,et al.  Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)). , 2001, American journal of respiratory and critical care medicine.

[51]  J Schwartz,et al.  Are diabetics more susceptible to the health effects of airborne particles? , 2001, American journal of respiratory and critical care medicine.

[52]  J Schwartz,et al.  Confounding and Effect Modification in the Short-Term Effects of Ambient Particles on Total Mortality: Results from 29 European Cities within the APHEA2 Project , 2001, Epidemiology.

[53]  L. Arab,et al.  Effect of antioxidant supplementation on ozone-induced lung injury in human subjects. , 2001, American journal of respiratory and critical care medicine.

[54]  R. Levins,et al.  The precautionary principle in environmental science. , 2001, Environmental health perspectives.

[55]  Thomas J. Smith,et al.  Association of Heart Rate Variability With Occupational and Environmental Exposure to Particulate Air Pollution , 2001, Circulation.

[56]  R. Devlin,et al.  Inflammatory lung injury after bronchial instillation of air pollution particles. , 2001, American journal of respiratory and critical care medicine.

[57]  R. D. Morris,et al.  Airborne particulates and hospital admissions for cardiovascular disease: a quantitative review of the evidence. , 2001, Environmental health perspectives.

[58]  A. Hartman,et al.  State-Specific Trends in Smoke-Free Workplace Policy Coverage: The Current Population Survey Tobacco Use Supplement, 1993 to 1999 , 2001, Journal of occupational and environmental medicine.

[59]  A Seaton,et al.  Ambient particle inhalation and the cardiovascular system: potential mechanisms. , 2001, Environmental health perspectives.

[60]  J C Bailar,et al.  Identification of persons with cardiorespiratory conditions who are at risk of dying from the acute effects of ambient air particles. , 2001, Environmental health perspectives.

[61]  M. Yoshiyama,et al.  Acute effects of passive smoking on the coronary circulation in healthy young adults. , 2001, JAMA.

[62]  A. Peters,et al.  Particulate air pollution is associated with an acute phase response in men; results from the MONICA-Augsburg Study. , 2001, European heart journal.

[63]  Gary R. Krieger,et al.  Clinical Environmental Health and Toxic Exposures , 2001 .

[64]  D. Dockery,et al.  Increased Particulate Air Pollution and the Triggering of Myocardial Infarction , 2001, Circulation.

[65]  J C Bailar,et al.  The association between daily mortality and ambient air particle pollution in Montreal, Quebec. 2. Cause-specific mortality. , 2001, Environmental research.

[66]  B. Brunekreef,et al.  The Association between Air Pollution and Heart Failure, Arrhythmia, Embolism, Thrombosis, and Other Cardiovascular Causes of Death in a Time Series Study , 2001, Epidemiology.

[67]  J. Sarnat,et al.  Fine particulate air pollution and mortality in 20 U.S. cities. , 2001, The New England journal of medicine.

[68]  P. Ridker,et al.  High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. , 2001, Circulation.

[69]  A. Peters,et al.  Effects of air pollution on blood pressure: a population-based approach. , 2001, American journal of public health.

[70]  B. Nemery,et al.  The Meuse Valley fog of 1930: an air pollution disaster , 2001, The Lancet.

[71]  C. Hogstedt,et al.  A Population-Based Case-Referent Study of Myocardial Infarction and Occupational Exposure to Motor Exhaust, Other Combustion Products, Organic Solvents, Lead, and Dynamite , 2001 .

[72]  H Checkoway,et al.  A Case-Crossover Analysis of Particulate Matter Air Pollution and Out-of-Hospital Primary Cardiac Arrest , 2001, Epidemiology.

[73]  D. Liao,et al.  Particulate matter and heart rate variability among elderly retirees: the Baltimore 1998 PM study , 2001, Journal of Exposure Analysis and Environmental Epidemiology.

[74]  K. Eriksson,et al.  Influence of Plasma Fibrinogen Levels on the Incidence of Myocardial Infarction and Death Is Modified by Other Inflammation-Sensitive Proteins: A Long-Term Cohort Study , 2001, Arteriosclerosis, thrombosis, and vascular biology.

[75]  L. Ferrucci,et al.  Cardiovascular Disease, Interleukin-6, and Risk of Mortality in Older Women: The Women’s Health and Aging Study , 2001, Circulation.

[76]  S. Becker,et al.  Human alveolar macrophage responses to air pollution particulates are associated with insoluble components of coarse material, including particulate endotoxin. , 2001, Toxicology and applied pharmacology.

[77]  J. Hogg,et al.  The effect of repeated exposure to particulate air pollution (PM10) on the bone marrow. , 2001, American journal of respiratory and critical care medicine.

[78]  F. Dominici,et al.  Fine particulate air pollution and mortality in 20 U.S. cities, 1987-1994. , 2000, The New England journal of medicine.

[79]  S. Simon,et al.  Vanilloid (capsaicin) receptors influence inflammatory sensitivity in response to particulate matter. , 2000, Toxicology and applied pharmacology.

[80]  J Schwartz,et al.  Airborne particles are a risk factor for hospital admissions for heart and lung disease. , 2000, Environmental health perspectives.

[81]  K. Woo,et al.  The impact of heavy passive smoking on arterial endothelial function in modernized Chinese. , 2000, Journal of the American College of Cardiology.

[82]  David M. Brown,et al.  Increased inflammation and intracellular calcium caused by ultrafine carbon black is independent of transition metals or other soluble components , 2000, Occupational and environmental medicine.

[83]  N Künzli,et al.  Public-health impact of outdoor and traffic-related air pollution: a European assessment , 2000, The Lancet.

[84]  R. Devlin,et al.  Concentrated ambient air particles induce mild pulmonary inflammation in healthy human volunteers. , 2000, American journal of respiratory and critical care medicine.

[85]  S. Fichtlscherer,et al.  Elevated C-Reactive Protein Levels and Impaired Endothelial Vasoreactivity in Patients With Coronary Artery Disease , 2000, Circulation.

[86]  C. Ill Epidemiology of Fine Particulate Air Pollution and Human Health: Biologic Mechanisms and Who's at Risk? , 2000 .

[87]  C. A. Pope,et al.  Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk? , 2000 .

[88]  C. Pope,et al.  Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk? , 2000, Environmental health perspectives.

[89]  P. Vacek,et al.  Inhaled particulate matter causes expression of nuclear factor (NF)-kappaB-related genes and oxidant-dependent NF-kappaB activation in vitro. , 2000, American journal of respiratory cell and molecular biology.

[90]  P. Cullinan,et al.  Airway inflammation after controlled exposure to diesel exhaust particulates. , 2000, American journal of respiratory and critical care medicine.

[91]  J Schwartz,et al.  The distributed lag between air pollution and daily deaths. , 2000, Epidemiology.

[92]  K. Berhane,et al.  Air pollution and daily hospital admissions in metropolitan Los Angeles. , 2000, Environmental health perspectives.

[93]  P. Ridker,et al.  Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. , 2000, Circulation.

[94]  J. Hogg,et al.  The human bone marrow response to acute air pollution caused by forest fires. , 2000, American journal of respiratory and critical care medicine.

[95]  J Schwartz,et al.  Ambient pollution and heart rate variability. , 2000, Circulation.

[96]  L. Martin,et al.  Residual oil fly ash induces cytotoxicity and mucin secretion by guinea pig tracheal epithelial cells via an oxidant-mediated mechanism. , 2000, Toxicology and applied pharmacology.

[97]  J. Schwartz,et al.  Harvesting and long term exposure effects in the relation between air pollution and mortality. , 2000, American journal of epidemiology.

[98]  J M Wolfson,et al.  Mechanisms of morbidity and mortality from exposure to ambient air particles. , 2000, Research report.

[99]  S T Holgate,et al.  Acute exposure to diesel exhaust increases IL-8 and GRO-alpha production in healthy human airways. , 2000, American journal of respiratory and critical care medicine.

[100]  A. Peters,et al.  Activation of the Autonomic Nervous System and Blood Coagulation in Association with an Air Pollution Episode , 2000, Inhalation toxicology.

[101]  V. Castranova From Coal Mine Dust To Quartz: Mechanisms of Pulmonary Pathogenicity , 2000, Inhalation toxicology.

[102]  D. Costa,et al.  Cardiac and Thermoregulatory Toxicity of Residual Oil Fly Ash in Cardiopulmonary-Compromised Rats , 2000, Inhalation toxicology.

[103]  J Schwartz,et al.  Air pollution and incidence of cardiac arrhythmia. , 2000, Epidemiology.

[104]  State-specific prevalence of current cigarette smoking among adults and the proportion of adults who work in a smoke-free environment--United States, 1999. , 2000, MMWR. Morbidity and mortality weekly report.

[105]  G. Howard,et al.  Environmental tobacco smoke and measures of subclinical vascular disease. , 1999, Environmental health perspectives.

[106]  M. Thun,et al.  Why is environmental tobacco smoke more strongly associated with coronary heart disease than expected? A review of potential biases and experimental data. , 1999, Environmental health perspectives.

[107]  G. Colditz,et al.  Workplace exposure to passive smoking and risk of cardiovascular disease: summary of epidemiologic studies. , 1999, Environmental health perspectives.

[108]  M. Thun,et al.  Epidemiologic studies of fatal and nonfatal cardiovascular disease and ETS exposure from spousal smoking. , 1999, Environmental health perspectives.

[109]  R. Elton,et al.  Particulate air pollution and the blood , 1999, Thorax.

[110]  J. Schwartz,et al.  Heart rate variability associated with particulate air pollution. , 1999, American heart journal.

[111]  T. Wong,et al.  Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. , 1999, Occupational and environmental medicine.

[112]  S. Becker,et al.  Exposure to urban air particulates alters the macrophage-mediated inflammatory response to respiratory viral infection. , 1999, Journal of toxicology and environmental health. Part A.

[113]  Ronald W. Williams,et al.  Daily variation of particulate air pollution and poor cardiac autonomic control in the elderly. , 1999, Environmental health perspectives.

[114]  T. Truelsen,et al.  Passive smoking as well as active smoking increases the risk of acute stroke , 1999, Tobacco control.

[115]  W. Pryor,et al.  Ozone exposure increases aldehydes in epithelial lining fluid in human lung. , 1999, American journal of respiratory and critical care medicine.

[116]  J. McNeil,et al.  Ischemic stroke risk and passive exposure to spouses' cigarette smoking. Melbourne Stroke Risk Factor Study (MERFS) Group. , 1999, American journal of public health.

[117]  P. Whelton,et al.  Passive smoking and the risk of coronary heart disease--a meta-analysis of epidemiologic studies. , 1999, The New England journal of medicine.

[118]  C. Monn,et al.  Cytotoxicity and induction of proinflammatory cytokines from human monocytes exposed to fine (PM2.5) and coarse particles (PM10-2.5) in outdoor and indoor air. , 1999, Toxicology and applied pharmacology.

[119]  R. Burnett,et al.  Effects of particulate and gaseous air pollution on cardiorespiratory hospitalizations. , 1999, Archives of environmental health.

[120]  S T Holgate,et al.  Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers. , 1999, American journal of respiratory and critical care medicine.

[121]  J Schwartz,et al.  Air pollution and hospital admissions for heart disease in eight U.S. counties. , 1998, Epidemiology.

[122]  Roy M. Harrison,et al.  Measurements of Concentrations of Air Pollutants , 1999 .

[123]  H. Gong,et al.  Day-to-day particulate exposures and health changes in Los Angeles area residents with severe lung disease. , 1999, Journal of the Air & Waste Management Association.

[124]  R. Neutra Epidemiology vs physiology? Drinking water magnesium and cardiac mortality. , 1999, Epidemiology.

[125]  J. Pearl,et al.  Causal diagrams for epidemiologic research. , 1999, Epidemiology.

[126]  I. Adamson,et al.  Acute effects of inhaled urban particles and ozone: lung morphology, macrophage activity, and plasma endothelin-1. , 1998, The American journal of pathology.

[127]  T. Tomita,et al.  Mechanism of pathophysiological effects of diesel exhaust particles on endothelial cells. , 1998, Environmental toxicology and pharmacology.

[128]  J. Carter,et al.  Copper-dependent inflammation and nuclear factor-kappaB activation by particulate air pollution. , 1998, American journal of respiratory cell and molecular biology.

[129]  G. Assmann,et al.  Relationship between plasma viscosity and the severity of coronary heart disease. , 1998, Arteriosclerosis, thrombosis, and vascular biology.

[130]  R. Burnett,et al.  The effect of the urban ambient air pollution mix on daily mortality rates in 11 Canadian cities. , 1998, Canadian journal of public health = Revue canadienne de sante publique.

[131]  M. Kraut,et al.  Cigarette smoking and other risk factors for silent cerebral infarction in the general population. , 1998, Stroke.

[132]  R. Favaloro,et al.  Critical analysis of coronary artery bypass graft surgery: a 30-year journey. , 1998, Journal of the American College of Cardiology.

[133]  D. Dockery,et al.  Pulmonary toxicity in hamsters of smoke particles from Kuwaiti oil fires. , 1998, Environmental health perspectives.

[134]  V. Smrčka,et al.  Environmental pollution and the occurrence of congenital defects in a 15-year period in a south Moravian district. , 1998, Acta chirurgiae plasticae.

[135]  A. J. Wells Heart disease from passive smoking in the workplace. , 1998, Journal of the American College of Cardiology.

[136]  H. Folgering,et al.  Endotoxin exposure as a major determinant of lung function decline in pig farmers. , 1998, American journal of respiratory and critical care medicine.

[137]  J. Seinfeld,et al.  Atmospheric Chemistry and Physics: From Air Pollution to Climate Change , 1998 .

[138]  A. Siegbahn,et al.  Prognostic influence of increased fibrinogen and C-reactive protein levels in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. , 1997, Circulation.

[139]  R. Sergysels,et al.  Dose-response relationship to inhaled endotoxin in normal subjects. , 1997, American journal of respiratory and critical care medicine.

[140]  T. Pechacek,et al.  Workplace smoking policies in the United States: results from a national survey of more than 100,000 workers. , 1997, Tobacco control.

[141]  W. MacNee,et al.  Free radical activity of PM10: iron-mediated generation of hydroxyl radicals. , 1997, Environmental health perspectives.

[142]  D. Costa,et al.  Bioavailable transition metals in particulate matter mediate cardiopulmonary injury in healthy and compromised animal models. , 1997, Environmental health perspectives.

[143]  J Pekkanen,et al.  Air pollution and respiratory health among children with asthmatic or cough symptoms. , 1997, American journal of respiratory and critical care medicine.

[144]  H. R. Anderson,et al.  Daily time series for cardiovascular hospital admissions and previous day's air pollution in London, UK. , 1997, Occupational and environmental medicine.

[145]  A. Peters,et al.  Increased plasma viscosity during an air pollution episode: a link to mortality? , 1997, The Lancet.

[146]  R. Burnett,et al.  Effects of air pollution on emergency room visits for respiratory illnesses in Montreal, Quebec. , 1997, American journal of respiratory and critical care medicine.

[147]  P. Lee Health effects of exposure to environmental tobacco smoke. California Environmental Protection Agency. , 1997, Tobacco control.

[148]  P. S. Gilmour,et al.  Free radical activity and pro-inflammatory effects of particulate air pollution (PM10) in vivo and in vitro. , 1996, Thorax.

[149]  K. Flegal,et al.  Exposure of the US population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988 to 1991. , 1996, JAMA.

[150]  J. Höjer,et al.  Nitrogen dioxide pneumonitis in ice hockey players , 1996, Journal of internal medicine.

[151]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[152]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[153]  J. Deanfield,et al.  Passive smoking and impaired endothelium-dependent arterial dilatation in healthy young adults. , 1996, The New England journal of medicine.

[154]  Oms. Regional Office for Europe Air quality guidelines for Europe , 1996, Environmental science and pollution research international.

[155]  U. Epa Air Quality Criteria for Particulate Matter , 1996 .

[156]  M. Green Air pollution and health , 1995 .

[157]  S. Glantz,et al.  Passive smoking and heart disease. Mechanisms and risk. , 1995 .

[158]  D. Dockery,et al.  Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. , 1995, American journal of respiratory and critical care medicine.

[159]  W. MacNee,et al.  Particulate air pollution and acute health effects , 1995, The Lancet.

[160]  J D Spengler,et al.  Acute effects of summer air pollution on respiratory symptom reporting in children. , 1994, American journal of respiratory and critical care medicine.

[161]  Inhalation of Steady‐State Sidestream Smoke From One Cigarette Promotes Arteriosclerotic Plaque Development , 1994, Circulation.

[162]  A. J. Wells Passive smoking as a cause of heart disease. , 1994, Journal of the American College of Cardiology.

[163]  S. Glantz,et al.  Exposure to environmental tobacco smoke increases myocardial infarct size in rats. , 1994, Circulation.

[164]  J. Spengler,et al.  Personal exposure to nitrogen dioxide in the Los Angeles Basin. , 1994, Air & waste : journal of the Air & Waste Management Association.

[165]  D. Dockery,et al.  An association between air pollution and mortality in six U.S. cities. , 1993, The New England journal of medicine.

[166]  J. Balmes,et al.  Ozone-induced airway inflammation in human subjects as determined by airway lavage and biopsy. , 1993, The American review of respiratory disease.

[167]  A. Penn,et al.  Inhalation of Sidestream Cigarette Smoke Accelerates Development of Arteriosclerotic Plaques , 1993, Circulation.

[168]  W. Pierson,et al.  Particulate air pollution and hospital emergency room visits for asthma in Seattle. , 1993, The American review of respiratory disease.

[169]  I. Norska-Borówka,et al.  Infant morbidity and mortality in a region of ecological disaster. , 1993, Folia medica Cracoviensia.

[170]  E. Antipenko,et al.  [The results of an epidemiological study of congenital developmental defects in children in cities with different levels of atmospheric pollution]. , 1993, Vestnik Rossiiskoi akademii meditsinskikh nauk.

[171]  C. Pope,et al.  Daily mortality and PM10 pollution in Utah Valley. , 1992, Archives of environmental health.

[172]  N B Hampson,et al.  Carbon monoxide poisoning in children riding in the back of pickup trucks. , 1992, JAMA.

[173]  R. Waller,et al.  Invited Commentary: Participate Air Pollution and Daily Mortality , 1992 .

[174]  Nitrogen dioxide and carbon monoxide intoxication in an indoor ice arena--Wisconsin, 1992. , 1992, MMWR. Morbidity and mortality weekly report.

[175]  D. Dockery,et al.  Particulate air pollution and daily mortality in Steubenville, Ohio. , 1992, American journal of epidemiology.

[176]  J. Schwartz,et al.  Particulate air pollution and daily mortality in Detroit. , 1991, Environmental research.

[177]  Sam Smoking-attributable mortality and years of potential life lost--United States, 1988. , 1991, MMWR. Morbidity and mortality weekly report.

[178]  P. Lioy,et al.  Tropospheric Ozone: The Dynamics of Human Exposure , 1989, Toxicology and industrial health.

[179]  J. Samet,et al.  Indoor residential NO2 concentrations in Albuquerque, New Mexico. , 1988, JAPCA.

[180]  J. Lodge Air quality guidelines for Europe: WHO regional publications, European series, No. 23, World Health Organization, 1211 Geneva 27, Switzerland; WHO publications center USA, 49 Sheridan Avenue, Albany, NY 12210, 1987, xiii + 426 pp. price: Sw. fr. 60 , 1988 .

[181]  G. Thurston,et al.  Associations between 1980 U.S. mortality rates and alternative measures of airborne particle concentration. , 1987, Risk analysis : an official publication of the Society for Risk Analysis.

[182]  D V Bates,et al.  Air pollution and hospital admissions in Southern Ontario: the acid summer haze effect. , 1987, Environmental research.

[183]  T. Higenbottam,et al.  Nitric oxide yields of contemporary UK, US and French cigarettes. , 1987, International journal of epidemiology.

[184]  Education . Office on Smoking,et al.  The health consequences of involuntary smoking : a report of the Surgeon General , 1986 .

[185]  V. Rose,et al.  A possible increase in the incidence of congenital heart defects among the offspring of affected parents. , 1985, Journal of the American College of Cardiology.

[186]  M Hagberg,et al.  Irritative complaints, carboxyhemoglobin increase and minor ventilatory function changes due to exposure to chain-saw exhaust. , 1985, European journal of respiratory diseases.

[187]  D V Bates,et al.  Relationship between air pollutant levels and hospital admissions in Southern Ontario. , 1983, Canadian journal of public health = Revue canadienne de sante publique.

[188]  B. Leaderer Air Pollutant Emissions from Kerosene Space Heaters , 1982, Science.

[189]  Robert H. Anderson,et al.  Pathology of Congenital Heart Disease , 1981 .

[190]  D. Dockery,et al.  Long-term measurements of respirable sulfates and particles inside and outside homes , 1981 .

[191]  Grinding Facility,et al.  Office Of Air Quality Planning And Standards , 1976 .

[192]  A. Nadas Cardiovascular Diseases: Guidelines for Prevention and Care , 1974 .

[193]  I. Wright,et al.  Cardiovascular diseases: guidelines for prevention and care , 1973 .

[194]  J. Nora Etiologic factors in congenital heart diseases. , 1971, Pediatric clinics of North America.

[195]  E. Alberman,et al.  Possible Teratogenic Effect of Cigarette Smoking , 1971, Nature.

[196]  F. Adams,et al.  Primary prevention of congenital heart disease. , 1970, The Journal of the American Osteopathic Association.

[197]  CARBON MONOXIDECO,et al.  Carbon monoxide. , 2020, JAMA.

[198]  I. Higgins The epidemiology of congenital heart disease. , 1965, Journal of chronic diseases.

[199]  M. Lev,et al.  Pathology of Congenital Heart Disease , 1982 .

[200]  W P D LOGAN,et al.  Mortality in the London fog incident, 1952. , 1953, Lancet.