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. 2007 Sep 10:6:26.
doi: 10.1186/1476-069X-6-26.

Effects of ambient air pollution on functional status in patients with chronic congestive heart failure: a repeated-measures study

Gregory A Wellenius  1 , Gloria Y Yeh, Brent A Coull, Helen H Suh, Russell S Phillips, Murray A Mittleman
Affiliations

Effects of ambient air pollution on functional status in patients with chronic congestive heart failure: a repeated-measures study

Gregory A Wellenius et al. Environ Health. .

Abstract

Background: Studies using administrative data report a positive association between ambient air pollution and the risk of hospitalization for congestive heart failure (HF). Circulating levels of B-type natriuretic peptide (BNP) are directly associated with cardiac hemodynamics and symptom severity in patients with HF and, therefore, serves as a marker of functional status. We tested the hypothesis that BNP levels would be positively associated with short-term changes in ambient pollution levels among 28 patients with chronic stable HF and impaired systolic function.

Methods: BNP was measured in whole blood at 0, 6, and 12 weeks. We used linear mixed models to evaluate the association between fine particulate matter (PM2.5), carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, and black carbon and log(BNP). Lags of 0 to 3 days were considered in separate models. We calculated the intraclass correlation coefficient and within-subject coefficient of variation as measures of reproducibility.

Results: We found no association between any pollutant and measures of BNP at any lag. For example, a 10 microg/m3 increase in PM2.5 was associated with a 0.8% (95% CI: -16.4, 21.5; p = 0.94) increase in BNP on the same day. The within-subject coefficient of variation was 45% on the natural scale and 9% on the log scale.

Conclusion: These results suggest that serial BNP measurements are unlikely to be useful in a longitudinal study of air pollution-related acute health effects. The magnitude of expected ambient air pollution health effects appears small in relation to the considerable within-person variability in BNP levels in this population.

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Figures

Figure 1
Figure 1
BNP concentrations over time in 28 subjects with chronic stable HF. Each line represents repeated measurements from a different subject.
Figure 2
Figure 2
Association between ambient air pollutants and BNP concentrations in 28 patients with chronic stable HF. Results are from single-pollutant mixed models and represent the increase in BNP levels associated with an interquartile range increase in each pollutant, shown in Table 2.
See this image and copyright information in PMC

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