Environmental Pollutants and Heart Failure
This chapter reviews the available studies linking pollution and heart failure. Heart failure is a common disorder that carries a high mortality. As such, it is of high significance from the standpoint of both cardiovascular health and health care costs. Epidemiological studies have demonstrated that both short-term and long-term exposure to air pollution can have adverse effects on disease exacerbations, progression and mortality in subjects with heart failure. Although several biological mechanisms have been put forth to explain these associations, the pathophysiological responses unique to individual particulate and gaseous constituents of urban air pollution remain incompletely defined. Aldehydes are important organic components of both particulate matter and the pollutant mix derived from other environmental sources. To define the effects of aldehyde exposure, we performed animal studies evaluating the cardiac effects of acrolein, a prototypical reactive α,β-unsaturated aldehyde classified by the Environmental Protection Agency as a high priority air and water toxic. These experiments indicated that acrolein, at concentrations observed clinically in human disease or within the range of estimated oral exposure, can induce myocardial dysfunction, augment the sensitivity of the heart to ischemic injury, and trigger pathological ventricular remodeling. Therefore, analogous exposure to acrolein and related aldehydes via inhalation may also contribute importantly to pollution-associated cardiovascular dysfunction and heart failure risk. The further recognition and identification of environmental factors that precipitate and/or exacerbate heart failure is of paramount importance for both individual and public health.