The “Six Cities Study,” as it is affectionately known by
epidemiologists, was published in 1993. This landmark
study laid the groundwork for an association between ambient
air particulate matter (ie, fine particulate matter [PM] or
PM2.5 [particulate matter of 2.5 m aerodynamic diameter or
less]) and the risk of all cause mortality in the United States.1
Simply put, the message of the study was: “Air pollution
kills.” Since then, a steady stream of studies has grown into
a river of reports that collectively have swelled the banks of
this initial association and have further specified that ischemic
heart disease (cardiovascular disease [CVD]) is the
single-most abundant cause of morbidity and mortality in this
association.2–4 Analysis of more than 100 studies (100
million people in 119 cities in the United States and Europe)
show that for each 10 g/m3 acute or chronic increase in
PM2.5, there is a significant increase in relative risk of
cardiovascular mortality (chronic relative risk, 1.06 to 1.76),
indicating that PM, even at ambient levels, has negative
health consequences.4 Moreover, chronic exposure to each 10
g/m3 PM2.5 increase is associated with a 4 to 6%increase in
CVD deaths, which translates to 800 000 deaths annually in
the world (according to the World Health Organization),
making PM exposure the 13th leading cause of CVD deaths4
and, thus, deserving of urgent scientific and social attention.
Currently, researchers in the field of environmental cardiology5
are addressing at least 1 of 2 major unanswered questions
regarding this association: (1) What constituent of inhaled PM2.5
is responsible for the association?; and (2) What is the mechanism
by which inhaled PM2.5 can specifically affect cardiovascular
disease risk?
In this issue of
The “Six Cities Study,” as it is affectionately known byepidemiologists, was published in 1993. This landmarkstudy laid the groundwork for an association between ambientair particulate matter (ie, fine particulate matter [PM] orPM2.5 [particulate matter of 2.5 m aerodynamic diameter orless]) and the risk of all cause mortality in the United States.1Simply put, the message of the study was: “Air pollutionkills.” Since then, a steady stream of studies has grown intoa river of reports that collectively have swelled the banks ofthis initial association and have further specified that ischemicheart disease (cardiovascular disease [CVD]) is thesingle-most abundant cause of morbidity and mortality in thisassociation.2–4 Analysis of more than 100 studies (100million people in 119 cities in the United States and Europe)show that for each 10 g/m3 acute or chronic increase inPM2.5, there is a significant increase in relative risk ofcardiovascular mortality (chronic relative risk, 1.06 to 1.76),indicating that PM, even at ambient levels, has negativehealth consequences.4 Moreover, chronic exposure to each 10g/m3 PM2.5 increase is associated with a 4 to 6%increase inCVD deaths, which translates to 800 000 deaths annually inthe world (according to the World Health Organization),making PM exposure the 13th leading cause of CVD deaths4and, thus, deserving of urgent scientific and social attention.Currently, researchers in the field of environmental cardiology5are addressing at least 1 of 2 major unanswered questionsregarding this association: (1) What constituent of inhaled PM2.5is responsible for the association?; and (2) What is the mechanismby which inhaled PM2.5 can specifically affect cardiovasculardisease risk?
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