Joel Kaufman: “Air Pollution and Cardiovascular Disease: Research and Implications”

Joel Kaufman: “Air Pollution and Cardiovascular Disease: Research and Implications”

(Joel Kaufman) The work in our group is
focused on air pollution and cardiovascular disease. The observation that high levels of air
pollution can actually kill people was most dramatically illustrated in the be
in the middle of the 20th century with the London Fog episode where an episode
of very high levels of air pollution led to an estimated 12,000 excess deaths
over the course of a few weeks due to a bad combination of coal burning in lots
of homes and a meteorological episode Since that time air pollution
concentrations have come down we know a lot more about how to control them
there’s still quite high internationally while they’ve been improved dramatically
in the United States and it’s been demonstrated that reduction of
air pollution concentrations is associated with both decreases in
mortality that is as the pollution levels came down mortality and
with increase in life expectancy and impressively in a report done by a US
Office of Management and Budget it was shown that the regulatory impact of the
Clean Air Act with a dramatic impact of reduced PM on mortality actually the
largest estimated impact of all regulations promulgated by the federal
government in terms of increased benefit was the the benefit of reductions in
fine particulate matter air pollution on overall mortality. So studies on this
issue of mortality and air pollution have been of increased interest and the
finding that actually most of the excess mortality is in the cardiovascular
system rather than the respiratory system has been the focus of our
research group. Our findings in the Women’s Health Initiative observational
study a major cohort study is that in postmenopausal women living in areas
with higher PM. exposures was associated with a nearly 25% increased
risk of a verified heart attack or stroke and our work with this group has
substantial improvements over research that had been done by other groups both
in the way we assess exposure and in the way
outcome was estimate was ascertained by the WHI investigators so based on this
it’s been recognized that there are several lines of research that are
needed to figure out the most efficient way to target this problem to prefer
Public Health efforts to prevent excess morbidity and mortality in air pollution
and cardiovascular disease and we have several initiatives underway that are
focused on this this issue the largest of which is our work in the multi-ethnic
study of atherosclerosis and air pollution or Mesa air. This represents an
unprecedented combination of environmental exposure assessment on a
very large NIH cohort epidemiology study. The EPA recognized the importance of
this project and actually provided us with their largest single research grant
ever a total of 33 million dollars over ten years to study several thousand
people in six states and provide an individual level of exposure estimate of
air pollutants and to determine if exposure to air pollutants was
associated with an acceleration of atherosclerosis or hardening of the
arteries and incidents of cardiovascular disease events in this population of
between six and seven thousand people. We’ve now completed an ambitious
probably never to be repeated effort to characterize exposures and which has
included monitoring campaigns in the communities where these participants
live across the United States and are marrying this information to a
remarkable suite of health measurements which includes CT scans of the heart
ultrasounds of the carotid arteries and so forth in more than 3,500 people and
using some novel outcomes that have been assessed through NIH funding of this
project we’ve been able to see things like the
fact that living near a major roadway is associated with increase in cardiac left
ventricular mass the actual weight of the heart a precursor of heart failure
and we’ve been able to see that those with higher PM 2.5 concentrations
actually have reduced caliber of the tiny blood vessels in the
retina. Impacting the small vessels around the body. At the same time we’ve
had an NIH specialized Center for research called the discover Center
which is focused on traffic related air pollution and cardiovascular disease we
have five projects with investigators from a broad range of disciplines
throughout the University Medical School School of Public Health, School of
Engineering, where we’re studying everything from basic mile molecular
biological impacts in animal models to clinical studies to population-based
studies of gene environment interactions in a project in our laboratory people
who are exposed to freshly generated diesel exhaust diluted to represent
real-world ambient concentrations we’ve been able to demonstrate experimentally
narrower blood vessels and increase in blood pressure with exposure compared to
filtered air exposures. A major focus of our work is being able
to translate basic science research and epidemiological research into public
health practice. Into actual steps that can improve regulations improve public
health practice and improve advice to patients. A lot of our work has been
focused on understanding what we call biological plausibility which is how
could these exposures actually cause meaningful health effects in people.
We’ve also been working in trying to understand what part of air pollution it
is that might be responsible for the effects and by doing that we believe
that we can we can have more targeted pollution control efforts and that these
will be particularly effective in the developing world as they try to focus
limited resources on reducing air pollution and having the most improved
public health in those communities. We’ve been working with a large number of
collaborators across the university and across the country on this work we’re
finding it a very exciting and we’re happy to talk to you more about it today
and answer any questions you might have.

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