10-year MESA Air study finds air pollution accelerates plaque build-up in arteries to heart

Long-term exposure to air pollution has been linked to an increased risk of heart disease, but the biological process has not been understood. A major, decade-long study of thousands of Americans found that people living in areas with more outdoor pollution —even at lower levels common in the United States — accumulate deposits in the arteries that supply the heart faster than do people living in less polluted areas. The study was published May 24 online in The Lancet.
photoJoel Kaufman
Previous epidemiologic studies have shown associations between particle pollution, referred to as particulate matter, and cardiovascular disease. It has been unclear, however, how exposure to particulate matter leads to disease of the cardiovascular system. The earlier studies had been shorter and had depended for their analysis on existing datasets collected for other purposes.
Now, direct evidence from the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air), a 10-year epidemiological study of more than 6,000 people from six U.S. states, shows that air pollution — even at levels below regulatory standards — accelerates the progression of atherosclerosis. The condition, also called hardening of the arteries, can cause heart attacks. Researchers repeatedly measured calcium deposits in the heart’s arteries by using CT scans. They also assessed each person’s exposure to pollution based on home address.
“The study provides important new information on how pollution affects the main biological process that leads to heart disease,” said Dr. Joel Kaufman, who directs MESA Air and is the lead author of the published paper. He is a University of Washington professor of environmental and occupational health sciences, and also a UW professor of epidemiology, and of medicine.
Air pollution monitors were deployed in more than 1500 locations within the six different metro areas. In addition to air pollution data from state and local air agencies, these MESA Air monitors collected and measured variable levels of PM2.5, oxides of nitrogen, and black carbon, among other pollutants over two-week periods between 2005-2009.Air pollution monitors were deployed in more than 1500 locations within the six different metro areas. In addition to air pollution data from state and local air agencies, these MESA Air monitors collected and measured variable levels of PM2.5, oxides of nitrogen, and black carbon, among other pollutants over two-week periods between 2005-2009.
“The evidence supports worldwide efforts to reduce exposures to ambient air pollutants,” Kaufman said.
He added, “This was the most in-depth study of air pollution exposures ever applied to a large study group specifically designed to examine influences on cardiovascular health.”
The researchers calculated each participant’s exposure to ambient fine particulate matter that is less than 2.5 microns in diameter and too small to be seen by the naked eye. In addition to PM2.5, they also measured exposure to nitrogen oxide and nitrogen dioxide, and black carbon or soot.
The research team collected thousands of air pollution measurements in the study participants’ communities and at their homes. The research team developed and applied computational models that included local information on land use, roadway and traffic volumes, weather conditions, and local sources of air pollution. These models could generate accurate pollution concentrations at each person’s home. Meanwhile, between the years 2000 and 2012, participants visited study clinics several times to undergo CT scanning to determine the amount of calcium deposits in their heart arteries.
Results were strongest for fine particulate matter and the traffic-related pollutant gases called oxides of nitrogen. The study found that for every 5 µg/m3 higher concentration of PM2.5, or 35 parts per billion higher concentration of oxides of nitrogen — about the difference between more and less polluted areas of a U.S. metropolitan area — individuals had a 4 Agatston units/year faster rate of progression of coronary artery calcium scores. This is about a 20 percent acceleration in the rate of these calcium deposits.
“The effects were seen even in the United States where efforts to reduce exposure have been notably successful compared with many other parts of the world,” Kaufman said. Exposures were low when compared to U.S. ambient air quality standards, which permit an annual average PM2.5concentration of 12 µg/m3. The participants in this MESA-Air study experienced concentrations between 9.2 and 22.6 µg/m3.
The two histograms for PM2.5 and NOx show the range of average, modeled pollution concentrations from 2000-2012 at study participants’ homes in the six metro areas. Exposures were low when compared to U.S. ambient air quality standards, which permit an annual average PM2.5 concentration of 12 µg/m3. The participants in this MESA-Air study experienced concentrations between 9.2 and 22.6 µg/m3.The two histograms for PM2.5 and NOx show the range of average, modeled pollution concentrations from 2000-2012 at study participants’ homes in the six metro areas. Exposures were low when compared to U.S. ambient air quality standards, which permit an annual average PM2.5 concentration of 12 µg/m3. The participants in this MESA-Air study experienced concentrations between 9.2 and 22.6 µg/m3.
In an accompanying editorial in The Lancet, Dr. Bert Brunekreef, a professor at Utrecht University in The Netherlands, and Dr. Barbara Hoffmann, a professor of the University of Düsseldorf in Germany, described the study as “exemplary.” Noting that the results are sobering, they called for decisive action in controlling pollution levels worldwide.
The MESA Air study was funded in 2004 by the U.S. Environmental Protection Agency. The project involved researchers at a number of institutions, and characterized air pollutant exposures experienced by people in the National Heart, Lung, and Blood Institute’s Multi-Ethnic Study of Atherosclerosis (MESA). The participants lived in six major cities across the United States. The clinics were in Baltimore, Chicago, Los Angeles, New York City, St. Paul and Winston-Salem. Of the people in the study, 39 percent were white, 27 percent black, 22 percent Hispanic, and 12 percent Chinese. Other funding for this study came from the National Heart, Lung, and Blood Institute and the National Institute of Environmental Health Sciences.
Authors, in addition to Kaufman, were Sara Adar, R. Graham Barr, Matthew Budoff, Gregory Burke, Cynthia Curl, Martha Daviglus, Ana Diez Roux, Amanda Gassett, David Jacobs, Jr.; Richard Kronmal, Timothy Larson, Ana Navas-Acien, Casey Olives, Paul Sampson, Lianne Sheppard, David Siscovick, James Stein, Adam Szpiro, and Karol Watson. The authors come from institutions that include the University of Washington, Columbia University, University of California, Los Angeles; Wake Forest University, Northwestern University, Johns Hopkins University, University of Michigan, University of Vermont, University of Minnesota, and University of Wisconsin, among others.
-- Elizabeth Sharpe
A map of L.A., California, shows a great deal of variation exists within the city for residential exposures to PM2.5. MESA Air researchers integrated multiple data sources into a computational model to calculate individual residential exposure to pollutants. These sources included: land use, roadway and traffic volumes, weather conditions, local and state agency air pollution measurements, and MESA-Air-deployed monitors.A map of L.A., California, shows a great deal of variation exists within the city for residential exposures to PM2.5. MESA Air researchers integrated multiple data sources into a computational model to calculate individual residential exposure to pollutants. These sources included: land use, roadway and traffic volumes, weather conditions, local and state agency air pollution measurements, and MESA-Air-deployed monitors.

EDGE Center researchers awarded NIH grant to study environmental influences on child health and development

EDGE Center researchers Catherine Karr and Sheela Sathyanarayana are co-PIs for a $4.7 million award by the National Institutes of Health (NIH). The award to the University of Washington School of Public Health (SPH) is part of a seven-year initiative called Environmental influences on Child Health Outcomes (ECHO) that will investigate how the environment influences neurodevelopment and asthma risk in children.

Dr. Catherine Karr
The NIH ECHO program encompasses $157 million in funding for FY2016-17 for a multitude of projects that will investigate how exposure to a range of environmental factors from conception through early childhood influences the health of children and adolescents. The studies will target four key pediatric outcomes with a high public health impact: airway health, obesity, neuro-development and birth outcomes.

According to NIH Director Francis S. Collins, “These projects will expand the toolbox available to researchers to improve our ability to characterize environmental exposures, understand how environmental exposures affect in utero development and function, and bolster the infrastructure for exposure research.”

 “Our UW-based PATHWAYS study is a microcosm of the national ECHO program, which capitalizes on collaboration among top scientists and existing research populations,” said Dr. Karr, professor of pediatrics and environmental and occupational health at the UW who will co-lead the investigative team with Sathyanarayana and co-PIs Kaja LeWinn and Nicole Bush from the University of California San Francisco (UCSF) and Francis Tylavsky from the University of Tennessee Health Science Center, Memphis (UTHSC). 

Dr. Sheela Sathyanarayana
The UW grant money will allow the SPH’s Department of Environmental and Occupational Health Sciences to oversee a combined study of more than 3,000 ethnically diverse pregnant mothers and their newborns. The cohorts are in communities across the United States, including Seattle, Yakima, San Francisco, Memphis, Minneapolis and Rochester. After this two-year study, grant recipients will have the opportunity to recompete for five more years of funding.

“We’ve assembled three successful cohorts of mothers and babies that have been collecting data since the pregnancy period,” Karr said. “Our study contributes specialty expertise characterizing air pollution and phthalate exposures as well as social factors such as stress, and examines their influence on child asthma, allergies and neurodevelopment.”

Karr and Sathyanarayana and their partners from UCSF and UTHSC will use maternal blood collected during pregnancy and placental tissues collected at birth, as well as air pollution modeling and surveys, to understand the impact of chemical and non-chemical stressors on the developing fetus. Other collaborating institutions include Meharry Medical College, Mount Sinai School of Medicine, New York University, University of Minnesota, University of Pittsburgh, University of Rochester and Vanderbilt University.

“The large and diverse study population and multidisciplinary expertise of UW PATHWAYS investigators enable us to better understand real-world, mixed-exposures scenarios,” said Karr. “We will examine how these may perturb important biological processes during pregnancy that may result in respiratory and neurodevelopmental problems in childhood."

NIH Director Collins believes “Every baby should have the best opportunity to remain healthy and thrive throughout childhood. ECHO will help us better understand the factors that contribute to optimal health in children.”

Here's the award announcement from the University of Washington School of Public Health.

-- Marilyn Hair


The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The PATHWAYS study is supported by the NIH under award number 1UG3OD023271-01.

10th Anniversary Duwamish River Festival


The UW EDGE Center and Superfund Research Program were among the sponsors of the 10thAnniversary Duwamish River Festival at Duwamish River Park on August 20, 2016. Outreach staff from both groups hosted an exhibit table.

Environmental Health wheel
EDGE Center Outreach Manager Marilyn Hair’s display was about ultraviolet (UV) light, sunburn, and skin cancer. Visitors spun the Environmental Health wheel to land on a question about UV, sunscreen, SPF, Vitamin D, cancer, or cloudy day. Participants received a prize of sunscreen or a UV-bead bracelet. Most people knew how to protect their skin but many don’t use enough sunscreen or apply it every two hours as recommended. Check out our factsheet about Protecting Your Skin from UV Exposure.


Superfund Research Project display
The Superfund Research Program Community Engagement Core’s display demonstrated river water turbidity and sedimentation rate variations that occur in the Lower Duwamish Waterway site. Program manager Katie Frevert asked children to invert test tubes filled with water samples and imagine the different environments experienced by fish. The samples ranged from cloudy, sediment-filled water to quick-clearing water from a rocky substrate. Participants then used an aquarium net to capture Swedish-fish gummy candies.  A plankton net and dose-response lab glassware caught additional inquiring eyes. 

The 10th festival included 44 tables hosted by a variety of government, non-profit, community, and commercial organizations. Festival-goers were entertained by 11 groups of performers, including the Duwamish Tribe, Ballet Folklorica Angeles de Mexico, Kapulli Tlaloktecuhtli Aztec Dancers, the Somali Youth Perforance Group, and a Zumba demonstration. 700 people attended the festival on a hot, sunny day, 97 ° to be exact, a perfect day to talk about sunscreen. We were grateful to be under a tent. 

-- Marilyn Hair & Katie Frevert  
Kalpulli Tlaloktecuhtli Aztec Dancers

EDGE Center hosts ATHENA Teacher Workshop for Washington Health & CTE teachers


What is environmental health? That was the first question for 20 high school health and career and technical education (CTE) teachers from Washington State who attended the EDGE Center Academy for Teaching about Health and Environment Associations (ATHENA) Teacher Workshop on August 2-3, 2016. The teachers came from Selah, Sunnyside, Wenatchee, Moses Lake, Kenniwick, Blaine, Olympia, Puyallup, Gig Harbor, Mukilteo, Edmonds, Shoreline, Tukwila, Bellevue and Seattle

The teachers weren’t all clear in the beginning, but by the end of the workshop everyone knew that environmental health is the effect of anything from outside our bodies on human health - air, water, food, pesticides, UV light, drugs, chemicals, vitamins, stress, and on and on. They also learned that environment + genetics + choices interact to affect our health. 

Dr. Rose James talked to teachers about cancer.
Over two days, the teachers met six University of Washington Department of Environmental and Occupational Health Sciences (UW DEOHS) scientists who discussed environmental health topics ranging from nutrition, vitamins, cancer and lung health, to ethics. 

One topic of particular interest was electronic cigarettes, as students are using them but many teachers don't know much about them. There were many questions about the health effects of using electronic cigarettes, or vaping, but we couldn't answer them yet because the FDA has only begun to regulate and study Electronic Nicotine Delivery Systems (ENDS). One teacher wondered, "Which is better, smoking or vaping?" PhD candidate David Scoville hesitated to choose - the best choice, he said, is not to use at all.  

Electronic Cigarettes and E-Juices
The American Lung Association's Beverly Stewart presented about kids and tobacco, describing various tobacco products such as e-cigarettes and hookah, and smokeless tobacco products that include strips, orbs, sticks and chewing tobacco. Beverly discussed tobacco marketing, showing teachers that tobacco products are packaged to look like candy and observing that tobacco products are displayed in convenience stores at a 10-year-old's eye level. Kids don't like to be fooled, she said. Talking with them about tobacco marketing is one strategy to discourage tobacco use: "Look how low that display for electronic cigarettes is. I can hardly read that. Whose attention do you think they're trying to get when they put it down so low?"

Teachers visited the Xu lab
Young researchers explained their work
 The teachers also toured  Libin Xu’s research lab in the UW Department of Medicinal Chemistry and listened to PhD students and post-docs describe their projects studying lipids. 

Teachers worked in small groups
ATHENA-trained teachers Lindzee Alvarez and Tori Marcum from the Bellevue School District introduced ATHENA environmental health classroom lessons about Sugars and Artificial Sweeteners, GMO Salmon, UV Exposure and Sunscreen, Electronic Cigarettes, and Ethics. The teachers were given lesson plans and resources as well as classroom kits for two of the lessons. The ATHENA curriculum is posted on the website and can be downloaded for free.

The teachers appreciated being able to talk with the researchers and also trying out the environmental health lessons alongside practical suggestions for the classroom from experienced teachers Marcum and Alvarez. 

Here are a few comments from the teachers:
 
Teachers listen to a UW presenter
I feel so fortunate to have been able to attend the workshop. Looking forward to trying the lessons in class this year ... I appreciate your enthusiasm for education. I can't wait to incorporate the lessons that were taught ... I have been telling everyone how much fun the workshop was. Thanks for a lovely, educational time ... ATHENA is a wonderful program that changed the way I teach environmental education. It is now part of our daily class discussion instead of just a few lessons over the semester.                                                                                                                                                    --Marilyn Hair

Costa Lab finds toxic PBDE flame retardant BDE-47 increases glutamate in the brain

Flame retardant chemicals are all around us. They are found in computers, upholstered chairs, and mattresses. They were added with good intentions, for safety in case of fire. But many flame retardants are now thought to be toxic. One class of flame retardants, polybrominated diphenyl ethers (PBDEs), which is now banned, has been found to be toxic to the brain, liver, and other organs. 


Dr. Lucio Costa
A new finding from the lab of CEEH member Dr. Lucio Costa in the Department of Environmental and Occupational Health Sciences (DEOHS), University of Washington School of Public Health, has found how one of these PBDEs, tetrabrominated diphenyl ether (BDE-47), exerts its toxic effects. Researchers from UW and the Department of Neuroscience at the University of Parma, Italy, found that particular types of receptors in the brain are involved in toxicity from BDE-47. 

The results in mouse neurons suggest that BDE-47 increases the amount of the neurotransmitter glutamate. More glutamate in turn activates glutamate receptors and leads to increased calcium levels and oxidative stress. This causes brain cells to become over-activated, culminating in cell death. This sequence of events is especially harmful to the developing brains of infants and toddlers. It can lead to higher impulsivity and diminished attention and motor coordination.

The level of BDE-47 in people in the United States is about ten times higher than in Europe or Japan, because, in trying to prevent deaths from fires, the US required that flame retardants be used in furniture. After realizing their toxicity, manufacture of PBDEs in the US was banned and the levels in people are going down. However, the safety of substitute flame retardants remains an issue for further investigation.

Because of public concern about exposure to flame retardants, and a slow response from the federal government to regulate them, activist groups are focusing on state regulations. California passed a law that took effect January 1, 2016 that stopped the requirement that flame retardants be used in furniture. In April, Washington passed the Toxic-Free Kids and Families Act (ESHB 2545) that prohibits the manufacture, sale, or distribution of children's products or residential upholstered furniture containing any of five flame retardants. The law also mandates the WA Department of Ecology to investigate whether six additional flame retardants meet the criteria of a chemical of high concern for children. Here is a one page summary of the new law.

For more information about flame retardants and regulation, see the presentation slides from The Alaska Community Action on Toxics (ACAT) webinar, Toxic Safety, presented by Dr. Alissa Cordner, Assistant Professor of Sociology at Whitman College in Walla Walla, Washington. Dr. Cordner discussed flame retardant chemicals, health effects, federal and state regulation, and current activism. She presented six conceptual risk formulas distilled from stakeholder interviews. 

Dr. Costa’s team's paper can be found here. Other authors include Dr. Pamela Roqué from the University of Washington and Dr. Sara Tagliaferri and Dr. Claudia Pellacani from the University of Parma. Their research was supported by the National Institute of Environmental Health Sciences Grant #ES07033.

Another summary of this research is at AASPH, the Association of Schools and Programs of Public Health > Members Research & Reports.
- Marilyn Hair