Supervisors info:
Γεωργόπουλος Σωτήριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Πικουλής Εμμανουήλ, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Καραβοκυρός Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Abstract
Context: Cardiovascular Disease (CVD) is the leading cause of morbidity and mortality in Low and Middle Income Countries (LMICs). Conventional risk factors of CVD alone, are unlikely to justify the accelerating incidence of the disease in these countries. At the same time, Air Pollution, Climate Change and Chemical Pollution affect disproportionally LMICs. Therefore, these environmental factors, may constitute substantial risk factors of CVD.
Objectives: The objective of the thesis is to assess, through current literature, the potential association between these environmental factors, and the CVDs in LMICs. Furthermore we evaluate and suggest future fields of research.
Method/ Eligibility Criteria: We conducted a systematic review of the bibliography, according to PRISMA guidelines and PRISMA Flowchart. We searched the literature, by using specific pairs of terms, in multiple databases, such as Pubmed, Sciencedirect, WHO reports etc. We only included studies from the last ten years, on adult populations, conducted in LMICs, which reported clinical outcomes of CVD and more specifically, mortality rates, emergency room visits and hospital admissions, in relation to the three environmental factors (Air Pollution, Climate change and Chemical Pollution). Only studies which presented relative risks, odds ratios etc., along with standard deviations or p-value, were included in the data evaluation.
Results: A total of 3391 articles were identified, of which we included data from 107 articles. Both Climate Change and Air Pollution, were found to have a negative impact on cardiovascular health, increasing significantly cardiovascular mortality and morbidity in LMICs. More specifically, we found that for a Particulate Matter (PM) increase of 10μg/m3, CVD mortality and morbidity increases ranged from 0.25% to 1.22% and 0.14% to 0.26% respectively. Stroke mortality and morbidity ranged from 1.22% to 3.43% and 1.16% to 1.37% respectively. Extreme temperatures were also related to increased mortality and morbidity rates, with inconsistent results, due to different median temperatures among the countries, as well as different definitions of “heat” and “cold”. Exposure to chemical pollution was linked to an OR= 1.25 (95%CI: 1.07, 1.39) and OR= 1.13 (95%CI: 1.01, 1.27) for arrhythmias and coronary disease, respectively.
Limitations: Diversity on exposure assessments, lack of common definitions and differences in the characteristics of the populations studied, limited the ability to generalize. Chemical Pollution is under investigated as a potential risk factor of CVD in LMICs and needs further investigation.
Conclusions: The results indicate that Air Pollution, Climate Change and Chemical Pollution could be important risk factors of CVD in LMICs. These findings can be implemented in public health policies.
Keywords:
Air pollution, Climate change, Chemical pollution, Cardiovascular disease, LMICs
