New Risk Factors: Air Pollution, Air Temperature, Pain, and Sleep Hours

Traditionally, we have used age, gender, obesity, hypertension, dyslipidemia, smoking, and diabetes as cardiovascular risk factors. However, this new era (during which the changes made to care for our shared home, the planet, will play a key role) has seen the emergence of new factors such as pollution, noise, temperature, sleep hours, and air quality. These elements are usually underappreciated compared with traditional factors, but recent studies show that the former are as important as the latter.

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As a matter of fact, a recent study determined that air pollution is a major respiratory and cardiovascular risk associated with mortality.

The authors, from the Johannes Gutenberg Universität, calculated excess mortality in Europe attributed to air pollution and determined that air pollution reduces life expectancy by 2.2 years. The number of deaths attributable to poor air quality is calculated to be 133 per 100,000 inhabitants, which exceeds the global mean by a lot.

Replacing fossil fuels with clean, renewable energy sources could reduce this figure by half.


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Another environmental factor is air temperature, which has been associated with hypertension and mortality, although its association with infarction is much more difficult to establish. Heat-related infarctions increased from 0.93 in 1987-2000 to 1.14 in 2001-2014. So far, they are a trend with increasing susceptibility in diabetics and people with dyslipidemia.

Pain is a common symptom of many diseases and it is associated with discomfort, anxiety, and sympathetic nerve activation. Prior pain is a common factor in patients admitted with acute coronary syndromes, and Takotsubo syndrome has a similar physiopathology.

The Framingham Heart Study showed a clear association between pain and cardiovascular mortality.

Sleep is an essential part of human life; it allows us to recover physically and psychologically from daytime stress. An article entitled “Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries,” addressed a study conducted in Canada that estimated the total daily sleep duration, including a daytime nap, of 116,632 individuals over an 8-year follow-up.


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After adjustment for multiple factors, both less than 6 hours and more than 8 hours of sleep duration per day were associated with an increased risk. For sleep, as well as exercise, there seems to be a just dose, as evidenced by their J-shaped curve.

This article, recently published by the editors of the European Heart Journal under the title “FAST TRACK,” is expected to cause ripples and create awareness within the medical community.

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Original title: Novel cardiovascular risk factors: air pollution, air temperature, pain, and sleep duration.

Reference: Thomas F. LÜscher


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