Association of ambient air pollution and cardiovascular symptoms: a systematic review and meta-analysis

Abstract

Background and purpose: Cardiovascular disease is the leading cause of disease burden globally. Previous studies have suggested that air pollution is a risk factor for cardiovascular symptoms, however, the results are controversial. Thus, we conducted this study to systematically review available evidence quantifying the relationship between exposure to ambient gaseous and particulate air pollutants and cardiovascular symptoms. Methods: Three databases were searched up to September 10, 2022, for articles investigating the association of air pollutants including sulfur dioxide, nitrogen dioxide, ozone, carbon monoxide, and particulate matter with aerodynamic diameters of ≤10 μm and ≤2.5 μm (PM10 and PM2.5) with cardiovascular symptoms of chest pain, shortness of breath, respiratory distress, and palpitation. Random-effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (95% CI) for chest pain in association with PM2.5. Egger test was used to assess publication bias in the included studies. Results: Of the 16 studies that were included in the systematic review, 10 were used to calculate the pooled OR for chest pain. Most of them were from developed countries, where air pollution levels were relatively low. Short-term exposure to air pollutants may increase the risk of chest pain, with the pooled OR 1.016 (95% CI 1.003–1.030) per 10 μg/m³ increment of PM2.5. Conclusions: Air pollution is a potential risk factor for cardiovascular symptoms, especially chest pain. However, most current studies are conducted in low-pollution regions. More studies from high-pollution regions are needed to confirm the role of ambient air pollution in cardiovascular symptoms and reveal the underlying health effects.