The effect of air pollution on haemostasis

Summary

Ambient environmental air pollutants include gaseous and particulate components. In polluted air, especially particulate matter seems responsible for cardiovascular complications: It consists of a heterogeneous mixture of solid and liquid particles with different diameters ranging from large thoracic to ultrafine particles, with a diameter < 100 nm. Ultrafines can penetrate deeply into the lung to deposit in the alveoli. Cardiovascular manifestations result both from short-term and long-term exposure and have been linked to interference with the autonomic nervous system, direct translocation into the systemic circulation, pulmonary inflammation and oxidative stress. Thrombotic complications associated with air pollution comprise arterial and probably venous thrombogenicity.

This review describes the existing epidemiological and experimental evidence to explain the rapid induction of myocardial infarction within 1–2 hours after exposure to polluted air and advances several explanations as to why more chronic exposure will lead to enhanced venous thrombogenicity. Mechanisms such as platelet activation, endothelial dysfunction, coagulation factor changes and microvesicle production are discussed.

Zusammenfassung

Luftschadstoffe in der Umwelt enthalten gasförmige und korpuskulare Bestandteile. Für kardiovaskuläre Komplikationen scheint besonders der Feinstaub in der schadstoffbelasteten Luft verantwortlich zu sein: Er enthält eine heterogene Mischung aus festen und flüssigen Bestandteilen, deren Durchmesser im Bereich zwischen großen thorakalen bis hin zu ultrafeinen Partikeln (Durchmesser < 100 nm) liegt. Ultrafeine Partikel können tief in die Lunge eindringen und sich in den Alveolen ablagern. Sowohl die kurzfristige als auch die Langzeitexposition führen zu kardiovaskulären Krankheitsbildern, die auf Störungen des autonomen Nervensystems, die direkte Translokation in den systemischen Kreislauf, entzündliche Lungenveränderungen sowie auf oxidativen Stress zurückgeführt wurden. Zu den feinstaubabhängigen thrombotischen Komplikationen gehören arterielle und wahrscheinlich auch venöse prothrombotische Effekte.

In dieser Übersicht werden die epidemiologische und experimentelle Daten dargestellt, welche die rasche Auslösung eines Myokardinfarkts innerhalb von 1–2 Stunden nach Exposition gegenüber verschmutzter Luft erklären. Verschiedene Erklärungsmodelle werden vorgestellt, weshalb die eher chronische Exposition die venöse Thrombogenität erhöht. Mechanismen wie Thrombozytenaktivierung, endotheliale Dysfunktion, Veränderungen der Gerinnungsfaktoren und Produktion von Mikrovesikeln werden diskutiert.

Keywords

Particulate matter - thrombosis - transepithelial passage - platelet activation - microvesicles - cardiovascular risk

Schlüsselwörter

Feinstaub - Thrombose - transepitheliale Passage - Thrombozytenaktivierung - Mikrovesikel - kardiovaskuläres Risiko

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