Exposure to PM2.5 and cardiovascular diseases in Portugal – the contribute of PMCardImpact project

Abstract   Particulate matter with a diameter of 2.5 μm or less (PM2.5) are one of the air pollutants more detrimental to human health, being responsible for around 400 000 premature deaths in Europe every year. The cardiovascular diseases (CVD) and air pollution are linked, with existing evidence of a causal relationship between exposure to particulate matter and cardiovascular morbidity and mortality. Under the scope of PMCardImpact, a national funded project, data collected from Portuguese air monitoring platform (2005-2021) (>60 stations) was used to estimate the attributable number of cases of acute myocardial infarction. The air monitoring data and parameters such as exposure-response factors will support the risk assessment in AirQ+ software (WHO Regional Office for Europe). Preliminary results showed that exceedances of Air Quality Directive in Portugal ranged between 0.1 % and 10.2% for PM10 and PM2.5 in 2019. Results obtained will include the number of cases of CVD attributable to exposure to PM2.5 in the Portuguese population. Four scenarios of exposure will be considered for presenting the results: current scenario of exposure, new WHO Air Quality guidelines, European Commission Air Quality Directive and lastly, a worst-case scenario. This assessment will be the starting point for calculation of the burden of disease of CVD that exposure to PM2.5 represent in Portugal. With a view to promote the science to policy interface, PMCardImpact project will make available to policy makers the needed supporting information to act, including actionable knowledge on air pollution trends and related health effects, to implement reducing air pollution policies. This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021) and CESAM (UIDP/50017/2020 + UIDB/50017/2020 + LA/P/0094/2020). Key messages • PMCardImpact will make available to policy makers the needed supporting information to act to implement reducing air pollution policies. • Risk assessment will allow to determine the number of CVD cases attributable to air pollution.


Background:
It has long been a maxim of climate and health research that heatwaves kill more people than all other natural disasters combined.Heatwave frequency, severity and duration have increased as climate change intensifies, and recorded temperatures during recent heat events now regularly surpass previous worst-case projections.Temperate zones, between 40 -60 north or south of the Equator, are particularly vulnerable, as small variations in mean temperature can trigger large-scale increases in morbidity, mortality and concomitant health service strain.Heat Health Warning Systems (HHWSs) combine temperature forecasts with public health actions to mitigate these impacts.However, in the absence of a consensus definition of heatwaves multiple systems have developed, and comparative analysis of the effectiveness of different HHWS and their interventions are hindered by lack of a common threshold metric for defining and predicting heatwave severity.

Methods:
This paper provides a comprehensive review of current HHWS and their evidence base in temperate zones in Europe, the United Kingdom and Australia -contiguous landmasses containing multiple jurisdictions with high heterogeneity in local HHWSs, in which single heatwave events trigger vastly different public health responses.A systematic review of available published and grey literature was undertaken to generate a schema of HHWSs in these zones.Results were then narrowed to review and synthesise evidence for each, with a focus on threshold effectiveness in predicting health impacts.

Results and conclusions:
Over twenty distinct HHWS are reviewed, with substantial variation in the evidence for their effectiveness.We make the case for a unified threshold metric for defining heatwaves, to facilitate research and identify warning systems which accurately predict health impacts and effectively communicate risk.

Key messages:
Lack of definitional consensus and heterogeneity in threshold metrics hinders comparison of Heat Health Warning Systems.
Particulate matter with a diameter of 2.5 mm or less (PM2.5) are one of the air pollutants more detrimental to human health, being responsible for around 400 000 premature deaths in Europe every year.The cardiovascular diseases (CVD) and air pollution are linked, with existing evidence of a causal relationship between exposure to particulate matter and cardiovascular morbidity and mortality.Under the scope of PMCardImpact, a national funded project, data collected from Portuguese air monitoring platform (2005-2021) (>60 stations) was used to estimate the attributable number of cases of acute myocardial infarction.The air monitoring data and parameters such as exposure-response factors will support the risk assessment in AirQ+ software (WHO Regional Office for Europe).Preliminary results showed that exceedances of Air Quality Directive in Portugal ranged between 0.1 % and 10.2% for PM10 and PM2.5 in 2019.Results obtained will include the number of cases of CVD attributable to exposure to PM2.5 in the Portuguese population.Four scenarios of exposure will be considered for presenting the results: current scenario of exposure, new WHO Air Quality guidelines, European Commission Air Quality Directive and lastly, a worst-case scenario.This assessment will be the starting point for calculation of the burden of disease of CVD that exposure to PM2.5 represent in Portugal.With a view to promote the science to policy interface, PMCardImpact project will make available to policy makers the needed supporting information to act, including actionable knowledge on air pollution trends and related health effects, to implement reducing air pollution policies.This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021) and CESAM (UIDP/50017/2020 + UIDB/50017/2020 + LA/P/0094/2020).

Key messages:
PMCardImpact will make available to policy makers the needed supporting information to act to implement reducing air pollution policies.Risk assessment will allow to determine the number of CVD cases attributable to air pollution.
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