September 2005
Environmental

hazards can

contribute to heart

disease and stroke.

Older adults should

minimize exposure

to environmental

hazards such as

air pollution,

arsenic, lead, and

excessive heat.
                               Environmental  Hazards
                              Weigh  Heavy  on  the  Heart
                              Information  for Older Americans and
                              their Caregivers
r/
        Did you know that environmental
        hazards can contribute to heart
        disease and stroke? This fact
        sheet summarizes environmen-
tal factors and how they can affect the
health of older adults. It also suggests how
older adults can minimize their exposure
to air and water pollutants that contribute
to heart disease and stroke or worsen
their symptoms.
Heart disease, the leading cause of death
in the United States, and stroke, the third
most lethal cause of death, cost the nation
hundreds of billions of dollars each year.
According to the CDC, in 2001, heart
disease killed 700,000  people, which
represented 29% of all deaths in the US.

Environmental  Factors Contribute
to Heart Disease and Stroke
Indoor Air Pollution
People who spend long periods of time
indoors are often the most susceptible to
the effects of indoor air pollution. Studies
suggest that older adults spend up to
90% of their time indoors. Indoor air is
comprised of a mixture of contaminants
penetrating from the outdoors and
those generated indoors. Indoor air can
contain secondhand smoke, fumes
from household cleaning products, and
even carbon monoxide. These indoor
contaminants can be dangerously toxic,
especially to those at risk of stroke and
heart disease.
Smoke: Secondhand smoke is one of
the worst indoor air pollutants. Smoking
is known to contribute to heart disease
and stroke, but inhaling the same dose
of secondhand smoke and smoke from
active smoking is equally detrimental.
Wood burning stoves and fireplaces can
generate smoke containing fine carbon
particles. These particles may trigger chest
pain and palpitations, shortness of breath,
and fatigue, especially in older  adults with
heart disease.1
Household Products: When  used
improperly, some household products can
be very dangerous for people with heart
conditions. Vapors from cleaning products,
paint solvents, and pesticides require
proper ventilation and limited exposure to
minimize detrimental affects.
Fumes from paint solvents, such as
mineral spirits, turpentine, methanol,
and xylene, stress the lungs and heart,
contributing to irregular heartbeat.
Although lead-based paints are now
banned, many homes built before
1978 used lead-containing paints. Take
appropriate precautions during  renovations
to minimize paint chips or dust generated
that pose serious health hazards, including
high blood pressure.
Pesticide poisonings often result from
exposure to toxic fumigants or  insecticides.
Symptoms of this type of  poisoning
include arrhythmia or a very slow pulse.2
In severe cases, exposure can contribute
to a heart attack or even death.
Carbon Monoxide: Carbon monoxide
(CO), an invisible and odorless gas,
is a dangerous pollutant because it is
difficult to detect. It is particularly harmful
to people with heart disease, clogged
arteries, or congestive heart failure
because it significantly limits the blood's

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ability to carry oxygen. For a person with heart
disease, exposure to even low levels of CO may
cause chest pain, increased heart rhythm irregularities
and make it difficult to exercise.3 Sources of CO
include fumes from furnaces, gas water heaters,
ranges, dryers, space heaters, fireplaces, wood stoves,
and exhaust from cars idling in enclosed garages.

Outdoor Air Pollution
Older adults who are at risk for heart disease and
stroke may benefit from lowering their contact with
air polluted with  particulates and vehicular exhaust.
Particle  Pollution: Small soot particles found in
outdoor air can be hazardous and the  risk is greatest
among people with heart disease, chronic obstructive
lung disease and asthma. Particles originate from a
variety of sources including vehicles, power plants,
industrial smokestacks,  and  fires. Some particles
are emitted into  the air directly, but others form
as a  result of complicated chemical reactions in
the atmosphere.  Particles can travel hundreds to
thousands of miles downwind, affecting people far
from the sources.
Traffic: Time spent in traffic has also been associated
with  the onset of a heart attack.4 It is not known
whether this is due to traffic-related air pollution  (e.g.,
particle pollution, CO), the stress of being caught in
traffic, or some other risk factor.
Pollutant Gases: Ozone, sulfur dioxide, and
nitrogen dioxide  are also important components
of air pollution and are  associated with adverse
health effects. Ozone is a strong irritant to the lungs
and airways and  can cause  chest pain  that  can be
mistaken for a heart attack.

Drinking Water
There is evidence that several metals found in
drinking water may contribute to heart disease or
aggravate its symptoms.
Lead: Exposure  to lead can  increase blood pressure.
While people are primarily exposed to  lead through
paint dust, drinking water is another source of lead
exposure. While water from a community's public
water supply must meet EPA standards for  lead, tap
water may still contain lead  exceeding  the allowable
levels due to the presence of older lead-containing
plumbing materials.
Arsenic: Long-term exposure to high levels of
arsenic, a natural element found in drinking water
in some areas of the country, can  harm the heart.
EPA has a drinking water standard for public drinking
water systems to ensure that people are not exposed
to high levels of  arsenic. If you obtain your  water
from a private well or small water system, see the
"Steps You Can Take" section for more information
about actions to limit your exposure.

Excessive Heat Events
Heat events are described as prolonged periods
when temperatures reach at least 10° F. (5.5°C.)
above a region's average high temperature. Heat
stroke is the most serious of a range of health effects
associated with excessive heat exposure. It occurs
when the  body's temperature control system fails
causing a rapid  rise in core body temperature. Heat
stroke is characterized by hot,  dry, and  red skin,
and a lack of perspiration. Other warning signs are
confusion  and hallucinations. Heat stroke is a serious
condition requiring immediate medical attention (call
911 or take the person to an emergency room).
Left untreated, heat stroke can cause severe and
permanent damage to vital organs, permanent
disability, or death.
Persons with  heart disease and stroke have impaired
cooling mechanisms and are more vulnerable during
heat events. The use of some medications can
make individuals more  susceptible to heat events
for example, anti-depressants and some circulatory
medications.
During heat events, air-conditioning is the best
protection against heat-related illness and death.
Even a few hours a day in air-conditioning can greatly
reduce the risk. Research indicates electric fans are
only effective if the ambient temperature is lower
than the body temperature. Electric fans may provide
comfort, but when temperatures are in the high 90s,
fans do not prevent heat-related  illness and could
actually be harmful.

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Steps You Can Take to

Help Control Heart Disease

and Stroke
A healthy lifestyle is the  best way to prevent
heart disease and stroke. In addition, older adults
should limit their contact with environmental risk
factors and encourage local governments to take
action to reduce environmental hazards.

Limit Contact With Environmental Factors
•  Keep smoke out of indoor spaces: Avoid
   smoke from tobacco. Encourage smokers to
   smoke outdoors. Avoid restaurants, bars, and
   other public places where people  smoke. Do
   not use or limit use of wood-burning stoves
   and fireplaces.
•  Use caution when working around the
   house: Improve ventilation when painting by
   scheduling indoor painting for times when
   windows can be  left open and by using fans.
   Take frequent fresh air breaks when painting;
   avoid painted rooms  for several days.
   Before renovating a home  built before 1978,
   take precautions  to avoid lead paint exposure.
   Do not use a belt-sander, propane torch, heat
   gun, dry scraper,  or dry sandpaper to remove
   lead-based paint because these actions
   generate unacceptable amounts of lead dust
   and fumes.
   If you must use pesticides, always read
   labels first and follow all precautions and
   restrictions. When handling pesticides, take
   protective measures;  follow directions and
   wear impermeable gloves, long pants, and
   long-sleeved shirts. Change clothes and
   wash your hands immediately after applying
   pesticides. Wash  clothes exposed to pesticides
   separately.
•  Avoid carbon monoxide poisoning: Never
   leave a car running in a garage, even with
   the garage door open. Keep gas appliances
   properly adjusted. Install and use exhaust fans.
   Have a trained professional inspect, clean, and
   tune-up your central heating system (furnaces,
   flues, and chimneys)  every fall. Install carbon
   monoxide detectors throughout your home.
•  Reduce exposure to traffic and outdoor
   air pollution: Pay attention to Air Quality
Index (AQI) forecasts to know when the
air is unhealthy for sensitive groups. Check
with your physician about lowering your
activity level when the AQI is high. Put air
conditioning on the re-circulate mode and
keep windows closed during smoke events
from fires in buildings or forests. Reduce your
time in traffic. Avoid physical activity and limit
exercise near busy roads.
Prevent heat stress: Use your air-
conditioner or go to air-conditioned buildings
in your community. Take a cool shower or
bath. Wear lightweight, light-colored, and
loose-fitting clothing. Ask your doctor if your
medications increase your susceptibility to
heat-related illness.
Drink lots of fluids, but avoid beverages
containing caffeine, alcohol, or large amounts
of sugar. These drinks cause dehydration. If a
doctor limits your fluid intake, be sure to ask
how much to drink when it's hot.
Drink clean water: To limit your exposure to
lead through your water, run cold water for at
least 30 seconds, preferably 2 to 3  minutes
before drinking. Testing for lead also may be
advisable for people who get their water from
municipal sources and live in older  homes
with lead service lines. If you receive your
water from a municipal system, you should
first request information from your municipal
system for results of federally mandated
testing for lead and copper, particularly in
homes from the area where you live.
EPA's arsenic standard exempts small water
systems that annually provide fewer than 15
"hook-ups" or serve fewer than 25 people. If
your water supply is from a private well or a
small system that is exempted from testing
and you live in an area where high  levels of
arsenic have been reported in the ground
water, you may want to  have your water
tested for arsenic.
The best source of specific information
about your drinking water is your water
supplier. Water suppliers that serve the same
people year-round are required to send their
customers an annual water quality report
(sometimes called a consumer confidence
report). Contact your water supplier to get
a copy.
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Encourage Your Local Government to
Take Action
Local governments should take these simple steps to
reduce hazards and publicize precautions older adults
can take.
•  Promote smoke-free policies in public  places:
   By keeping public places (restaurants, bars,  and
   parks) smoke-free, communities can limit exposure
   to secondhand smoke.
•  Promote Active Heat Health Watch Warning
   and Response Systems: These systems can
   help identify when a heat-related threat is likely,
   alert residents, and provide assistance to at-risk
   individuals.
•  Ensure that Air Quality Index forecasts are
   publicized and followed: EPA's Air Quality Index
   is an  index for reporting daily air quality. See www.
   epa.gov/airnow.
•  Promote public transit options that reduce
   traffic and air pollution: Public transit is the  best
   way to alleviate road congestion, air pollution, and
   stress.
•  Locate parks, bike paths, and trails away
   from major  roads: Physical activity is one  of
   the best ways to lower your risk for heart disease
   and stroke. Exercise away from roads and traffic
   pollution.

Control Your Major Risk Factors for Heart
Disease and Stroke
The environment is just one factor that influences a
person's susceptibility to heart disease and stroke.
The most important steps you can take to reduce risk
factors for heart disease and stroke include:
•  Avoid smoke from tobacco
•  Schedule time for regular physical activity 30
   minutes per day at least 5 days a week
•  Follow the 2005  Dietary Guidelines for
   Americans
•  See your health care provider regularly to
   screen for and treat high blood pressure,
   diabetes, and hyperlipidemia  (elevated levels
   of lipids  in the bloodstream)

Additional Resources
Environmental Protection Agency
Air Quality Index: www.airnow.gov

Arsenic:  www.epa.gov/safewater/arsenic.html

Indoor Air Quality: www.epa.gov/iaq/

Publication Number
EPA 1OO-F-05-020
Lead: www.epa.gov/lead
Painting: www.epa.gov/iaq/homes/hip-painting.html

Pesticides: www.epa.gov/pesticides/
Smoke free homes: www.epa.gov/smokefree/
Centers for Disease Control and Prevention
Cardiovascular health: www.cdc.gov/cvh/
Physical Fitness Guidelines:http://www.cdc.gov/
nccdphp/dnpa/physical/recommendations/older_
adults.htm

Dietary Guidelines for Americans
www.health.gov/dietaryguidelines/
Federal Emergency Management Administration
www.fema.gov/hazards/extremeheat/heat.shtm
National Weather Service: www.nws.noaa.gov/
om/brochures/heat_wave.shtml

American Heart Association: www.americanheart.org

Health Effects Institute
www.healtheffects.org/about.htm
   Learn  More
   The EPA Aging Initiative works to protect the
   health of older adults through the coordination
   of research, prevention strategies, and public
   education on environmental factors. For more
   information, or to join the EPA Aging Initiative
   listserve visit: www.epa.gov/aging. Older adults
   can improve their health and quality of life by
   being aware of environmental contributors to
   heart disease and stroke and controlling major
   non-environmental risk factors.
Footnotes
1    U.S. Environmental Protection Agency. Air Quality Guide for
    Particle Pollution. http://www.epa.gOV/airnow//aqLcl.pdf
2   U.S. Environmental Protection Agency. Regulation and
    Management of Pesticide Poisonings. 1999. http://www.epa.gov/
    pestiddes/safety/healthcare/handbook/lndexl.pdf
3   U.S. Environmental Protection Agency. J\ir Quality Criteria for
    Carbon Monoxide, EPA 600-P-99-001F. Research Triangle Park,
    NC: U.S. Environmental Protection Agency, Office Research and
    Development, National Center for Environmental Assessment.
    June 2000.
4   Peters, A., S. von Klot, M. Heier, I. Trentinaglia, H. Ines, A.
    Hermann, H.E. Erich, H. Lowel. "Exposure to Traffic and the Onset
    of Myocardial Infarction." The New England Journal of Medicine.
    Oct 21, 2004. 351 (17): 1721-30.

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