December 2005
                            Environmental  Hazards
                            Weigh  Heavy  on  the Heart
                            Information  for Older Americans and
                            their Caregivers
Environmental

hazards can

contribute to heart

disease and stroke.

Older adults should

limit exposure

to air pollution,

arsenic, lead, and

excessive heat.
                             Did you know that environmental
                             hazards can contribute to heart
                             disease and stroke? Factors in
                             the environment, such as pol-
                      lutants in the air and water, are known or
                      thought to affect heart disease and stroke.
                      The purpose of this fact sheet is to make
                      older people in particular aware of some
                      of these factors. It is also intended to help
                      older persons reduce their exposure to
                      these factors. By controlling factors in your
                      environment, you may be able to protect
                      yourself and your loved ones.
                      Heart disease is the leading cause of
                      death in the United States, and stroke
                      is the third highest cause of death.
                      They cost the nation hundreds of
                      billions of dollars each year. In 2001,
                      heart disease  killed 700,000 people in
                      the US.
What in the Environment can
Contribute to Heart Disease and
Stroke Problems?

Indoor Air Pollution
People who spend long periods
of time indoors may be the most
affected by indoor air pollution.
Studies suggest that older adults
spend up to 90% of their time
indoors. Indoor air can contain toxic
pollution that comes from both
indoors and outdoors. Pollutants that
people are  exposed to outdoors are
described later in  this fact sheet
Indoor air pollution can come from:
  secondhand smoke
                                   fumes from household
                                   cleaning products
                                   carbon monoxide
Smoke: Secondhand smoke is one
of the worst indoor air pollutants.
Smoking is known to be bad for the
heart. Breathing secondhand smoke
can be just as harmful. Smoke from
wood burning stoves and fireplaces
are also hazardous. Smoke contains
particles that can cause chest pain and
shortness of breath. For older persons
with heart disease smoke can also
make people feel tired.


Household Products: Fumes
from paints, pesticides, and cleaning
products can place stress on the lungs
and heart To stay safe, older adults
should limit the time they spend
around these fumes and  keep their
indoors full of fresh air.
Many homes built before 1978 used
paints that contained lead. Breathing in
small  amounts of lead dust can cause
serious health problems including high
blood pressure. If you are renovating
your home, make sure to limit your
exposure to lead found in  paint chips
and dust
Pesticide poisonings often result from
breathing in toxic fumes or insect
repellants. Be careful when you or a
hired  professional sprays pesticides
in or around your home. Signs of
poisoning include irregular heart beats
or a very slow pulse.

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Carbon Monoxide: Carbon monoxide (CO), a
gas that you can't see or smell, is a dangerous
pollutant because it is difficult to detect. It is very
harmful to people with heart disease, clogged
arteries, or heart failure because it limits the
blood's ability to carry oxygen. For a person with
heart disease, exposure to even low levels of CO
may cause chest pain, or irregular heart beats. It
may also make exercising difficult. Sources of CO
include fumes from furnaces, gas water heaters,
ranges, dryers, space heaters, fireplaces, wood
stoves, and exhaust from cars left running in
enclosed garages.
Outdoor Air Pollution
Older adults who are at risk for heart disease
and stroke may benefit from less contact with
pollutants in the air and car exhaust.


Particle  Pollution: Small soot particles found
in the air outdoors can be hazardous and the
risk is greatest among people with  heart disease,
emphysema, chronic bronchitis, and asthma.
These particles come from many sources such
as vehicles, power plants, industrial smokestacks,
and fires. Particles can travel hundreds to
thousands of miles downwind, and affect people
far from the sources.
Traffic: Time spent in traffic has also been
associated with the start of a heart attack. It
is not known if this is due to traffic-related air
pollution  (e.g., particle pollution, CO), the stress
of being in traffic, or some other risk factor.


Pollutant Gases: Ozone, sulfur dioxide, and
nitrogen dioxide are gases that can cause
negative health effects. Ozone can bother the
lungs and airways causing chest pains that can
be mistaken for a  heart attack.
Drinking Water
Some metals found in drinking water may cause
heart disease or worsen its symptoms.


Lead: Exposure to lead can increase blood
pressure. Both paint dust and drinking water are
sources of lead exposure. Old lead plumbing
may contaminate the clean drinking water in
your community.
Arsenic: Arsenic is a natural element found in
drinking water in some areas of the country.
Long-term exposure to high levels of arsenic
can harm the heart. If your water comes from a
private well or small water system, see the "Steps
You Can Take" section for more information on
how to limit exposure.
Excessive Heat Events
Heat events are when temperatures reach at
least 10 F (5.5C.) above a region's average
high temperature for  long periods of time.
Excessive heat can cause heat stroke. When
the body's temperature control system fails, the
core temperature in your body rises. Symptoms
of heat stroke are hot, dry, red skin, and  a
lack of perspiration. Other warning signs  are
confusion and hallucinations. Heat stroke is a
serious condition and needs 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. It can also lead to permanent disability,
or even  death.
People with heart disease and stroke do not
cool down easily during heat events. The use of
some medications such as anti-depressants and
some circulatory medications can make a person
exposed to excessive heat more at risk.
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. While electric fans may provide comfort, but
when temperatures are in the high 90s,  (35C or
higher) 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. Also, older adults
should stay away from environmental
hazards and ask local governments to take
action to reduce these hazards.
Limit Contact with Environmental
Factors
 Keep smoke out of indoor spaces:
  Stay away from tobacco smoke and
  places where people smoke. Try not to
  use wood-burning stoves and fireplaces.


 Use caution when working around
  the house: Keep fresh air moving when
  painting by leaving windows open and
  by using fans. Take many fresh air breaks
  when painting; stay away from 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.
  If you use pesticides, always read labels
  first and follow all precautions and
  restrictions. Follow all directions and wear
  rubber gloves, long pants, and long-
  sleeved  shirts. Change  clothes and wash
  your hands immediately after  applying
  pesticides. Wash clothes that have
  pesticides on them separately.
Avoid carbon monoxide poisoning:
Never leave a car running in a garage,
even with the garage door open. Take
care of gas appliances. Install and use
exhaust fans. Have a trained professional
inspect, clean, and tune-up your furnaces
and chimneys every fall. Install carbon
monoxide detectors around the home.
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 clothes. Ask your
doctor if your medications may increase
your chance  of getting a heat-related
illness when  it is hot. Drink lots of water. If
a doctor limits how much you can  drink,
be sure to  ask what is okay when it's hot.


Drink clean water: Run cold water for
at least 30 seconds, preferably 2 to 3
minutes before drinking to help  limit your
risk of lead poisoning. For extra protection
test your drinking water for lead  and
arsenic, and ask for test results and more
information from your water supplier.
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Stay away from traffic and outdoor
air pollution: Watch the Air Quality Index
(AQI) to know when the air is unhealthy
for sensitive groups. Check with your
doctor about being less active when the
AQI is high. Reduce your time in traffic
and try not to exercise near busy roads.
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Encourage Your Local Government
to Take Action
Local governments should take these simple
steps to reduce hazards and inform older adults
of precautions they 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 avoid 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 affects
a person's risk for 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 (high 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/
Lead: www.epa.gov/lead
Painting: www.epa.gov/iaq/homes/hip-painting.html

Pesticides: www.epa.gov/pesticide/

Smoke free homes: www.epa.gov/smokefree/

Centers for Disease Control and Prevention
Cardiovascular health: www.cdc.gov/cvh/

Physical Fitness Guidelines: 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 research,
   prevention suggestions, and public
   education. 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. Air 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.
                                               Publication Number
                                               EPA 100-F-05-025

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