October 2006
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
      Did you know that environmental hazards can
      contribute to heart disease and stroke? This
      fact sheet summarizes environmental 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 symp-
toms.

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 dol-
lars 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 com-
prised 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

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monoxide. These indoor contami-
nants 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 inhal-
ing 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 palpita-
tions, 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 limit-
ed exposure to minimize detrimen-
tal 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 pollu-
tant 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
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.

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Outdoor Air Pollution
Older adults who are at risk for
heart disease and stroke may
benefit from lowering their con-
tact with air polluted with particu-
lates and vehicular exhaust.

PARTICLE POLLUTION: Small soot
particles found in outdoor air can
be hazardous and the risk is great-
est among people with heart dis-
ease, chronic obstructive lung dis-
ease and asthma. Particles originate
from a variety of sources including
vehicles, power plants, industrial
smokestacks, and fires. Some parti-
cles are emitted into the air directly,
but others form as a result of com-
plicated 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 air-
ways 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 peo-
ple 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 pres-
ence of older lead-containing
plumbing materials.

ARSENIC: Long-term exposure to
high levels of arsenic, a natural ele-
ment  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

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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 expo-
sure.

Excessive Heat Events

Heat events are described as pro-
longed periods when temperatures
reach at least 10 F. (5.5C.) 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 tempera-
ture 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  per-
spiration. Other warning signs are
confusion and hallucinations. Heat
stroke is a serious condition requir-
ing 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 mech-
anisms 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-condition-
ing is the best protection against
heat-related illness and death.
Even a  few hours a day in air-con-
ditioning can greatly reduce the
risk. Research indicates electric
fans are only effective if the ambi-
ent 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 tobac-
co. 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 fre-
quent fresh air breaks when paint-
ing; avoid painted rooms for sever-
al 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 sand-
paper 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 pre-
cautions and restrictions. When han-
dling 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 run-
ning in a garage, even with the
garage door open. Keep gas appli-
ances 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

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groups. Check with your physician
about lowering your activity level
when the AQI is high. Put air condi-
tioning on the re-circulate mode
and keep windows closed during
smoke events from fires in buildings
or forests.  Reduce your time in traf-
fic. Avoid physical activity and limit
exercise near busy roads.

PREVENT  HEAT STRESS: Use your
air-conditioner or go to air-condi-
tioned buildings in your communi-
ty. Take a cool shower or bath.
Wear lightweight, light-colored, and
loose-fitting clothing. Ask your doc-
tor if your  medications increase
your susceptibility to heat-related
illness.

Drink lots  of fluids, but avoid bever-
ages containing caffeine, alcohol, or
large amounts of sugar. These
drinks cause dehydration. If a doc-
tor 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 informa-
tion 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 con-
sumer 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 haz-
ards 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-relat-
ed 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.airnow.gov

Promote public transit options
that reduce traffic and air
pollution: Public transit is the
best way to alleviate road con-
gestion, 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 fac-
tor that influences a person's sus-
ceptibility to heart disease and
stroke. The most important steps
you can take to reduce risk fac-
tors for heart disease and stroke
include:

  Avoid smoke from tobacco
  Schedule time for regular physi-
  cal 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 blood-
  stream)

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               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/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/dnp/
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
http://www.nws.noaa.gov/om/
broch u res/h eat_wa ve.shtm I

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 environ-
 mental factors. For more infor-
 mation, 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-environ-
 mental risk factors.

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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/pesticides/safety/
healthcare/handbook/lndexl .pdf

3  U.S. Environmental Protection Agency. Air Quality Criteria for Carbon
Monoxide, EPA 600-P-99-001 F. 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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