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.
August 2009
Environmental Hazards
Weigh Heavy on the Heart
Information for Older Adults and
Their Caregivers
Did you know that environmen-
tal hazards can contribute to
heart disease and stroke? This
fact sheet summarizes envi-
ronmental 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 pollut-
ants 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 frequent cause of death,
cost the nation hundreds of billions of
dollars each year. According to the CDC,
in 2005, heart disease killed 652,091
people, which represented 27.1% of all
deaths in the U.S.1
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.2
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
effects.
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.3 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
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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.4 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.5 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.
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.
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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 custom-
ers an annual water quality report (some-
times called a consumer confidence report).
Contact your water supplier to get a copy.
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• Promote Active Heat Health Watch/Warning
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)
Resources
Environmental Protection Agency
Air Quality Index: http://airnow.gov/
Indoor Air Quality: http://www.epa.gov/iaq/
Lead: http://www.epa.gov/lead/
Painting: http://www.epa.gov/iaq/homes/
hip-painting.html
Pesticides: http://www.epa.gov/pesticides/
Smoke Free Homes and Cars: http://www.epa.
gov/smokefree/
Health and Human Services
Dietary Guidelines: http://www.health.gov/
DietaryGuidelines/
Centers for Disease Control and Prevention
Heart Disease: http://www.cdc.gov/HeartDisease/
Physical Fitness Guidelines:
http://www.cdc.gov/physicalactivity/everyone/
guidelines/olderadults.html
Federal Emergency Management
Administration:
Extreme Heat: http://www.fema.gov/hazard/heat/
index.shtm
National Weather Service
http://www.nws.noaa.gov/om/brochures/heat_
wave.shtml
American Heart Association
http://www.americanheart.org/
Health Effects Institute
http://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
listserv, visit: www.epa.gov/aging.
Endnotes
1 Kung HC, Hoyert DL, Xu J, Murphy SL Deaths: final data for
2005. National Vital Statistics Reports. 2008;56(10).
2 U.S. Environmental Protection Agency. Air Quality Guide for
Partide Pollution. http://www.epa.gOV/airnow//aqLcl.pdf
3 U.S. Environmental Protection Agency. Regulation and
Management of Pesticide Poisonings. 1999. http://www.epa.
gov/pesticides/safety/healthcare/handbook/lndexl.pdf
4 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.
5 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.
Oct21,2004. 351 (17): 1721-30.
Protecting t i,f Health
of Older Americans
Publication Number EPA 100-F-09-043
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