Short-term Effects of Fine Particulate Matter on Heart Rate
in Heart Failure Patients
Miyuki Breen1, Wayne E Cascio2, Joshua M Moyer2, Joel Schwartz3, Qian Di4, Emily R Pfaff5,
Environmental	Robert B Devlin2, David Diaz-Sanchez2, Cavin K Ward-Caviness2
Protection Agency	1 Center for Public Health and Environmental Assessment, ORISE/US Environmental Protection Agency, Chapel Hill, NC, USA;
2Centerfor Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA;
3Harvard TH Chan School of Public Health, Boston, MA, USA ; 4Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China;
5NC Translational and Clinical Sciences Institute, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA

Conclusion
Elevated PM2 5 is associated with increased heart rate in heart failure patients
Background
Results
Air pollution particularly, particulate matter < 2.5 jim in diameter
(PM2 5) and increased heart rate (HR) are significant risk factors
for cardiovascular morbidity and premature mortality
-	yet, limited information is available for individuals with pre-
existing disease
We sought to examine:
-	the association between short-term PM25 exposure and HR in
heart failure (HF) patients, and
-	the potential effect modification by beta-blockers, a common
medication class used to treat HF that modifies HR
Methods
HF Cohort: 26,634 HF patients with
3,048,856 HR measurements taken
between January 2014 and December
2016.
PM2 5: Satellite data, land use, and
ground-based monitoring were combined
to estimate daily PM2 5 concentrations at
1km resolution. Immediate (lag 0),
delayed (lag 1 to 4), and 5 day moving
average (5dMA) exposures were
computed at each primary address.
Modeling Approach: We used linear
additive mixed models to associate PM2 5
with HR while adjusting for age, sex, race,
season, time-trend, daily temperature, and
relative humidity, with a random intercept
for individual.
Discussion
Effect estimates of associations are small
but consistent only in those time periods
when people were not on beta-blockers
Associations with heart rate indicate
potential autonomic nervous system
regulation by PM2 5 with effect
modification by beta-blocker medications
Disclaimer
This work does not necessarily
represent the views or policy of the US
EPA. Any mention of tradenames does
not constitute endorsement
Heart Rate
Systolic
Diastolic
(N = 3 048 856)
(N = 2 553 553)
(N = 2 546 880)
Mean (SD)
Mean (SD)
Mean (SD)
Age (y)
66.8 (14.4)
67.4 (14.4)
67.4 (14.3)
Heart Rate (bpm)
82.2 (17.2)
81.8 (17.1)
81.8 (17.1)
Systolic Blood Pressure
(mmHg)
127.4 (25.2)
127.4 (25.2)
127.4 (25.1)
Diastolic Blood Pressure
(mmHg)
68.5 (14.4)
68.5 (14.4)
68.5 (14.4)
PM„ (pg/m3)
8.95 (4.58)
8.96 (4.55)
8.96 (4.55)
Air temperature (°C)
16.8 (8.41)
16.8 (8.43)
16.8 (8.42)
Relative humidity (%)
66.5 (21.3)
66.5 (21.1)
66.5 (21.1)
Medication
N (%)
N (%)
N (%)
Beta Blocker
2 347 821 (77.0)
1 958 068 (76.7)
1 952 839 (76.7)
Calcium Channel Blocker
1 435 207 (47.1)
1 196 654(46.9)
1 193 894 (46.9)
Antihypertensive
1 860 080 (61.0)
1 552 152 (60.8)
1 548 218 (60.8)
Diuretic
2 587 316 (84.9)
2 127 703 (83.3)
2 122 315 (83.3)
Study Subject
N (%)
N (%)
N (%)
Number of Individuals
26 634 (100)
26 654 (100)
26 655 (100)
African American
7 565 (28.4)
7 569 (28.4)
7 569 (28.4)
European American
18 168 (68.2)
18 184 (68.2)
18 185 (68.2)
Other Race
901 (3.4)
901 (3.4)
901 (3.4)
Male
13 829 (49.5)
13 847 (49.5)
13 846 (49.5)
Association between PM25 and HR
in HF patients
Subgroup: No Beta Blocker Use
0.010
0.100
0.075
0.050
0.025
0.000-
lag 0 lag 1 lag 2 lag 3 lag 4 5dMA
lag 0 lag 1 lag 2 lag 3 lag 4 5dMA
Map of EPA CARES participant density, participating hospitals,
and PM2 5 monitors
Legend
O UNC Hospital
UNC Hospitals
X Chapel Hill
A PM 2.5 Monitor
Number of participants
1 to 10
_ 11 to 25
26 t0 50
|j 51 to 100
I 101 or more
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