Based on recent population-based studies of both morbidity and mortality, efforts have been directed toward understanding potential mechanisms whereby effects of exposure to ambient air pollutants could result in cardiovascular events. Our laboratory investigations have provided clues about potential autonomic nervous system responses that are modulated by the underlying pathophysiologic state of animals undergoing exposure to concentrated air particles. Testing these potential mechanisms in human populations requires a multidisciplinary approach joining epidemiologists, physiologists, cardiologists, ambient air monitoring specialists, and statisticians to develop protocols and carry Out investigations that will 1) characterize the physiologic state of at-risk groups; 2) mOnitOr exposure in sufficient detail to characterize and quantify the putative environmental agents; 3) make detailed and appropriately sustained measures of cardiac function that are relevant to assessing the autonomic response of the heart; and 4) correlate these potential findings with those found in animals exposed to concentrated air particles. Projects proposed will provide data on a spectrum of at-risk subjects that include patients with mild to moderately severe coronary artery disease, documented conduction defects, and elderly subjects with and without documented underlying cardiac disease. In subsequent years, we propose to expand the investigations to include other at-risk groups. Alternatively, some of these same groups of at-risk subjects can be studied in other regions of the country where the ambient particulate mix may be at higher levels or have different constituents. The projects are supported by: an Administrative and Statistical Core (Core 1) that will oversee the planning and analysis of the data; the Air Monitoring Core (Core 2) that will provide detailed characterizations and quantification of the participants' exposure; and the Cardiac Monitoring Core (Core 3) that will provide the electrocardiographic assessments. With the documentation of impacts of specific components of air pollutants on specific at-risk groups, these studies will provide additional insight into the understanding of the mechanisms whereby ambient pollution is associated with excess morbidity and mortality and may provide clues as to how to develop preventive strategies to reduce this excess.
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