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EPA Green Hearts Campaign

Wayne E. Cascio, MD, FACC, FAHA Director, Environmental Public Health Division National Health and Environmental Effects Research Laboratory

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•  None to report •  The content of this presentation does not

necessarily reflect the policy of EPA

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Disclosure of Conflicts of Interest

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Green Heart Initiative

The Green Heart initiative intended to:

•  Complement Million Hearts™

•  Increase environmental health literacy related to the cardiovascular effects of air pollution in individuals at risk

•  Focus on aged-adults, women and men with heart disease, and those at risk for heart disease

•  Decrease morbidity and mortality related to air pollution among those at high risk

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Particulate Matter and Health Risk Susceptible Populations

Populations and clinical groups having increased vulnerability to the adverse health effects of air particle pollution include: •  Aged adults •  Children •  Cardiovascular disease

Heart failure Ischemic heart disease Arrhythmia

•  Diabetes •  Pulmonary disease

Asthma COPD

•  Genetic polymorphisms e.g. GSTM-1

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• Evidence-based management of the traditional CV risk factors should be emphasized:

-  Life-style changes o  Healthy diet and weight management o  Increase physical activity

-  Aspirin (when appropriate) -  Blood pressure control -  Cholesterol management -  Smoking cessation (avoid second hand smoke) -  Diabetes management -  Pharmacological management as appropriate:

o  Anti-platelet and anticoagulation o  Beta-blockers o  ACE inhibitors or ARBs

-  Influenza vaccination

AHA Scientific Statement Particulate Matter Air Pollution and CVD

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A B C S

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AHA Scientific Statement Particulate Matter Air Pollution and CVD

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•  Patients with CVD •  Give consideration to educating patients without CVD but who are at high risk: -  aged-adults -  diabetes -  metabolic syndrome -  obesity -  multiple CV risk factors

Who should be educated about the CV risks posed by air pollution:

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Advice for Reducing Exposure to PM2.5

• Know when and where PM2.5 levels may be unhealthy – Any time of the year – Near busy roads, especially during

rush hour – When there is smoke in the air – Check air quality forecasts

• Plan activities when and where levels are lower – Delay activities or move them

indoors – Change your activity levels – Avoid exercising near busy roads

• Reduce your overall risk for heart disease or stroke • Know the warning signs of heart attack or stroke

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www.airnow.gov

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Forecasts

Publications

Enviroflash

Health providers

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Forecasts

• Over 400 cities • Multi-pollutants (Ozone, PM2.5, PM10, CO, and NO2) • Disseminated to national (e.g., CNN, The Weather Channel, USA Today) and local media • Available from Enviroflash and on mobile phone apps

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AQI Booklet

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Particle Pollution and Your Health

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Web courses for Healthcare Providers

• Updated ozone Web course – Offers CME credit from the

American Academy of Family Physicians (AAFP)

– Supporting tools

• PM Web course – Developing with CDC,

available 2012 – CDC will offer CME credit – Will contain section on

emergency situations

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AHA Scientific Statement Particulate Matter Air Pollution and CVD

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•  Part of patient education should include the provision of the daily EPA Air Quality Index. Available sources include: -  Local and national newspapers [e.g. USA Today]

-  EPA World Wide Web site [http://airnow.gov/]

-  The Weather Channel and its World Wide Web site [http://www.weather.com/])

What education should be provided:

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AHA Scientific Statement Particulate Matter Air Pollution and CVD

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• Based upon the forecasted AQI, prudent recommendations for decreasing exposure and limiting activity should be provided based upon the patient’s level of risk (http://airnow.gov/) (http://weather.com) - Reduce or eliminate non-mandatory travel and/or commutes - Reduce outdoor activities in highly polluted areas or times (rush hours) - Stay indoor or exercise inside using air conditioning/filters - Consider closing car windows, using recycled air, maintaining car filters

• No recommendations given for home filtration systems, air conditioning, or use of highly efficient facemasks (HEPA).

- Risk of PM exposures appears to be lessened by air conditioning - Simple facemask reduced BP-raising effect of PM in Beijing over 2

hours

- Air filtration in apartments improved endothelial function in 48 hours

- Closing apartment windows lower BP-raising effect of PM in Taiwan

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•  More than 80 million Americans are living with heart disease increasing their vulnerability to air pollutants

•  CV mortality is decreasing, yet the rising prevalence of obesity and diabetes is concerning

•  Advocacy and awareness campaigns have educated people about the risks of heart disease, yet many are still not aware of their risk from heart disease

•  Even fewer are aware of environmental triggers that can harm those living with some form of CV disease or DM

•  Incorporating an environmental health risk message as part of a healthy heart campaign is likely to improve environmental health literacy and lower short-term CV risk

•  The Green Heart initiative is intended to increase environmental health literacy and improve public health

Final Thoughts

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