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Association of Ozone Exposure With Cardiorespiratory Pathophysiologic Mechanisms in Healthy Adults
Open accessAbstract
Importance: Exposure to ozone has been associated with cardiovascular mortality, but the underlying biological mechanisms are not yet understood. Objective: To examine the association between ozone exposure and cardiopulmonary pathophysiologic mechanisms. Design, Setting, and Participants: A longitudinal study involving 89 healthy adult participants living on a work campus in Changsha City, China, was conducted from December 1, 2014, to January 31, 2015. This unique quasiexperimental setting allowed for better characterization of air pollutant exposure effects because the participants spent most of their time in controlled indoor environments. Concentrations of indoor and outdoor ozone, along with the copollutants particulate matter, nitrogen dioxide, and sulfur dioxide, were monitored throughout the study period and then combined with time-activity information and filtration conditions of each residence and office to estimate 24-hour and 2-week combined indoor and outdoor mean exposure concentrations. Associations between each exposure measure and outcome measure were analyzed using single-pollutant and 2-pollutant linear mixed models controlling for ambient temperature, secondhand smoke exposure, and personal-level time-varying covariates. Main Outcomes and Measures: Biomarkers indicative of inflammation and oxidative stress, arterial stiffness, blood pressure, thrombotic factors, and spirometry were measured at 4 sessions. Results: Of the 89 participants, 25 (28%) were women and the mean (SD) age was 31.5 (7.6) years. The 24-hour ozone exposure concentrations ranged from 1.4 to 19.4 parts per billion (ppb), corresponding to outdoor concentrations ranging from 4.3 to 47.9 ppb. Within this range, in models controlling for a second copollutant and other potential confounders, a 10-ppb increase in 24-hour ozone was associated with mean increases of 36.3% (95% CI, 29.9%-43.0%) in the level of platelet activation marker soluble P-selectin, 2.8% (95% CI, 0.6%-5.1%) in diastolic blood pressure, 18.1% (95% CI, 4.5%-33.5%) in pulmonary inflammation markers fractional exhaled nitric oxide, and 31.0% (95% CI, 0.2%-71.1%) in exhaled breath condensate nitrite and nitrate as well as a -9.5% (95% CI, -17.7% to -1.4%) decrease in arterial stiffness marker augmentation index. A 10-ppb increase in 2-week ozone was associated with increases of 61.1% (95% CI, 37.8%-88.2%) in soluble P-selectin level and 126.2% (95% CI, 12.1%-356.2%) in exhaled breath condensate nitrite and nitrate level. Other measured biomarkers, including spirometry, showed no significant associations with either 24-hour ozone or 2-week ozone exposures. Conclusions and Relevance: Short-term ozone exposure at levels not associated with lung function changes was associated with platelet activation and blood pressure increases, suggesting a possible mechanism by which ozone may affect cardiovascular health.
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“In addressing exposure to low-level concentrations (such as concentrations below the current air quality standard), however, 24-h average may be another relevant measure of daily exposure, at least for certain outcomes (21–24).”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [21]
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Metadata
- Authors
- Day, D. B., Xiang, J., Mo, J., Li, F., Chung, M., Gong, J., Weschler, C. J., Ohman-Strickland, P. A., Sundell, J., Weng, W., Zhang, Y., & Zhang, J. (.
- Affiliations
- Duke University (US)
- Tsinghua University (CN)
- Shanghai Jiao Tong University (CN)
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
- Rutgers, The State University of New Jersey (US)
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey
- Corresponding author
- Zhang, Junfeng (Jim)
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2017-09-01
- Volume
- 177
- Issue
- 9
- Pages
- 1344
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC5710579
- OpenAlex
- W2736092386
- Cited by
- 264
- References
- 50
- Citations by year
- 2026: 19 · 2025: 31 · 2024: 39 · 2023: 23 · 2022: 37 · 2021: 29 · 2020: 33 · 2019: 34 · 2018: 15 · 2017: 3
- FWCI
- 12.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- ozone exposure, air pollution health effects, oxidative stress, inflammation, arterial stiffness, blood pressure, platelet activation, soluble P-selectin, exhaled nitric oxide, lung function, spirometry, particulate matter, nitrogen dioxide, sulfur dioxide
- MeSH terms
- Adult, Air Pollution, Breath Tests, Cardiovascular Diseases, China, Environmental Exposure, Female, Humans, Male, Nitrates, Nitrites, Nitrogen Dioxide, Ozone, Pneumonia, Prothrombin Time, Spirometry, Oxidative Stress, Vascular Stiffness
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