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Urban Noise Pollution May Impact Cardiovascular Risk Prediction and Prognosis After Heart Attack
European Society of Cardiology (ESC) News
Key take-aways
- Two separate studies highlight the negative impact of noise pollution on cardiovascular health.
- Incorporating noise pollution into cardiovascular risk assessment has the potential to improve risk prediction, reclassifying patients into higher risk categories and enabling earlier intervention for myocardial infarction prevention.
- In a separate French study, there was a strong association between urban noise exposure and worse prognosis 1 year after a first heart attack.
- Urgent measures are needed to mitigate the adverse effects of pollution, including noise exposure, to reduce the burden of cardiovascular disease.
London, United Kingdom – Research from two studies in different European cities1,2 highlights that urban noise pollution has a significant negative impact on heart health, according to data presented at ESC Congress 2024.
“The DECIBEL-MI study shows that young patients aged 50 years or less who had a myocardial infarction (MI) had been exposed to higher levels of noise than the general population. The study demonstrates that urban noise could significantly increase the risk of early-onset MI in young people with low traditional risk factors. Including noise exposure in risk prediction models helps accurately identify at-risk individuals, leading to better-targeted prevention. Recognising noise as a risk factor fills a critical gap and underscores the need for public health strategies to reduce noise pollution, thereby improving cardiovascular health in young populations,” explained study investigator, Dr. Hatim Kerniss from the Gesundheit Nord Clinic Group, Bremen, Germany.
The DECIBEL-MI study included 430 consecutive patients living in Bremen, Germany, aged 50 years or younger with acute MI who were admitted to a local heart centre. When levels of residential noise exposure were calculated, the researchers observed a higher incidence of noise exposure compared to the general population in the same region. Patients with MI and a low LIFE-CVD score (≤2.5%), indicating a low level of traditional risk factors, such as smoking or diabetes, exhibited significantly higher noise exposure compared to those with a high LIFE-CVD score. This is crucial because traditional risk assessment models might underestimate the cardiovascular risk in young individuals who are otherwise considered low risk. By incorporating noise exposure into these models, it is possible to more accurately identify those at elevated risk for MI, allowing for better-targeted preventive measures and interventions.
A separate study in France assessed the impact of environmental noise exposure on prognosis after a first MI. “In the ENVI-MI study, we found a strong association between urban noise exposure, particularly at night, and worse prognosis at 1 year after a first MI,” explained study investigator, Professor Marianne Zeller from the University of Burgundy and Hospital of Dijon, France.
Data from the French observatory database (RICO) were collected for 864 patients hospitalised for an acute MI who survived at least 28 days after the MI. At 1-year follow-up, 19% presented with a major adverse cardiovascular event (MACE; cardiac death, rehospitalisation for heart failure, recurrent MI, emergency revascularisation, stroke, angina and/or unstable angina). The daily noise exposure levels measured at each patient’s home address (average noise level in A-weighted decibels [dB(A)]: 56.0 over 24 hours and 49.0 at night) were considered as moderate and representative of a large part of the European population. Of note, there was a 25% increased risk of MACE for each 10 dB(A) increase in noise during the night (hazard ratio 1.25; 95% confidence interval 1.09–1.43), independent of air pollution, socio-economic levels and other confounding factors.
“These data provide some of the first insights that noise exposure can affect prognosis. If confirmed by larger prospective studies, our analysis could help to identify new opportunities for environment-based secondary-prevention strategies, including noise barriers for high-risk MI patients,” added Professor Zeller.
Funding: The DECIBEL-MI study was supported by the Bremer Institut für Herz- und Kreislaufforschung, Bremen. The ENVI MI study was supported by a grant from Fondation Coeur et Recherche. RICO survey is supported by the University Hospital of Dijon, the Association de Cardiologie de Bourgogne, Fédération Française de Cardiologie, and by grants from the Conseil Régional de Bourgogne Franche-Comté.
Disclosures: Hatim Kerniss has no conflicts of interest to declare. Marianne Zeller reports research grants from Amarin Corp and lecture fees from Amgen, Pfizer and Organon.
References and notes
The ESC recognises noise pollution as an important factor contributing to the burden of cardiovascular disease3 and is advocating for European and national cardiovascular health plans4 to be created, which include strategies to address environmental issues including lowering noise exposure. The health benefits of reducing pollution are being increasingly realised, as detailed in the World Heart Report 2024 from the World Heart Federation.5 Population-level approaches to prevent cardiovascular disease occurring, such as tackling pollution, are a key way to reverse the impact of the world’s biggest killer.
1‘Influence of urban noise exposure on early-onset myocardial infarction risk prediction’ will be presented at the session ‘Cardiovascular risk factors and risk prediction’ on Friday 30 August 2024 at 13.00 to 13.50 BST at Station 4.
2‘Environmental noise exposure is associated with one-year survival after a first myocardial infarction’ will be presented at the session ‘Assessment of residual risk in cardiovascular conditions’ on Friday 30 August 2024 at 17.00 to 17.50 BST at Station 4.
3Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41:407–477.
4Improving cardiovascular health in Europe: the case for EU and national CVH plans. Hungarian Ministry of Health in collaboration with the European Society of Cardiology.
5World Heart Federation. World Heart Report 2024. Clearing the air to address pollution’s cardiovascular health crisis. Last accessed August 2024.
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