{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:12:15Z","timestamp":1790017935709,"version":"4.0.1"},"reference-count":58,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,2,24]],"date-time":"2019-02-24T00:00:00Z","timestamp":1550966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Persons living with chronic medical conditions (such as coronary artery disease (CAD)) are thought to be at increased risk when exposed to air pollution. This systematic review critically evaluated the short-term health effects of air pollution in persons living with CAD. Original research articles were retrieved systematically through searching electronic databases (e.g., Medical Literature Analysis and Retrieval System Online (MEDLINE)), cross-referencing, and the authors\u2019 knowledge. From 2884 individual citations, 26 eligible articles were identified. The majority of the investigations (18 of 22 (82%)) revealed a negative relationship between air pollutants and cardiac function or overall health. Heart rate variability (HRV) was the primary cardiovascular outcome measure, with 10 out of 13 studies reporting at least one index of HRV being significantly affected by air pollutants. However, there was some inconsistency in the relationship between HRV and air pollutants, mediated (at least in part) by the confounding effects of beta-blocker medications. In conclusion, there is strong evidence that air pollution can have adverse effects on cardiovascular function in persons living with CAD. All persons living with CAD should be educated on how to monitor air quality, should recognize the potential risks of excessive exposure to air pollution, and be aware of strategies to mitigate these risks. Persons living with CAD should minimize their exposure to air pollution by limiting outdoor physical activity participation when the forecast air quality health index indicates increased air pollution (i.e., an increased risk).<\/jats:p>","DOI":"10.3390\/jcm8020274","type":"journal-article","created":{"date-parts":[[2019,2,25]],"date-time":"2019-02-25T03:06:52Z","timestamp":1551064012000},"page":"274","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["A Systematic Review of the Short-Term Health Effects of Air Pollution in Persons Living with Coronary Heart Disease"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2842-9170","authenticated-orcid":false,"given":"Darren E. R.","family":"Warburton","sequence":"first","affiliation":[{"name":"Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon S. D.","family":"Bredin","sequence":"additional","affiliation":[{"name":"Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"Laboratory for Knowledge Mobilization, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Shellington","sequence":"additional","affiliation":[{"name":"Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"Laboratory for Knowledge Mobilization, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christie","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Heart Wise Exercise, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"de Faye","sequence":"additional","affiliation":[{"name":"Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"Laboratory for Knowledge Mobilization, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Heart Wise Exercise, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D.","family":"Kim","sequence":"additional","affiliation":[{"name":"Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"Laboratory for Knowledge Mobilization, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Abelsohn","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/S0140-6736(13)60898-3","article-title":"Global association of air pollution and heart failure: A systematic review and meta-analysis","volume":"382","author":"Shah","year":"2013","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"h1295","DOI":"10.1136\/bmj.h1295","article-title":"Short term exposure to air pollution and stroke: Systematic review and meta-analysis","volume":"350","author":"Shah","year":"2015","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1164\/ajrccm\/151.3_Pt_1.669","article-title":"Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults","volume":"151","author":"Pope","year":"1995","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","unstructured":"World Health Organization (2014). Burden of Disease from Ambient Air Pollution for 2012, World Health Organization."},{"key":"ref_5","unstructured":"Canadian Medical Association (2008). No Breathing Room: National Illness Costs of Air Pollution, Canadian Medical Association."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/EDE.0b013e3181878b50","article-title":"Ambient air pollution and daily mortality among survivors of myocardial infarction","volume":"20","author":"Berglind","year":"2009","journal-title":"Epidemiology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1289\/ehp.8145","article-title":"Effects of particle size fractions on reducing heart rate variability in cardiac and hypertensive patients","volume":"113","author":"Chuang","year":"2005","journal-title":"Environ. Health Perspect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1289\/ehp.1408387","article-title":"Effects of ambient coarse, fine, and ultrafine particles and their biological constituents on systemic biomarkers: A controlled human exposure study","volume":"123","author":"Liu","year":"2015","journal-title":"Environ. Health Perspect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1289\/ehp.8856","article-title":"Coarse particles and heart rate variability among older adults with coronary artery disease in the Coachella Valley, California","volume":"114","author":"Lipsett","year":"2006","journal-title":"Environ. Health Perspect."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3073","DOI":"10.1161\/CIRCULATIONAHA.105.548743","article-title":"HormanAmbient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in five European cities","volume":"112","author":"Peters","year":"2005","journal-title":"Circulation"},{"key":"ref_11","unstructured":"Environment Canada (2015). Air Quality Health Index."},{"key":"ref_12","unstructured":"Environment Canada (2013). National Air Pollution Surveillance Program (NAPS)."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1093\/oxfordjournals.aje.a010121","article-title":"Patients with chronic obstructive pulmonary disease are at increased risk of death associated with urban particle air pollution: A case-crossover analysis","volume":"151","author":"Sunyer","year":"2000","journal-title":"Am. J. Epidemiol."},{"key":"ref_14","first-page":"487","article-title":"Identification of persons with cardiorespiratory conditions who are at risk of dying from the acute effects of ambient air particles","volume":"109","author":"Goldberg","year":"2001","journal-title":"Environ. Health Perspect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/00001648-200107000-00011","article-title":"Effects of ambient air pollution on daily mortality in a cohort of patients with congestive heart failure","volume":"12","author":"Kwon","year":"2001","journal-title":"Epidemiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/01.ede.0000112210.68754.fa","article-title":"Who is sensitive to the effects of particulate air pollution on mortality? A case-crossover analysis of effect modifiers","volume":"15","author":"Bateson","year":"2004","journal-title":"Epidemiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1097\/EDE.0b013e3181d5e19b","article-title":"Traffic-related air pollution and blood pressure in elderly subjects with coronary artery disease","volume":"21","author":"Delfino","year":"2010","journal-title":"Epidemiology"},{"key":"ref_18","first-page":"1217","article-title":"Ambient carbon monoxide may influence heart rate variability in subjects with coronary artery disease","volume":"46","author":"Dales","year":"2004","journal-title":"J. Occup. Environ. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1289\/ehp.11062","article-title":"Associations between PM2.5 and heart rate variability are modified by particle composition and beta-blocker use in patients with coronary heart disease","volume":"117","author":"Lanki","year":"2009","journal-title":"Environ. Health Perspect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1097\/JOM.0b013e3181e8071f","article-title":"Exposure error masks the relationship between traffic-related air pollution and heart rate variability","volume":"52","author":"Suh","year":"2010","journal-title":"J. Occup. Environ. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1046\/j.1475-097X.2003.00478.x","article-title":"Effect of acute carbon monoxide exposure on heart rate variability in patients with coronary artery disease","volume":"23","author":"Tarkiainen","year":"2003","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1289\/ehp.8337","article-title":"The relationship between ambient air pollution and heart rate variability differs for individuals with heart and pulmonary disease","volume":"114","author":"Wheeler","year":"2006","journal-title":"Environ. Health Perspect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1289\/ehp.0901003","article-title":"Reduction in heart rate variability with traffic and air pollution in patients with coronary artery disease","volume":"118","author":"Zanobetti","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/sj.jea.7500453","article-title":"Personal PM2.5 and CO exposures and heart rate variability in subjects with known ischemic heart disease in Mexico City","volume":"16","author":"Vallejo","year":"2006","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1503\/cmaj.051351","article-title":"Health benefits of physical activity: The evidence","volume":"174","author":"Warburton","year":"2006","journal-title":"Can. Med. Assoc. J."},{"key":"ref_26","unstructured":"Weather Channel (2015). Air Quality Index: Weather Channel, Weather Channel."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and Prisma Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA staement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.cjca.2012.07.003","article-title":"A systematic review of the health benefits of exercise rehabilitation in persons living with atrial fibrillation","volume":"29","author":"Giacomantonio","year":"2013","journal-title":"Can. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/1479-5868-7-39","article-title":"A systematic review of the evidence for Canada\u2019s Physical Activity Guidelines for Adults","volume":"7","author":"Warburton","year":"2010","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1136\/jech.52.6.377","article-title":"The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions","volume":"52","author":"Downs","year":"1998","journal-title":"J. Epidemiol. Comm. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"669","DOI":"10.7326\/0003-4819-77-5-669","article-title":"Effect of freeway travel on angina pectoris","volume":"77","author":"Aronow","year":"1972","journal-title":"Ann. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1056\/NEJMoa066314","article-title":"Ischemic and thrombotic effects of dilute diesel-exhaust inhalation in men with coronary heart disease","volume":"357","author":"Mills","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"343","DOI":"10.7326\/0003-4819-113-5-343","article-title":"Production of arrhythmias by elevated carboxyhemoglobin in patients with coronary artery disease","volume":"113","author":"Sheps","year":"1990","journal-title":"Ann. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1136\/hrt.2004.051672","article-title":"Effect of inhaled sulphur dioxide and carbon particles on heart rate variability and markers of inflammation and coagulation in human subjects","volume":"92","author":"Routledge","year":"2006","journal-title":"Heart"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1136\/oemed-2011-100126","article-title":"Lack of effect of nitrogen dioxide exposure on heart rate variability in patients with stable coronary heart disease and impaired left ventricular systolic function","volume":"69","author":"Scaife","year":"2012","journal-title":"Occup. Environ. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1136\/hrt.2010.199042","article-title":"Diesel exhaust inhalation does not affect heart rhythm or heart rate variability","volume":"97","author":"Mills","year":"2011","journal-title":"Heart"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S0140-6736(17)32643-0","article-title":"Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: A randomised, crossover study","volume":"391","author":"Sinharay","year":"2018","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1161\/01.CIR.0000027561.41736.3C","article-title":"Particulate air pollution and risk of ST-segment depression during repeated submaximal exercise tests among subjects with coronary heart disease: The Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air (ULTRA) study","volume":"106","author":"Pekkanen","year":"2002","journal-title":"Circulation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1161\/CIRCULATIONAHA.108.765669","article-title":"Particulate air pollution as a risk factor for ST-segment depression in patients with coronary artery disease","volume":"118","author":"Chuang","year":"2008","journal-title":"Circulation"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1289\/ehp.8578","article-title":"Can we identify sources of fine particles responsible for exercise-induced ischemia on days with elevated air pollution? The ULTRA study","volume":"114","author":"Lanki","year":"2006","journal-title":"Environ. Health Perspect."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s12940-017-0335-0","article-title":"Ozone exposure in associated with acute changes in inflammation, fibrinolysis, and endothelial cell function in coroary artery disease patients","volume":"16","author":"Mirowsky","year":"2017","journal-title":"Environ. Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1289\/ehp.1104262","article-title":"Are Ambient Ultrafine, Accumulation Mode, and Fine Particles Associated with Adverse Cardiac Responses in Patients Undergoing Cardiac Rehabilitation?","volume":"120","author":"Rich","year":"2012","journal-title":"Environ. Health Perpect."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1161\/01.CIR.0000154546.32135.6E","article-title":"Ozone air pollution is associated with acute myocardial infarction","volume":"111","author":"Ruidavets","year":"2005","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12989-018-0275-z","article-title":"Short-term effects of fine particulate matter and ozone on the cardiac conduction system in patients undergoing cardiac catheterization","volume":"15","author":"Zhang","year":"2018","journal-title":"Part. Fibre Toxicol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/1476-069X-8-58","article-title":"Fine particulate air pollution and its components in association with cause-specific emergency admissions","volume":"8","author":"Zanobetti","year":"2009","journal-title":"Environ. Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1161\/01.CIR.0000108927.80044.7F","article-title":"Cardiovascular mortality and long-term exposure to particulate air pollution: Epidemiological evidence of general pathophysiological pathways of disease","volume":"109","author":"Pope","year":"2004","journal-title":"Circulation"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1056\/NEJM199312093292401","article-title":"An association between air pollution and mortality in six U.S. cities","volume":"329","author":"Dockery","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/01.ede.0000152528.22746.0f","article-title":"Ambient particulate matter and health effects: Publication bias in studies of short-term associations","volume":"16","author":"Anderson","year":"2005","journal-title":"Epidemiology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1161\/01.CIR.102.11.1239","article-title":"Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: The ARIC Study. Atherosclerosis Risk In Communities","volume":"102","author":"Dekker","year":"2000","journal-title":"Circulation"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1042\/CS20070444","article-title":"Cardiovascular effects of air pollution","volume":"115","author":"Brook","year":"2008","journal-title":"Clin. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1743-8977-11-1","article-title":"Ambient fine particulate air pollution triggers ST-elevation myocardial infarction, but not non-ST elevation myocardial infarction: A case-crossover study","volume":"11","author":"Gardner","year":"2014","journal-title":"Part. Fibre Toxicol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1042\/cs0970585","article-title":"Use of opposing reflex stimuli and heart rate variability to examine the effects of lipophilic and hydrophilic beta-blockers on human cardiac vagal control","volume":"97","author":"Vaile","year":"1999","journal-title":"Clin. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1038\/sj.jea.7500460","article-title":"Effects of ultrafine and fine particulate and gaseous air pollution on cardiac autonomic control in subjects with coronary artery disease: The ULTRA study","volume":"16","author":"Timonen","year":"2006","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/HCR.0b013e318284ec82","article-title":"International Charter on Cardiovascular Prevention and Rehabilitation: A call for action","volume":"33","author":"Grace","year":"2013","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_55","first-page":"CD007130","article-title":"Home-based versus centre-based cardiac rehabilitation","volume":"2010","author":"Taylor","year":"2010","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_56","unstructured":"Stone, J.A. (2009). Health behaviour interventions and cardiovascular disease risk factor modifications. Canadian Guidelines for Cardiac Rehabilitation and Cardiovascular Disease Prevention, Canadian Association of Cardiac Rehabilitation. [3rd ed.]."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Warburton, D.E.R., Bredin, S.S.D., Jamnik, V., Shephard, R.J., and Gledhill, N. (2016). Consensus on Evidence-Based Preparticipation Screening and Risk Stratification. Annual Review of Gerontology and Geriatrics, Springer Publishing Company.","DOI":"10.1891\/0198-8794.36.53"},{"key":"ref_58","unstructured":"Heart and Stroke Foundation of Canada (2008). 2008 Heart and Stroke Foundation Report Card on Canadians\u2019 Health, Heart and Stroke Foundation of Canada."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/2\/274\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:34:30Z","timestamp":1760186070000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/2\/274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,24]]},"references-count":58,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,2]]}},"alternative-id":["jcm8020274"],"URL":"https:\/\/doi.org\/10.3390\/jcm8020274","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,24]]}}}