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• W4385457070 abstract "Traditional cardiovascular disease (CVD) risk factors, such as diabetes, hypertension, dyslipidemia, and smoking, have been well recognized in terms of their effect on CVD and all-cause mortality.1deGoma E.M. Knowles J.W. Angeli F. Budoff M.J. Rader D.J. The evolution and refinement of traditional risk factors for cardiovascular disease.Cardiol Rev. 2012; 20: 118-129Crossref Scopus (51) Google Scholar However, nontraditional CVD risk factors, such as inflammatory markers, environmental exposures, and genetic polymorphisms, have only recently begun to be studied extensively.2Jin J. Risk assessment for cardiovascular disease with nontraditional risk factors.JAMA. 2018; 320: 316Crossref Google Scholar Park et al3Park H. Yang P.S. Sung J.H. et al.Association between the combined effects of physical activity intensity and particulate matter and all-cause mortality in older adults.Mayo Clinic Proc. 2023; 98: 1153-1163Abstract Full Text Full Text PDF Scopus (1) Google Scholar analyzed a large data set in more than a half-million individuals from South Korea, focusing on data from 161,234 adults aged 60 to 85 years, especially from 81,326 who participated in regular physical activity (PA); their analysis investigated the association between the combined effects of PA intensity and particulate matter of 10 μm or less in diameter (PM10) and all-cause mortality during a median follow-up of 45 months. They found that for the same level of total PA, moderate PA (MPA) was associated with delayed mortality, whereas vigorous PA (VPA) was associated with hastened mortality in high levels of PM10. Nonetheless, VPA and MPA were associated with delayed mortality in low to moderate levels of PM10, with VPA offering additional benefit. The findings of this study may provide guidance on the choice between VPA and MPA activity level in older adults, given the environmental exposure of those adults. This is a unique study in that in combines 2 risk factors for CVD (lack of exercise and harmful environmental exposure) and assesses how these 2 factors, when combined, can have an impact on mortality. It has been well studied that PA and exercise have numerous cardiovascular benefits and, in turn, positive results on mortality in individuals both with and without CVD. Sanchis-Gomar et al4Sanchis-Gomar F. Lavie C.J. Marín J. et al.Exercise effects on cardiovascular disease: from basic aspects to clinical evidence.Cardiovasc Res. 2022; 118: 2253-2266Crossref Scopus (29) Google Scholar conducted a comprehensive state-of-the-art review that sought to elucidate the beneficial effects of PA on CVD. They found that regular PA provided benefits in cardiac remodeling, metabolic energy optimization, angiogenesis, protection against ischemia-reperfusion injuries, protection against oxidative stress, and calcium handling. In addition, a review by Franklin et al5Franklin B.A. Wedig I.J. Sallis R.E. Lavie C.J. Elmer S.J. Physical activity and cardiorespiratory fitness as modulators of health outcomes: a compelling research-based case presented to the medical community.Mayo Clin Proc. 2023; 98: 316-331Abstract Full Text Full Text PDF Scopus (4) Google Scholar reported yet again how increased PA and cardiorespiratory fitness are associated with increased survival and decreased CVD events, chronic disease, CVD mortality, and all-cause mortality. Kim et al6Kim M.H. Sung J.H. Jin M.N. et al.Impact of physical activity on all-cause mortality according to specific cardiovascular disease.Front Cardiovasc Med. 2022; 9811058Google Scholar conducted a large cohort study in Korea that sought to evaluate the effect that PA had on mortality in patients with and without CVD; they concluded that PA is associated with a reduced risk of all-cause mortality in patients with and without prior CVD. Physiologically speaking, exercise induces changes in the body that help in decreasing blood pressure, improving mood disorders, and improving metabolism, all of which reduce the risk for development of CVD and thus improving mortality risk for individuals.7Burton D.A. Stokes K. Hall G.M. Physiological effects of exercise.Contin Educ Anaesth Crit Care Pain. 2004; 4: 185-188Abstract Full Text Full Text PDF Scopus (95) Google Scholar Exposure to harmful particulate matter can increase the risk of CVD and thus negatively affect mortality. Our recent meta-analysis evaluated 18 prospective studies consisting of more than 7 million people who were exposed to increasing levels of PM2.5 (particulate matter <2.5 μm in length) and found that exposure to increasing levels of PM2.5 was associated with an increased risk of all-cause mortality, CVD, and CVD mortality.8Krittanawong C. Qadeer Y.K. Hayes R.B. et al.PM2.5 and cardiovascular health risks.Curr Probl Cardiol. 2023; 48101670Crossref Scopus (7) Google Scholar Potential mechanisms for how this occurred included induction of a chronic vascular inflammatory state on inhalation of the particulate matter.9Rajagopalan S. Al-Kindi S.G. Brook R.D. Air pollution and cardiovascular disease: JACC state-of-the-art review.J Am Coll Cardiol. 2018; 72: 2054-2070Crossref PubMed Scopus (615) Google Scholar, 10Meier R. Cascio W.E. Ghio A.J. Wild P. Danuser B. Riediker M. Associations of short-term particle and noise exposures with markers of cardiovascular and respiratory health among highway maintenance workers.Environ Health Perspect. 2014; 122: 726-732Crossref Scopus (58) Google Scholar, 11Münzel T. Gori T. Al-Kindi S. et al.Effects of gaseous and solid constituents of air pollution on endothelial function.Eur Heart J. 2018; 39: 3543-3550Crossref PubMed Scopus (213) Google Scholar Now, Park and colleagues specifically evaluated PM10 in their study, but it is no surprise that larger particulate matter would have a similar effect on CVD and overall mortality. A large retrospective cohort study conducted by Zhang et al12Zhang L.W. Chen X. Xue X.D. et al.Long-term exposure to high particulate matter pollution and cardiovascular mortality: a 12-year cohort study in four cities in northern China.Environ Int. 2014; 62: 41-47Crossref PubMed Scopus (129) Google Scholar in China reported how increased PM10 levels are associated with increased CVD mortality. The suspected pathophysiologic mechanism involved in this process seemed to be systemic inflammation, accelerated atherosclerosis, and altered autonomic cardiac function.13Pope 3rd, C.A. Burnett R.T. Thurston G.D. et al.Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease.Circulation. 2004; 109: 71-77Crossref PubMed Scopus (2159) Google Scholar Given the beneficial effects of PA and a clean environment, guidelines have been proposed that sought to incorporate these beneficial health effects into everyday life. For example, the Physical Activity Guidelines for Americans recommend 150 to 300 min/wk of MPA or 75 to 150 min/wk of VPA.14Piercy K.L. Troiano R.P. Ballard R.M. et al.The Physical Activity Guidelines for Americans.JAMA. 2018; 320: 2020-2028Crossref PubMed Scopus (2730) Google Scholar Similarly, air pollution causes significant mortality on a yearly basis, on the magnitude of millions of people.15Cohen AJ, Brauer M, Burnett R, et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet. 2017;389(10082):1907-1918. Published correction appears in Lancet. 2017;389(10087):e15; Lancet. 2018;391(10130):1576.Google Scholar This led to the World Health Organization global air quality guideline suggesting that annual average concentration of inhalable PM10 should not exceed 15 μg/m.16World Health OrganizationWHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide.2021https://apps.who.int/iris/handle/10665/34532Google Scholar We applaud Park and colleagues because their research will enable future research and legislation about exercise and environmental exposure to be created with regard to older individuals. Specifically, on the basis of their findings, it seems that MPA and VPA for older adults with access to areas with minimal pollution offer decreased risk of mortality, whereas engaging in VPA in areas with higher levels of pollution seems to result in an increased risk of mortality. In areas of high air pollution, VPA should probably be performed indoors or with effective masking, whereas MPA appeared more universally safe. There is strong evidence backing them about the detrimental effects of increasing levels of particulate matter and strong evidence backing them about the beneficial effects of increasing levels of PA and exercise, especially that increase levels of cardiorespiratory fitness. Going forward, continuing to optimize the level of PA and exercise and an effort to decrease environmental pollution will serve to reduce the mortality risk in the entire population, including in older individuals. A substantial meta-analysis performed by Laukkanen et al17Laukkanen J.A. Isiozor N.M. Kunutsor S.K. Objectively assessed cardiorespiratory fitness and all-cause mortality risk: an updated meta-analysis of 37 cohort studies involving 2,258,029 participants.Mayo Clin Proc. 2022; 97: 1054-1073Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar analyzed 37 cohort studies including more than 2 million individuals that sought to look at the effect of increasing levels of cardiorespiratory fitness and all-cause mortality. They were able to show a strong inverse relationship between cardiorespiratory fitness and all-cause mortality, or in other words, as cardiorespiratory fitness increases, then all-cause mortality decreases. Likewise, a review conducted by Lavie et al18Lavie C.J. Arena R. Kaminsky L.A. Making the case to measure and improve cardiorespiratory fitness in routine clinical practice.Mayo Clin Proc. 2022; 97: 1038-1040Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar echoed the findings of Laukkanen while touching on data that showed that increased PA, in addition to having CVD benefits, seemed to affect prognosis in patients diagnosed with COVID-19. The authors report no competing interests. Association Between the Combined Effects of Physical Activity Intensity and Particulate Matter and All-Cause Mortality in Older AdultsMayo Clinic ProceedingsVol. 98Issue 8PreviewTo investigate the association between the combined effects of physical activity (PA) intensity and particulate matter ≤10 μm in diameter (PM10) and mortality in older adults. Full-Text PDF" @default.
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