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Air quality improvement during 2010 Asian games on blood coagulability in COPD patients

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Abstract

Exposure to elevated levels of ambient air pollutants can lead to adverse cardiovascular effects. Perturbation of the coagulation balance is one of the potential mechanisms. However, evidence regarding the impact of improvement in air pollution on blood coagulability in COPD patients has never been reported. Coagulation processes are known to be of relevance for cardiovascular pathology; therefore, this study aimed to investigate the association of short-term air pollution exposure with blood marker (D-dimer) of coagulation. A 3-year (through the Asian game) cohort study based on the GIRD COPD Biobank Project was conducted in 36 COPD patients to estimate whether changes in measurements of D-dimer were associated with changes in pollutant concentration, comparing for 51 intervention days (November 1–December 21) in 2010 with the same calendar date of baseline years (2009 and 2011). Daily mean concentrations of air pollutants and meteorological variables were measured during the time. Daily PM10 decreased from 65.86 μg/m3 during the baseline period to 62.63 μg/m3 during the Asian Games period; daily NO2 decreased from 51.33 to 42.63 μg/m3. SO2 and other weather variables did not differ substantially. We did not observe statistically significant improvements in D-dimer levels by 9.86 % from a pre-Asian game mean of 917 ng/ml to a during-Asian game mean of 1007 ng/ml, platelet number by 11.66 %, PH by −0.15 %, PCO2 by −6.54 %, and PO2 by −1.16 %. In the post-Asian game period, when pollutant concentrations increased, most outcomes approximated pre-Asian game levels, and similar effects were also demonstrated in D-dimer, platelet number, and arterial blood gas. For D-dimer and platelet number, we observed statistically significant increases associated with increases in NO2 at lag 1–3 and SO2 at lag 2–4. For PH, PCO2, and PO2, any significant effect was not demonstrated. This study gives no support to the hypothesis that reduction in air pollution levels during the 2010 Asian game is associated with activation of blood coagulation with COPD patients. However, one step forward has been made on the gap between improved air pollution and blood coagulability. Meanwhile, our study also provides evidence for the presence of a hypercoagulative state in systemic circulation in COPD patients. Additional studies employing other susceptible populations and endpoints are pending.

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Abbreviations

COPD:

Chronic obstructive pulmonary disease

PM10 :

Diameter measuring less than 10 μm

SO2 :

Sulfur dioxide

NO2 :

Nitrogen dioxide

VTE:

Venous thrombus embolism

PE:

Pulmonary embolism

References

  • Altiay G, Ciftci A, Demir M, Kocak Z, Sut N, Tabakoglu E, Hatipoglu ON, Caglar T (2007) High plasma D-dimer level is associated with decreased survival in patients with lung cancer. Clin Oncol (R Coll Radiol) 19:494–498

    Article  CAS  Google Scholar 

  • Arregui MA, Ezquerra KL, Lopez FC, Lacasa RC (2010) Hypercoagulability state and endotelial injury in stable chronic obstructive pulmonary disease patients. An Sist Sanit Navar 33:43–50

    Google Scholar 

  • Ay C, Dunkler D, Pirker R, Thaler J, Quehenberger P, Wagner O, Zielinski C, Pabinger I (2012) High D-dimer levels are associated with poor prognosis in cancer patients. Haematologica 97:1158–1164

    Article  CAS  Google Scholar 

  • Barnes PJ (2000) Chronic obstructive pulmonary disease. N Engl J Med 343:269–280

    Article  CAS  Google Scholar 

  • Batschauer AP, Figueiredo CP, Bueno EC, Ribeiro MA, Dusse LM, Fernandes AP, Gomes KB, Carvalho MG (2009) D-dimer as a possible prognostic marker of operable hormone receptor-negative breast cancer. Ann Oncol 21:1267–1272

    Article  Google Scholar 

  • Becker S, Mundandhara S, Devlin RB, Madden M (2005) Regulation of cytokine production in human alveolar macrophages and airway epithelial cells in response to ambient air pollution particles: further mechanistic studies. Toxicol Appl Pharmacol 207:269–275

    Article  Google Scholar 

  • Bick RL, Baker WF (1992) Diagnostic efficacy of the D-dimer assay in disseminated intravascular coagulation (DIC). Thromb Res 65:785–790

    Article  CAS  Google Scholar 

  • Blomberg A, Tornqvist H, Desmyter L, Deneys V, Hermans C (2005) Exposure to diesel exhaust nanoparticles does not induce blood hypercoagulability in an at-risk population. J Thromb Haemost 3:2103–2105

    Article  CAS  Google Scholar 

  • Buller HR, van Doormaal FF, van Sluis GL, Kamphuisen PW (2007) Cancer and thrombosis: from molecular mechanisms to clinical presentations. J Thromb Haemost 5(Suppl 1):246–254

    Article  CAS  Google Scholar 

  • Carlsten C, Kaufman JD, Peretz A, Trenga CA, Sheppard L, Sullivan JH (2007) Coagulation markers in healthy human subjects exposed to diesel exhaust. Thromb Res 120:849–855

    Article  CAS  Google Scholar 

  • Carter CJ, Doyle DL, Dawson N, Fowler S, Devine DV (1993) Investigations into the clinical utility of latex D-dimer in the diagnosis of deep venous thrombosis. Thromb Haemost 69(8–11):24

    Google Scholar 

  • Demetz G, Ott I (2012) The interface between inflammation and coagulation in cardiovascular disease. Int J Inflamm 2012:860301

    Article  Google Scholar 

  • Dupuy E, Hainaud P, Villemain A, Bodevin-Phedre E, Brouland JP, Briand P, Tobelem G (2003) Tumoral angiogenesis and tissue factor expression during hepatocellular carcinoma progression in a transgenic mouse model. J Hepatol 38:793–802

    Article  CAS  Google Scholar 

  • Esmon CT (2000) Does inflammation contribute to thrombotic events? Haemostasis 30(Suppl 2):34–40

    CAS  Google Scholar 

  • Ghio AJ, Hall A, Bassett MA, Cascio WE, Devlin RB (2003) Exposure to concentrated ambient air particles alters hematologic indices in humans. Inhal Toxicol 15:1465–1478

    Article  CAS  Google Scholar 

  • Gottesman RF, Cummiskey C, Chambless L, Wu KK, Aleksic N, Folsom AR, Sharrett AR (2009) Hemostatic factors and subclinical brain infarction in a community-based sample: the ARIC study. Cerebrovasc Dis 28:589–594

    Article  CAS  Google Scholar 

  • Gunen H, Gulbas G, In E, Yetkin O, Hacievliyagil SS (2009) Venous thromboemboli and exacerbations of COPD. Eur Respir J 35:1243–1248

    Article  Google Scholar 

  • Imrich A, Ning Y, Lawrence J, Coull B, Gitin E, Knutson M, Kobzik L (2007) Alveolar macrophage cytokine response to air pollution particles: oxidant mechanisms. Toxicol Appl Pharmacol 218:256–264

    Article  CAS  Google Scholar 

  • Kilic M, Yoldas O, Keskek M, Ertan T, Tez M, Gocmen E, Koc M (2008) Prognostic value of plasma D-dimer levels in patients with colorectal cancer. Color Dis 10:238–241

    Article  CAS  Google Scholar 

  • Kleinegris MC, ten Cate H, ten Cate-Hoek AJ (2013) D-dimer as a marker for cardiovascular and arterial thrombotic events in patients with peripheral arterial disease. A systematic review. Thromb Haemost 110:233–243

    Article  CAS  Google Scholar 

  • Komurcuoglu B, Ulusoy S, Gayaf M, Guler A, Ozden E (2012) Prognostic value of plasma D-dimer levels in lung carcinoma. Tumori 97:743–748

    Google Scholar 

  • Libby P, Simon DI (2001) Inflammation and thrombosis: the clot thickens. Circulation 103:1718–1720

    Article  CAS  Google Scholar 

  • Libby P, Ridker PM, Maseri A (2002) Inflammation and atherosclerosis. Circulation 105:1135–1143

    Article  CAS  Google Scholar 

  • Lippi G, Franchini M, Biasiutti C, Dellagiacoma G, Salvagno GL, Guidi GC (2007) Increased D-dimer value and occult cancer in the absence of detectable thrombosis. Haematologica 92:e53–e55

    Article  CAS  Google Scholar 

  • Lowe GD, Yarnell JW, Rumley A, Bainton D, Sweetnam PM (2001) C-reactive protein, fibrin D-dimer, and incident ischemic heart disease in the speedwell study: are inflammation and fibrin turnover linked in pathogenesis? Arterioscler Thromb Vasc Biol 21:603–610

    Article  CAS  Google Scholar 

  • Mitchell RS, Silvers GW, Dart GA, Petty TL, Vincent TN, Ryan SF, Filley GF (1968) Clinical and morphologic correlations in chronic airway obstruction. Aspen Emphysema Conf 9:109–123

    CAS  Google Scholar 

  • Panasevich S, Leander K, Rosenlund M, Ljungman P, Bellander T, de Faire U, Pershagen G, Nyberg F (2009) Associations of long- and short-term air pollution exposure with markers of inflammation and coagulation in a population sample. Occup Environ Med 66:747–753

    Article  CAS  Google Scholar 

  • Peters A, Doring A, Wichmann HE, Koenig W (1997) Increased plasma viscosity during an air pollution episode: a link to mortality? Lancet 349:1582–1587

    Article  CAS  Google Scholar 

  • Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, Enright PL, Hankinson JL, Ip MS, Zheng J, Stocks J (2012) Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 40:1324–1343

    Article  Google Scholar 

  • Raj SD, Zhou X, Bueso-Ramos CE, Ravi V, Patel S, Benjamin RS, Vadhan-Raj S (2011) Prognostic significance of elevated D-dimer for survival in patients with sarcoma. Am J Clin Oncol 35:462–467

    Article  Google Scholar 

  • Rowbotham BJ, Carroll P, Whitaker AN, Bunce IH, Cobcroft RG, Elms MJ, Masci PP, Bundesen PG, Rylatt DB, Webber AJ (1987) Measurement of crosslinked fibrin derivatives—use in the diagnosis of venous thrombosis. Thromb Haemost 57:59–61

    CAS  Google Scholar 

  • Ruckerl R, Ibald-Mulli A, Koenig W, Schneider A, Woelke G, Cyrys J, Heinrich J, Marder V, Frampton M, Wichmann HE, Peters A (2006) Air pollution and markers of inflammation and coagulation in patients with coronary heart disease. Am J Respir Crit Care Med 173:432–441

    Article  Google Scholar 

  • Seaton A, MacNee W, Donaldson K, Godden D (1995) Particulate air pollution and acute health effects. Lancet 345:176–178

    Article  CAS  Google Scholar 

  • Stone AC, Nici L (2007) Other systemic manifestations of chronic obstructive pulmonary disease. Clin Chest Med 28(553–7):vi

    Google Scholar 

  • Stott DJ, Spilg E, Campbell AM, Rumley A, Mansoor MA, Lowe GD (2001) Haemostasis in ischaemic stroke and vascular dementia. Blood Coagul Fibrinolysis 12:651–657

    Article  CAS  Google Scholar 

  • Tomimaru Y, Yano M, Takachi K, Kishi K, Miyashiro I, Ohue M, Ohigashi H, Sasaki Y, Ishikawa O, Imaoka S (2006) Plasma D-dimer levels show correlation with number of lymph node metastases in patients with esophageal cancer. J Am Coll Surg 202:139–145

    Article  Google Scholar 

  • Tzoulaki I, Murray GD, Lee AJ, Rumley A, Lowe GD, Fowkes FG (2007) Inflammatory, haemostatic, and rheological markers for incident peripheral arterial disease: Edinburgh artery study. Eur Heart J 28:354–362

    Article  CAS  Google Scholar 

  • Utell MJ, Frampton MW (2000) Acute health effects of ambient air pollution: the ultrafine particle hypothesis. J Aerosol Med 13:355–359

    Article  CAS  Google Scholar 

  • van Eeden SF, Tan WC, Suwa T, Mukae H, Terashima T, Fujii T, Qui D, Vincent R, Hogg JC (2001) Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)). Am J Respir Crit Care Med 164:826–830

    Article  Google Scholar 

  • Wannamethee SG, Whincup PH, Shaper AG, Rumley A, Lennon L, Lowe GD (2009) Circulating inflammatory and hemostatic biomarkers are associated with risk of myocardial infarction and coronary death, but not angina pectoris, in older men. J Thromb Haemost 7:1605–1611

    Article  CAS  Google Scholar 

  • Zakai NA, Katz R, Jenny NS, Psaty BM, Reiner AP, Schwartz SM, Cushman M (2007) Inflammation and hemostasis biomarkers and cardiovascular risk in the elderly: the cardiovascular health study. J Thromb Haemost 5:1128–1135

    Article  CAS  Google Scholar 

  • Zhang Z, Wang J, Chen L, Chen X, Sun G, Zhong N, Kan H, Lu W (2013) Impact of haze and air pollution-related hazards on hospital admissions in Guangzhou, China. Environ Sci Pollut Res Int 21:4236–4244

    Article  Google Scholar 

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    Authors and Affiliations

    1. State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, People’s Republic of China

      Zili Zhang, Jian Wang, Meihua Guo, Mingmei Xiong, Qipeng Zhou, Defu Li, Jiaze Shu & Wenju Lu

    2. Department of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

      Jian Wang

    3. Department of Respiratory Medicine, Inner Mongolia Autonomous Region People’s Hospital, Hohhot, 010017, Inner Mongolia Autonomous Region, China

      Dejun Sun

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    1. Zili Zhang
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    Correspondence to Wenju Lu or Dejun Sun.

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    Funding sources

    This work was supported by National Natural Science Foundation of China (81560013, 81173112, 81220108001, 81520108001), Key Project of Chinese National Programs for Fundamental Research and Development (973 Program; 2015CB553406), the Science and Technology Innovation Guiding Project of Inner Mongolia Autonomous Region; the Hospital Fund from Inner Mongolia Autonomous Region People’s Hospital (No. 201403), the Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (W. Lu; 2014), the Key Project of Department of Education of Guangdong Province (cxzd1142), Guangzhou Department of Education Yangcheng Scholarship (12A001S), Guangzhou Department of Education Team Grant for Innovation (13C08), and the Municipal Project of Department of Education of Guangzhou (1201430298). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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    The authors have declared that no competing interests exist

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    Responsible editor: Philippe Garrigues

    Zili Zhang, Jian Wang, Meihua Guo, and Mingmei Xiong contributed equally to this work.

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    Zhang, Z., Wang, J., Guo, M. et al. Air quality improvement during 2010 Asian games on blood coagulability in COPD patients. Environ Sci Pollut Res 23, 6631–6638 (2016). https://doi.org/10.1007/s11356-015-5871-y

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