title: Air pollution and heart rate variability: effect modification by chronic lead exposure.
abstract: BACKGROUND
  Outdoor air pollution and lead exposure can disturb cardiac autonomic function, but the effects of both these exposures together have not been studied.
  
  
  METHODS
  We examined whether higher cumulative lead exposures, as measured by bone lead, modified cross-sectional associations between air pollution and heart rate variability among 384 elderly men from the Normative Aging Study. We used linear regression, controlling for clinical, demographic, and environmental covariates.
  
  
  RESULTS
  We found graded, significant reductions in both high-frequency and low-frequency powers of heart rate variability in relation to ozone and sulfate across the quartiles of tibia lead. Interquartile range increases in ozone and sulfate were associated respectively, with 38% decrease (95% confidence interval = -54.6% to -14.9%) and 22% decrease (-40.4% to 1.6%) in high frequency, and 38% decrease (-51.9% to -20.4%) and 12% decrease (-28.6% to 9.3%) in low frequency, in the highest quartile of tibia lead after controlling for potential confounders. We observed similar but weaker effect modification by tibia lead adjusted for education and cumulative traffic (residuals of the regression of tibia lead on education and cumulative traffic). Patella lead modified only the ozone effect on heart rate variability.
  
  
  CONCLUSIONS
  People with long-term exposure to higher levels of lead may be more sensitive to cardiac autonomic dysfunction on high air pollution days. Efforts to understand how environmental exposures affect the health of an aging population should consider both current levels of pollution and history of lead exposure as susceptibility factors.
authors: Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109, USA. sungkyun@umich.edu
authors: Sung Kyun
authors: SK
authors: Park
authors: Marie S
authors: MS
authors: O'Neill
authors: Pantel S
authors: PS
authors: Vokonas
authors: David
authors: D
authors: Sparrow
authors: Robert O
authors: RO
authors: Wright
authors: Brent
authors: B
authors: Coull
authors: Huiling
authors: H
authors: Nie
authors: Howard
authors: H
authors: Hu
authors: Joel
authors: J
authors: Schwartz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000032:analysis* / Q000633:toxicity; D001842:Bone and Bones / Q000737:chemistry; D001900:Boston; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis*; D006334:Heart Function Tests; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007854:Lead / Q000032:analysis* / Q000633:toxicity*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010126:Ozone / Q000032:analysis; D013431:Sulfates / Q000032:analysis
chemical_list: D000393:Air Pollutants; D013431:Sulfates; D007854:Lead; D010126:Ozone