title: Systematic review of the effects of black carbon on cardiovascular disease among individuals with pre-existing disease.
abstract: OBJECTIVE
  Recent interest has developed in understanding the health effects attributable to different components of particulate matter. This review evaluates the effects of black carbon (BC) on cardiovascular disease in individuals with pre-existing disease using evidence from epidemiologic and experimental studies.
  
  
  METHODS
  A systematic literature search was conducted to identify epidemiologic and experimental studies examining the relationship between BC and cardiovascular health effects in humans with pre-existing diseases. Nineteen epidemiologic and six experimental studies were included. Risk of bias was evaluated for each study.
  
  
  RESULTS
  Evidence across studies suggested ambient BC is associated with changes in subclinical cardiovascular health effects in individuals with diabetes and coronary artery disease (CAD). Limited evidence demonstrated that chronic respiratory disease does not modify the effect of BC on cardiovascular health.
  
  
  CONCLUSIONS
  Results in these studies consistently demonstrated that diabetes is a risk factor for BC-related cardiovascular effects, including increased interleukin-6 and ECG parameters. Cardiovascular effects were associated with BC in individuals with CAD, but few comparisons to individuals without CAD were provided in the literature.
authors.affiliation: National Center for Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, 109 T.W. Alexander Drive B243-01, Research Triangle Park, NC, 27711, USA, nichols.jennifer@epa.gov.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Nichols
authors.forename: Elizabeth Oesterling
authors.initials: EO
authors.lastname: Owens
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Dutton
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Luben
mesh_terms: D000397:Air Pollution / Q000032:analysis*; D001249:Asthma / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004781:Environmental Exposure / Q000032:analysis*; D006801:Humans; D052638:Particulate Matter / Q000032:analysis*; D011634:Public Health; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D018570:Risk Assessment; D053260:Soot / Q000032:analysis*
chemical_list: D052638:Particulate Matter; D053260:Soot
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