Volume 1, Issue 5 , Pages 331-335, September 2005
Environmental Cardiology: Addressing an Emerging Public Health Concern
Article Outline
- Matters of the Heart
- The Dangers of Arsenic
- Complications From Fish
- The Problem of Air Pollution
- Holistic Medical Archives
- Twin Cities United Way’s Mind-body Wellness Program a Success
- Call for Abstracts
- Call for Submissions
- NCCAM Announces Oncology Fellowship
- Copyright
Cardiovascular disease is the leading cause (38%) of death in the United States today and a contributing cause in many other types of fatal conditions. Traditional risk factors for heart disease include hypertension, elevated cholesterol, lack of exercise, obesity, smoking, and diabetes. However, more recently, scientists have determined that environmental factors such as air pollution, exposure to some chemicals and metals, and contaminated drinking water also play a role in the development of cardiovascular disease and pose an increasing risk to public health.
Until May 2004, the American Heart Association (AHA) had not issued any expert-reviewed statement about the health effects of chronic exposure to different air pollutants. This, they explained, was due to flaws in research design and methodology of many pollution studies. However, the recently published AHA report, “Air Pollution, Heart Disease and Stroke,” states that, during the last decade, “epidemiological studies conducted worldwide have shown a consistent, increased risk for cardiovascular events, including heart and stroke deaths, in relation to short- and long-term exposure to present-day concentrations of (air) pollution, especially particulate matter.”
Environmental contamination and heart disease are clearly linked: but by what mechanisms? “Some metals, air pollutants, some synthetic chemicals, and the mineral content of drinking water can affect the heart by altering the heart rate or rhythm, the contractility and excitability of heart muscle, and/or the conduction of electrical impulses. Contaminants can also cause atherosclerosis, a common arterial disease in which areas of inflammation, degeneration, and cholesterol deposits (plaque) form on the inner surfaces of the arteries,” explained Ted Schetter, MD, MPH, science director for the Science and Environmental Health Network (www.sehn.org). “This information is extremely important because even small increases in risks in a large population can have a significant public health implication.”
The Collaborative on Health and the Environment (CHE) is “a nonpartisan partnership of individuals and organizations concerned with the role of the environment in human and ecosystem health. CHE seeks to raise the level of scientific and public dialogue about the role of environmental contaminants and other environmental factors in many of the common diseases, disorders, and conditions of our time.”
Among its many activities, CHE hosts the CHE Partnership Call, a monthly series of telephone presentations on the environment and health. There is no fee to join CHE or to participate in the calls.
For more information about CHE, please visit www.cheforhealth.org or contact Collaborative on Health and The Environment, c/o Commonweal, P.O. Box 316, Bolinas, CA 94924. Telephone: 415-868-0970. E-mail: info@cheforhealth.org.
Consensus Statement
(Reprinted with permission)
1. The State of the Science
The public believes what scientists have long known—that environmental factors are important contributors to disease and developmental disabilities. The understanding of risk varies widely among individual toxicants and diseases. The developing human fetus appears to be uniquely at risk of harm from environmental toxicants, and such damage can be profound and permanent. Although some linkages are well established and knowledge about others is emerging, more research is needed regarding the mechanisms, levels, and types of exposures that can adversely affect health. Research must include the study of interactions among chemicals and longitudinal studies examining links between early developmental exposures and health challenges much later in life to determine what might be making us sick and how to prevent future illnesses.
2. The Need for a Heightened Public Health Response
Many cases of some diseases and developmental disabilities could likely be prevented if exposure to contributory environmental factors before and after birth were lessened or eliminated. Some strategies for prevention are well-known, but more resources need to be devoted to prevention research and practice than is currently the case. Better epidemiological tracking of chronic diseases and developmental disabilities is needed. More detailed and widespread monitoring of human exposure to toxicants is vital. This should include health tracking of conditions, including disease surveillance, biomonitoring to inform individuals and healthcare professionals regarding the extent of actual “body burdens” of known and suspected toxicants, and rapid-response epidemiology where indicated. Innovative, scientifically reliable methods are needed to study communities with clusters of diseases versus unaffected populations. Where the weight of plausible scientific evidence shows that contaminants are likely to contribute to increased disease, exposures should be reduced or eliminated. Good, uncompromised science must be the underpinning of all such efforts.
3. The Importance of a Precautionary Approach
The precautionary principle should become a guiding factor in public health and environmental policy. The precautionary principle indicates that, when there is plausible scientific evidence of significant harm from a proposed or ongoing activity, preventive or corrective action should be taken to reduce or eliminate that risk of harm, despite residual scientific uncertainty about cause and effect relationships. Implementing the precautionary principle requires assessment of how to accomplish desired goals, looking for the safest alternatives, democratic participation, and reversal of the burden of proof. That is, the proponent of an activity bears the burden of assessing its safety and of showing that it is both necessary and the least harmful alternative. Decisions affecting public and environmental health should be fully participatory.
4. The Need for New Models of Collaboration in Environmental Health
Efforts in environmental health have too often been fragmented. Medical, patient, public health and environmental groups, and others sharing some convictions too often have not worked together toward common goals. Our emerging realization of the scale of the problem, and the growing body of scientific information linking plausible cause with effect, encourages a commensurate response. A new emphasis on a diverse and inclusive collaboration is essential to reducing successfully public exposure to environmental toxicants and helping to implement preventive strategies. Established researchers and health-affected (or patient/client) groups can collaborate in conducting important new research. Medical organizations can also work with health-affected groups toward better approaches to treatment, services, or interventions. Organizations that are engaged in the issues of environmental justice, poverty, civil rights, and human rights must be represented and work together as equal partners. Everyone concerned—health-affected groups, scientists, health professionals, and environmental organizations—can serve as resources for each other in collaborations such as these that will help reduce public exposure to environmental toxicants and contribute significantly toward creating a healthier society.
As more information about the impact that environments can cause on the heart and its related systems is uncovered, and more correlations between exposure and disease are found, scientists are beginning to reframe environmental pollution as a public health concern. Helping to address this emerging field of environmental cardiology is the Collaborative on Health and the Environment (CHE), a nonpartisan partnership of individuals and organizations concerned with the role of the environment in human and ecosystem health.
Matters of the Heart
CHE recently hosted a one-hour telephone briefing titled, “Matters of the Heart: The Emerging Field of Environmental Cardiology,” which was free and open to any health professional, researcher, or member of a patient or advocacy group concerned about this subject. “Compelling scientific evidence increasingly indicates that the proliferation of chemicals in our air, water, soil, food, homes, schools, and workplaces can be an important factor in many human diseases and health conditions,” said Philip R. Lee, MD, chairman of CHE. “CHE hopes to take environmental health efforts into a new era of improved scientific understanding and cooperation among diverse interests sharing similar goals.”
“The monthly CHE Partner calls are a wonderful part of what CHE offers,” said Michael Lerner, president of Commonweal, a health and environmental research institute in Bolinas, California, and cofounder of CHE. “People join CHE free, receive only two e-mails a month, and are invited to participated in these monthly calls in which we hear from national experts on the role of environmental contaminants in many different diseases. CHE has created a remarkable forum for serious people with two commitments. The first is to understanding the science in environmental health. The second, equally important, is to civility: CHE is a forum for mutually respectful dialogue, since all CHE Partners are free to interpret the science according to their own lights.”
Those CHE Partners with deeper interests in a specific subject area join working groups on learning and developmental disabilities, cancer, asthma, infertility, and other subject areas. It has proven to be a very effective approach to sophisticated continuing education for people who truly care about health and the environment.”
The Dangers of Arsenic
Although mercury, arsenic, cadmium, lead, and cobalt have each been implicated in heart disease of one kind or another, Dr. Schettler, who was the first presenter at the Matter of the Heart briefing, focused his discussion on the recent research on arsenic and its relationship to heart disease. “Arsenic exists in both inorganic and organic forms. Inorganic arsenic is generally the more toxic,” he explained. People are often unwittingly exposed to inorganic arsenic through such things as drinking water (it can occur there both naturally and unnaturally) and wood (arsenic is often a common compound used in wood preservatives).
Arsenic, if ingested or assimilated into the body, can cause thickening of the walls of arteries. “As the coronary arteries are thickened, mortality from cardiovascular disease is elevated,” said Schettler.
In addition, there is now a growing concern that the organic arsenic used in large commercial poultry-raising operations to prevent and treat parasites in the birds and as a growth promoter contributes to the total arsenic concentration in chicken, most of which is inorganic arsenic. “Chicken consumption has become a significant source of arsenic exposure in the general population,” Schettler said. “Approximately 65% of the arsenic in chicken meat is in the inorganic form. In addition, as the manure of chickens treated with arsenic is spread on the ground, the organic arsenic in the manure can be converted into inorganic form, which then leaches into the ground and surface water.” Schettler raised this issue, in part, to point out the need to look at these issues from a broad ecological perspective.
Complications From Fish
Eliseo Guallar, MD, DrPH, an assistant professor of Epidemiology at Johns Hopkins Bloomberg School of Public Health and associate editor of the Annals of Internal Medicine, spoke about the complications facing healthcare providers today regarding food and health and, most specifically, around fish. What is good for you or not good for you is no longer a simple subject, thanks to environmental pollution. “Many of us working with cardiovascular disease promote fish intake as a source of cardio-protective omega-3 fatty acids. This type of fat from fish oils has several physiological effects that we believe protect us from cardiovascular disease, including reducing the risks of fatal arrhythmias, lowering triglyceride levels, lowering inflammation, and diminishing the activity of platelets,” Guallar explained.
However, by increasing fish intake, people also increase the intake of methyl mercury and other contaminants found in fish. Mercury is of particular concern. “The specific mechanics of how mercury impacts cardiovascular disease are not known at this point,” Guallar said. It is thought that mercury can participate in the production of free radicals, initiate an increase of oxidative stress, and interact with proteins through the sulfhydryl group. Regardless, there appears to be a strong association between mercury levels and oxidized low-density lipoprotein (LDL), which is thought to initiate heart disease. However, given the current levels of contamination found in seafood, CHE believes it is no longer prudent to simply instruct people to eat fish as a source of omega-3 fatty acids. “First, we need to make sure that we understand all the beneficial effects and all the risks derived from the contaminants in fish,” Guallar explained. “Then we need to give sound advice so that the general public can make the intelligent choices.”
The Problem of Air Pollution
Murray Mittleman, MD, DrPH, a cardiologist who is an associate professor, Department of Epidemiology at Harvard School of Public Health and associate professor of medicine at Harvard Medical School, also spoke during the briefing regarding the increasing amount of evidence from epidemiological studies that link air pollution to different health effects, including heart disease. “The long-term health effect studies look at the association between living in a region with higher levels of pollution over many years—how does that impact the rate of incident cardiovascular disease or cardiovascular mortality?” Mittleman explained. “The short-term studies look at the effects of transient changes in air quality. Does having a transient spike in the level of fine particulate air pollution influence your risk of having a heart attack or a stroke or an arrhythmia over the next hours to days?”
Numerous studies have shown that there is a considerable increase in the rate of mortality from cardiovascular causes with people living in regions with higher levels of air pollution. Other studies show increased exacerbations of heart failure, an increased incidence of admissions to hospitals, and an increased incidence of arrhythmias in patients who have implanted defibrillators. “In addition,” said Mittleman, “there is very strong evidence now that inhaling these particles can trigger pulmonary inflammation—acutely. And there’s good epidemiologic evidence that, on the days following high pollution levels, the levels of markers of inflammation, including C-reactive protein and interleukin-6—which are markers that are associated with adverse cardiovascular events—do go up within days of exposure.”
The evidence is so strong, in fact, that the AHA Expert Panel on Population and Prevention Science recently issued a “Scientific Statement on Air Pollution and Cardiovascular Disease,” which states that, “Over the last decade, a growing body of epidemiological and clinical evidence has led to a heightened concern about the potential deleterious effects of ambient air pollution on health and its relation to heart disease and stroke. Of special interest are several environmental air pollutants that include carbon monoxide, oxides of nitrogen, sulfur dioxide, ozone, lead, and particulate matter. These pollutants are associated with increased hospitalization and mortality due to cardiovascular disease, especially in persons with congestive heart failure, frequent arrhythmias, or both.” (Note: This paper, which was published in the June 1, 2004, issue of Circulation, was approved by the American Heart Association Science Advisory and Coordinating Committee. A single reprint is available by calling 800-242-8721 (United States only) or by writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596.)
“We commend the American Heart Association for its pioneering initiative in environmental cardiology,” said Michael Lerner. “Just as AHA is recognizing the role of chemical contaminants in heart disease, so dozens of other patient and health professional associations are working together to develop a stronger basis in science for disease prevention and to promote more prudent approaches to chemical management. CHE scientists have identified almost 200 diseases, disorders, and conditions in which the leading toxicology textbooks report that environmental contaminants may play some role. We urgently need better science to help understand the role of contaminants in these diseases. However, we already know enough to take a more precautionary approach to chemicals and to insist that all chemicals should be tested for health and safety before they are allowed to enter the environment and our bodies.”
Holistic Medical Archives
The AHMA and the Louisiana State University Medical School have recently formed an agreement that will enable the creation of the Archives of Holistic Medicine at the LSU Medical School campus in New Orleans.
The archive is being established to recognize the significance of the events leading to the paradigm shift in medicine toward a holistic patient-centered profession as well as the significance of certain key pioneers in this process. LSU will house and maintain the archive, and the AHMA will work to populate it with key materials and artifacts that will illuminate the progress of this movement in the medical field. LSU and the AHMA will also be working to develop an on-line database of documents that will be available at no charge to AHMA members.
The founders and leaders of the AHMA include C. Norman Shealy, Gladys McGarey, Evarts Loomis, Bernie Siegel, Christiane Northrup, and many others. It is hoped that this archive will help to commemorate their work, as well as illuminating and assisting the growth of holistic medicine.
Twin Cities United Way’s Mind-body Wellness Program a Success
The history of charitable donations has always included the funding of educational programs to increase public welfare. One typically thinks of efforts focusing on teenage pregnancy prevention, safe sex, nutrition, smoking cessation, or diversity tolerance. However, recently, United Way Twin Cities stepped out of the box and embraced the subject of stress reduction as a way to increase wellness and improve public health outcomes.
Made possible by an on-going grant from Bill and Penny George through the George Family Foundation of Minneapolis, Minnesota, and supervised by Kathy Lentz, Director of Children and Families Community Impact, Greater Twin Cities United Way, the Mind-Body Wellness Program has now trained over 600 “trainers” in mind-body interventions that reduce stress and promote health.
“The grant was based on a belief that collaboration among those who share a common vision leads to greater impact,” said Penny George. “The George Family Foundation’s belief in strengths of integrative medicine in helping people cope with stress, the United Way’s interest in creating a healthy community, and the Center for Mind-Body Medicine’s demonstrated effectiveness in training trainers in stress management techniques all made for a powerful synergy.”
The program, which started five years ago, was a definite departure from the norm, but, after a lengthy discussion and a review of the research outcome information, United Way agreed that using its extensive community network would be a good way to get the message out. “The vision was to train trainers,” says Lentz. “We felt we would get the greatest impact by offering curriculum and a variety of therapeutic strategies so that, once trained, people use the information both personally and with clientele.” The first grant allowed Kathy Lentz to study at Jim Gordon’s Center for Mind Body Medicine in Washington, DC, so that she would be able to return to Twin Cities, train other trainers, and run the program from a knowledgeable foundation.
Kathy Lentz
The Greater Twin Cities United Way training sessions are free of charge, and several scholarships to the Center for Mind Body Medicine for more advanced training are also granted each year. “In the beginning, we weren’t sure how it would be received, so we held informational sessions in the nine surrounding countries and asked people if they would attend a four-hour training in mind-body intervention to reduce stress. And we were amazed at the positive response.”
The training takes four hours, and six sessions are held throughout each year. The program has now trained more than 600 “trainers” from a variety of sectors including government, healthcare, nonprofits, police and fire departments, business, and community volunteers. The curriculum combines both didactic and experiential learning and includes such things as imagery, music, movement, biofeedback, mindfulness meditation, and nutrition.
“We have one session in which people have to eat in silence for five minutes,” explains Lentz. “It’s an eating meditation. We want people to focus on tasting their food and being aware of the meal rather than just gulping down dinner in front of a TV. And people are finding it intriguing.”
More recently, Lentz had received numerous requests for a children’s program, so, for this year (2005), in addition to their adult classes, the United Way’s Mind-Body Wellness Program is offering a curriculum for people who provide services to children such as healthcare providers and volunteers at the Children’s Hospitals and Clinics of Minnesota and the staff of local Catholic charities. They are also looking into developing a curriculum for senior organizations because the research data show that mind-body interventions can be helpful with memory loss.
“Improving stress hardiness and the capacity thereby to delay or avoid illness, through individual self-care, is an important feature of integrative medicine and of the values of the George Family Foundation,” said Penny George. “I am so grateful to Kathy Lentz for seeing the potential in this idea and for the United Way’s willingness to think outside the box.”
By all measures, the program is a success. “Practicing these skills can help people to reduce stress, regain health, and maximize wellness. The newfound abilities can also assist them in taking better control of their own lives,” says Lentz. “Who can argue with that?”
For more information, contact Michelle Newman at Greater Twin Cities United Way at (612) 340-7416 or e-mail: newmanm@unitedwaytwincities.org. Information is also available on their Web site at www.unitedwaytwincities.org.
Call for Abstracts
The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) is currently planning the 2006 North American Research Conference on Complementary and Integrative Medicine. The conference will be May 23-26, 2006, in Edmonton, Canada, at the Shaw Conference Centre.
Proposals for scientific sessions as well as abstracts are being accepted through September 30, 2005. Submission forms and instructions may be downloaded at www.imconsortium-conference2006.com.
Members of the CAHCIM Conference Organizing Committee are as follows:
The conference is being supported by grants from the following organizations:
In addition to CAHCIM, participating organizations include the following:
For more information, please visit www.imconsortium-conference2006.com.
Call for Submissions
The American Holistic Medical Association (AHMA) is now accepting submissions for the 2006 Annual Scientific and Clinical Conference “Holism in Action: Building Integrated Health Care,” which will be held June 7-10, 2006, in Minneapolis, MN. The conference is being presented in parallel with the annual American Holistic Nurses Association conference. Along with general presentations about holistic healthcare, the AHMA will provide expert knowledge about forming progressive healthcare facilities and uniting healthcare providers in pursuit of mind-body-spirit medicine. All presentations should be submitted via the Web form provided on the AHMA Web site: www.holisticmedicine.org. Details regarding tracks and formats are available there. Submissions will be accepted through September 15, 2005.
NCCAM Announces Oncology Fellowship
The National Center for Complementary and Alternative Medicine (NCCAM), the National Cancer Institute (NCI), and the Food and Drug Administration’s (FDA) Center for Drug Evaluation and Research recently announced the creation of a three-year fellowship for new researchers to gain expertise in complementary and alternative medicine (CAM) and cancer.
CAM approaches are being increasingly used by people with cancer and their practitioners to address medical, psychosocial, and spiritual needs. Medical oncologists are frequently asked for their opinion on the use, benefits, and risks of CAM practices in the treatment of cancer. Because of this high use of CAM by cancer patients, more basic and clinical research is needed.
The Fellows will be trained both in medical oncology and CAM and will be exposed to clinical and regulatory aspects unique to this field. A detailed description of the Fellowship is available at www.nccam.nih.gov.
Eligible candidates are oncology fellows at the NCI or at another accredited fellowship program in the United States who are completing their first clinical year. For more information, contact the NCCAM/NCI fellowship coordinator Patrick Mansky, MD, via telephone at 301-435-6760 or via e-mail at manskyp@mail.nih.gov.
PII: S1550-8307(05)00310-1
doi:10.1016/j.explore.2005.06.017
© 2005 Elsevier Inc. All rights reserved.
Volume 1, Issue 5 , Pages 331-335, September 2005
