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Ozone exposure linked to potential heart attack

Young, healthy adult volunteers exposed for two hours to ozone developed physiological changes associated with cardiovascular ailments, according to a study1 reported in Circulation.

Study participants showed evidence of vascular inflammation, a potential reduced ability to dissolve artery-blocking clots, and changes in the autonomic nervous system. The changes were temporary and reversible in these young, healthy participants.

Recent epidemiology studies on ground level ozone have reported associations between acute exposure to ozone and death, but little is known about the underlying pathophysiological pathways responsible.

“This study provides a plausible explanation for the link between acute ozone exposure and death,” said Dr Robert B Devlin, the study’s lead author and senior scientist at the US Environmental Protection Agency’s (EPA) National Health and Environmental Effects Research Laboratory in Research Triangle Park, North Carolina.

iStock_000001590716XSmallDevlin and colleagues focused on a single, short-term exposure and not the effects of years of exposure to ozone. Researchers exposed 23 volunteers, ages 19 to 33, to 0.3 parts per million (ppm) of ozone. The dose was higher than the EPA’s eight hour ozone standard of 0.076 ppm.

However, a person breathing 0.3 ppm for two hours receives roughly the same amount of ozone as does a person breathing the lower 0.076 ppm for eight hours, Devlin noted.

Study participants underwent two controlled exposures — one to clean air and one to ozone-polluted air — at least two weeks apart. During each exposure, participants alternated 15-minute periods of stationary cycling and rest.

None of the participants reported complaints or physical symptoms after inhaling clean air or ozone. However, immediately following and the morning after ozone inhalation, tests showed significant ozone-induced vascular changes compared to clear-air exposure. These changes included:

  • Increase in blood levels of interleukin 1 beta
  • Decrease in plasminogen activator inhibitor 1 and plasminogen
  • A change in heart rhythm, indicating altered autonomic nervous system control of heart rate.

Epidemiology studies have also associated acute exposure to another ubiquitous air pollutant, particulate matter (PM), with death in elderly people with cardiovascular disease.

Controlled exposure studies of both humans and animals have described PM-induced changes that are very similar to those described in this ozone study, suggesting that both pollutants may be causing death by affecting similar pathways, the researchers said.

“People can take steps to reduce their ozone exposure, but a lot of physicians don’t realize this,” Devlin said.  The EPA website,, contains guidelines on ways to reduce ozone exposure.


1. Devlin RB, Duncan KE, Jardim M, Schmitt MT, Rappold AG, Diaz-Sanchez D.  Controlled exposure of healthy young volunteers to ozone causes cardiovascular effects.  Circulation 2012;126. doi: 10.1161/CIRCULATIONAHA.112.094359

Published on: June 25, 2012

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