Occupational exposure to dust: inflammation and ischaemic heart disease

Our plain-English summary of Occupational exposure to dust: inflammation and ischaemic heart disease, by B. Sjögren (Occupational and Environmental Medicine, 1997).

The study

• Author: B. Sjögren
• Journal: Occupational and Environmental Medicine
• Published: 1997;54(7):466-9
• Type of article: Review
• Cited by: 75 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: To review the possible association between occupational exposure to dust and ischaemic heart disease (IHD).

Methods: A literature search was performed of relevant studies regarding IHD in specific exposures to dust. The chosen exposures were arsenic, asbestos, beryllium, lead, polycyclic aromatic hydrocarbons, and quartz. The chosen occupations were farmers, paper and paper pulp workers, sawyers, and welders.

Discussion: A theory was launched in 1995 that urban particulate air pollution may provoke alveolar inflammation, with release of mediators capable of increasing blood coagulability in susceptible people and cause cardiovascular deaths. The present review expands this hypothesis and links occupational exposure to inhaled particles with the occurrence of ischaemic heart disease.

Conclusion: This hypothesis should be tested by comparing the concentrations of fibrinogen in workers exposed and nonexposed to particles with control for other possible confounders such as smoking habits.

In plain English

This article was a review and hypothesis paper, not a new study. The author searched Medline (1990-6) and NIOSHTIC (1986-96) for studies of ischaemic heart disease in workers exposed to dust: arsenic, asbestos, beryllium, lead, polycyclic aromatic hydrocarbons and quartz, and farmers, paper and pulp workers, sawyers and welders. The author proposed that breathing workplace particles over a long time may cause low-grade inflammation that raises blood fibrinogen and so heart disease risk. For asbestos, the review cited two earlier studies. In a cohort of 1725 Swedish male shipyard workers exposed to asbestos, men with asbestosis or suspected asbestosis had a higher risk of dying from ischaemic heart disease than men without asbestosis (RR 3.1, 95% CI 1.5 to 6.4). In United States workers exposed to chrysotile asbestos, deaths from circulatory diseases were increased (SMR 1.3, P<0.05). The author noted that most earlier cohort studies of dust-exposed workers showed lower heart disease risk than national rates, explained by the healthy worker effect. The author concluded that the hypothesis should be tested by comparing fibrinogen levels in exposed and non-exposed workers, controlling for smoking.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published studies, presenting a hypothesis; no new data were collected
• Who was studied: Published studies found by a literature search of case-control studies on ischaemic heart disease in specific dust exposures (Medline 1990-6, NIOSHTIC 1986-96), plus some other studies of specific exposures or occupations
• Exposure: Occupational dust: arsenic, asbestos (including chrysotile in one cited study), beryllium, lead, polycyclic aromatic hydrocarbons and quartz; also the occupations farmers, paper and paper pulp workers, sawyers and welders
• Main results:
  • Cited earlier study (not this article's own data): in a cohort of 1725 Swedish male shipyard workers exposed to asbestos, with analyses stratified for age and smoking, men with asbestosis or suspected asbestosis had a significantly higher risk of dying from ischaemic heart disease than men without asbestosis (RR 3.1, 95% CI 1.5 to 6.4)
  • Cited earlier study: in the same shipyard cohort, men with impaired lung function also had a significantly increased risk of dying from ischaemic heart disease
  • Cited earlier study: workers exposed to chrysotile asbestos in the United States had increased mortality from diseases of the circulatory system (SMR 1.3, P<0.05); their smoking habits were about the same as in the comparison group of United States men
  • The author proposed that long-term inhalation of workplace particles hypothetically creates low-grade inflammation associated with higher plasma fibrinogen, which would then raise the risk of myocardial infarction and ischaemic heart disease
• The authors' conclusion: The author concluded that the hypothesis should be tested by comparing fibrinogen concentrations in workers exposed and not exposed to particles, controlling for other possible confounders such as smoking habits
• Limitations the authors state:
  • The author stated that most earlier cohort studies of dust-exposed workers showed a decreased risk of ischaemic heart disease compared with national death rates, which the author attributed to the healthy worker effect
  • The author stated that, for this reason, ischaemic heart disease has seldom been studied with proper designs in occupational medicine

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Inflammation, Habit.

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