Ambient particulate matter and respiratory and cardiovascular illness in adults: particle-borne transition metals and the heart-lung axis(,).

Epidemiological studies have consistently shown associations of exposure to ambient particulate matter (PM) with severe health effects, including mortality and hospitalization, in adults. From the standpoints of both relative risk and attributable risk, the public health burden of ambient PM exposure is potentially greatest in elderly adults with underlying cardiopulmonary illness. Recent experimental data suggest that PM-borne transition metals have toxicity that could be mechanistically relevant to PM-related epidemiological findings. These data may prove to be especially relevant in elderly adults with cardiopulmonary illness. At the same time, important uncertainties remain in the epidemiological and experimental databases, such that the true degree of correspondence between the two is not yet known. In our opinion, this combination of emerging experimental-epidemiological coherence and remaining uncertainty imparts high priority to further research into the health effects of PM-borne transition metals. This research should not be confined to the respiratory system. Rather, it should examine the entire heart-lung axis and should probably consider other body systems (e.g. the vascular system) as well. In this research, close interdisciplinary communication should be sustained and experimental and epidemiological approaches should be coordinated to the maximum feasible extent.