Air Pollution & the Risk of Deep Venous Thrombosis (DVT)

Health Report:


Air Pollution & the Risk of Deep Venous Thrombosis (DVT)



"A critical weekly review of important new research findings for health-conscious readers..."



By, Robert A. Wascher, MD, FACS

Updated: 06/28/2009


The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.



AIR POLLUTION & THE RISK OF DEEP VENOUS THROMBOSIS (DVT)

As I’ve mentioned in previous columns, venous thromboembolic (VTE) disorders are a major cause of disability and death throughout the world. Deep venous thrombosis (DVT) results when blood clots form within the deep veins of the body (most commonly within the large veins of the legs and pelvis). A variety of conditions and circumstances can lead to DVT formation. These include decreased blood flow, or “stasis,” involving the body’s deep veins, injury or inflammation of the internal surfaces (endothelium) of these veins, and any underlying health condition that increases the blood’s tendency to form blood clots (hypercoagulable state). Pulmonary embolism (PE) is a potentially life-threatening condition, and most commonly arises in patients who have already developed DVT (PE occurs when chunks of DVT-associated clots break away and travel to the lungs). When the lungs’ circulation becomes clogged-up with these itinerant clots (emboli), patients may experience shortness of breath, chest pain, or in severe cases of PE, complete cardiovascular collapse and death.

VTE remains an underappreciated cause of serious illness, disability, and death. Patients with severe or repeated cases of DVT often develop chronic swelling, pain, and skin damage of the affected extremities, due to the progressive destruction of the one-way valves in the large veins of the lower body that help to prevent pooling of blood in these dependent areas (post-thrombotic syndrome). Patients who survive significant PEs may also go on to develop permanent damage to the venous circulation of the lungs, leaving them with decreased blood flow to the lungs (pulmonary hypertension) and, in severe cases, chronic shortness of breath, lung injury, and heart damage (PE also remains the most common cause of unexpected death in hospitalized patients). An estimated 900,000 new cases of VTE occur in the United States each year, and as many as one-third of these cases of VTE are fatal, which makes VTE a more common cause of death than either heart attacks or strokes! As these statistics suggest, VTE remains a very serious public health problem in the United States, and throughout much of the world, as well.

While exposure to particulate air pollution from diesel and gasoline engines has previously been linked to an increased risk of coronary artery disease, the effects of these environmental pollutants on the body’s venous system, if any, are less clear. Now, an innovative new study from Italy suggests that chronic exposure to automobile and truck exhaust may actually increase the risk of VTE. In this study, which has just been published in the journal Circulation, 663 patients who were diagnosed with DVT were compared with 859 age-matched “control” patients without any history of DVT. All patients who were included in this study lived in cities with a population of more than 15,000 inhabitants in the Lombardia region of Italy. In this study, the researchers calculated the distance that each study volunteer lived from major highways and high-traffic streets. The researchers also factored other DVT risk factors, for each of the patient volunteers, into their analysis of the data collected in this study. Among those patient volunteers who lived between 0 feet and 2,400 feet from major highways and high-traffic streets, the risk of developing DVT was more or less linearly proportional to the distance between these patients’ homes and the site of increased automobile and truck traffic. When comparing the patients who lived approximately 10 feet from major streets and highways with patients who lived 800 feet away from major thoroughfares, and after adjusting for other risk factors for DVT among these 1,522 patient volunteers, the researchers noted a 47 percent greater risk of DVT among the patient volunteers who lived closer to high-traffic highways and streets.

Therefore, the findings of this study strongly suggest that chronic exposure to particulate air pollution from vehicle exhaust significantly increases the risk of developing DVT. Other well established risk factors for DVT include prolonged immobility (e.g., sitting for long periods on a plane or in a car; or prolonged bed rest), cancer, recent major injury or surgery, pregnancy, birth control pills or other forms of hormonal therapy, heart failure, obesity, smoking, severe infections, older age, high blood pressure, chronic lung disease, inherited clotting abnormalities, and a family history of DVT or other forms of VTE.

As many of the known risk factors for DVT, and other forms of VTE, are preventable, it is possible to reduce the risk of developing potentially life-threatening blood clots by taking steps to avoid as many of these risks as possible. For example, if you must take a long plane or automobile ride, you should take frequent walking breaks, and remember to also frequently exercise your legs while you are seated. Drinking plenty of caffeine-free and alcohol-free drinks will also reduce the risk of DVT during long trips. If you also have one or more non-modifiable risk factors for VTE and you must take a long trip, you might also want to talk with your doctor about taking aspirin or/and anticoagulant medications before and during your trip, as well as wearing compression stockings on your legs during your long trip. As for the risk of DVT associated with increased exposure to gasoline and diesel engine exhaust (in addition to an increased risk of lung disease and heart disease), this new clinical research study suggests that it is best to avoid living close to busy highways and high-traffic streets, if at all possible.


Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

(Anticipated Publication Date: March 2010)

(Click above image for TV36 interview of Dr. Wascher)

Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net



Dr. Wascher's Biography


Links to Other Health & Wellness Sites



http://doctorwascher.com


Copyright 2009

Robert A. Wascher, MD, FACS

All rights reserved



Dr. Wascher's Archives:

6-21-2009: Red Yeast Rice, Statins & Cholesterol
6-14-2009: Bone Marrow Stem Cell Transplant & Congestive Heart Failure (CHF)
6-7-2009: Diet, Soy & Breast Cancer Risk
5-31-2009: Diet and Prostate Cancer Risk
5-24-2009: Diabetes, Glucose Control & Death
5-17-2009: Drug Company Marketing & Physician Prescribing Bias
5-10-2009: Hemorrhoids & Surgery
5-3-2009: Statin Drugs & Blood Clots (Thromboembolism)
4-26-2009: Are We Really Losing the War on Cancer?
4-19-2009: Exercise in Middle Age & Risk of Death
4-12-2009: Can Chronic Stress Harm Your Heart?
4-5-2009: Does PSA Testing for Prostate Cancer Save Lives?
3-22-2009: CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease
3-15-2009: Depression, Stress, Anger & Heart Disease
3-8-2009: Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children
3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children
2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer
2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones
2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum
2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence
1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?
1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors
1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer


Dr. Wascher's Home Page