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August 2009

Environ'mental HazardsWeigh Heavy on the HeartInformation for Older Adults andTheir Caregivers

Environmental

hazards can

contribute to heart

disease and stroke.

Older adults should

minimize exposure

to environmental

hazards such as

air pol/.roon,

arsenic, lead, and

excessive heat

Did you know that environmen­tal hazards can contribute toheart disease and stroke? Thisfact sheet summarizes envi­

ronmental factors and how they canaffect the health of older adults. It alsosuggests how older adults can minimizetheir exposure to air and water pollut­ants that contribute to heart disease andstroke or worsen their symptoms.Heart disease, the leading cause ofdeath in the United States, and stroke; ."the third most frequent cause of dea'th,cost the nation hundreds of billions ofdollars each year. According to the CDC,in 2005, heart disease killed 652,091people, which represented 27.1% of alldeaths in the u.s.'

Environmental Factors Contributeto Heart Disease and StrokeIndoor Air PollutionPeople who spend long periods of timeindoors are often the most susceptibleto the effects of indoor air pollution.Studies suggest that older adultsspend up to 90% of their time indoors.Indoor air is comprised of a mixture-of contaminants penetrating from theoutdoors and those generated indoors.Indoor air can contain secondhandsmoke, fumes from household cleaningproducts, and even carbon monoxide.These indoor contaminants can bedangerously toxic, especially to those atrisk of stroke and heart disease.

Smoke: Secondhand smoke is one ofthe worst indoor air pollutants. Smokingis known to contribute to heart disease

and stroke, but inhaling the same doseof secondhand smoke and smoke fromactive smoking is equally detrimental.

Wood burning stoves and fireplaces cangenerate smoke containing fine carbonparticles. These particles may triggerchest pain and palpitations, shortness ofbreath, and fatigue, especially in olderadults with heart disease.2

Household Products: When usedimproperly, some household productscan be very dangerous for people withheart conditions. Vapors from cleaningproducts, paint solvents, and pesticidesrequire proper ventilation and limitedexposure to minimize detrimentaleffects.

Fumes from paint solvents, such asmineral spirits, turpentine, methanol,and xylene, stress the lungs and heart,contributing to irregular heartbeat.Although lead-based paints are nowbanned, many homes built before, 978 used lead-containing paints.Take appropriate precautions duringrenovations to miQimize paint chips ordust generated that pose serious healthhazards, including high blood pressure.

Pesticide poisonings often resultfrom exposure to toxic fumigants orinsecticides. Symptoms of this type ofpoisoning include arrhythmia or a veryslow pulse.3 In severe cases, exposurecan contribute to a heart attack or evendeath.carbon Monoxide: Carbon monoxide(CO), an invisible and odorless gas,is a dangerous pollutant because itis difficult to detect. It is particularly

Excessive Heat EventsHeat events are described as prolonged periodswhen temperatures reach at least 10° F. (5.5°C.)above a region's average high temperature. Heatstroke is the most serious of a range of healtheffects associated with excessive heat exposure.It occurs when the body's temperature controlsystem fails causing a rapid rise in core bodytemperature. Heat stroke is characterized by hot,dry, and red skin, and a lack of perspiration. Otherwarning signs are confusion and hallucinations.Heat stroke is a serious condition requiringimmediate medical attention (call 911 or take theperson to an emergency room). Left untreated,heat stroke can cause severe and permanentdamage to vital organs, permanent disability, ordeath.

Persons wTth heart disease and stroke haveimpaired cooling mechanisms and are morevulnerable during heat events. The use ofsome medications can make individuals moresusceptible to heat events for example, anti­depressants and some circulatory medications.

During heat events, air-conditioning is the bestprotection against heat-related illness and death.Even a few hours a day in air-conditioning cangreatly reduce the risk.. Research indicates electricfans are only effective if the ambient temperatureis lower than the body temperature. Electric fansmay provide comfort, but wh~n temperatures arein the high 90s, fans do not prevent heat-relatedillness and could actually be harmful.

Encourage Your Local Government toTake ActionLocal governments should take these simplesteps to reduce hazards and publicize precautionsolder adults can take.

Promote smoke-free policies in publicplaces: By keeping public places (restaurants,bars, and parks) smoke-free, communities canlimit exposure to secondhand smoke.

Drinking WoterThere is evidence that several metals found indrinking water may contribute to heart disease oraggravate its symptoms.

Lead: Exposure to lead can increase bloodpressure. While people are primarily exposedto lead through paint dust. drinking water isanother source of lead exposure. While waterfrom a community's public water supply mustmeet EPA standards for lead, tap water may stillcontain lead exceeding the allowable levels dueto the presence of older lead-containing plumbingmaterials.

harmful to people wTth heart disease, clogged Arsenic: Long-term exposure to high levels ofarteries, or congestive heart failure because it arsenic, a natural element found in drinkingsignificantty limits the blood's ability to carry ". water in some areas of the country, can harmoxygen. For a person with heart disease, exposure the heart EPA has a drinking water standardto even low levels of CO may cause chest pain, for public drinking water systems to ensure thatincreased heart rhythm irregularitIes and make people are not exposed to high levels of arsenic.it difficult to exercise.4 Sources of CO include If you obtain your water from a private well orfumes from furnaces, gas water heaters, ranges, small water system, see the "Steps You can Take"dryers, space heaters, fireplaces, wood stoves, and section for more information about actions toexhaust from cars idling in enclosed garages. limit your exposure.

Outdoor Air PollutionOlder adults who are at risk for heart disease andstroke may benefit from lowering their contactwith air polluted with particulates and vehicularexhaust.

Particle Pollution: Small soot particles foundin outdoor air can be hazardous and the riskis greatest among people with heart disease,chronic obstructive lung disease and asthma.Particles originate from a variety of sourcesincluding vehicles, power plants, industrialsmokestacks, and fires. Some particles areemitted into the air directty, but others form asa result of complicated chemical reactions inthe atmosphere. Particles can travel hundreds tothousands of miles downwind, affecting peoplefar from the sources.

Traffic: Time spent in traffic has also beenassociated with the onset of a heart attack..5 It isnot known whether this is due to traffic-relatedair pollution (e.g., partide pollution, CO), thestress of being caught in traffic, or some other riskfactor.

Pollutant Gases: Ozone, sulfur dioxide, andnitrogen dioxide are also important componentsof air pollution and are associated with adversehealth effects. Ozone is a strong irritant to thelungs and airways and can cause chest pain thatcan be mistaken for a heart attack..

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,• Reduce exposure to traffic and outdoor

~. . air pollution: Pay attention to Air QualityIndex (AQI) forecasts to know when theair is unhealthy for sensitive groups. Checkwith your physician about lowering youractivity level when the AQI is high. Put airconditioning on the re-circulate mode and Ikeep windows closed during smoke eventsfrom fires in buildings or forests. Reduce yourtime in traffic. Avoid physical activity and limitexercise near busy roads.

Prevent heat stress: Use your air-conditioner Ior go to air-conditioned buildings in yourcommunity. Take a cool shower or bath. Wearlightweigh~ light-colored, and loose-fittingclothing. Ask your doctor if your medicationsincrease your susceptibility to heat-relatedillness.

Drink lots of fluids, but avoid beveragescontaining caffeine, alcohol, or large amounts Iof sugar. These drinks cause d,ehydration. If adoctor limits your fluid intake, be sure to askhow much to drink when it's hot

Drink clean water: To limit your exposure tolead through your water, run cold water for at Ileast 30 seconds, preferably 2 to 3 minutesbefore drinking. Testing for lead also may beadvisable for people who get their water frommunicipal sources and live in older homeswith lead service lines. If you receive yourwater from a municipal system, you shouldfirst request information from your municipalsystem for results of federally mandatedtesting for lead and copper, particularly inhomes from the area where you live.

EPA's arsenic standard exempts small watersystems that annually provide fewer than 15"hook-ups" or serve fewer than 25 people. Ifyour water supply is from a private well or asmall system that is exempted from testingal)d you live in an area where high levels ofarsenic have been reported in the groundwater, you may want to have your watertested for arsenic.

The best source of specific information aboutyour drinking water is your water supplier.Water suppliers that serve the same peopleyear-round are required to send their custom- Iers an annual water quality report (some-times called a consumer confidence report).Contact your water supplier to get a copy.

I •Limit Contact With Environmental Factors• Keep smoke out of indoor spaces: Avoid

smoke from tobacco. Encourage smokers to

Ismoke outdoors. Avoid restaurants, bars, andother public places where people smoke. Donot use, or limit use of, wood·burning stovesand fireplaces.

• Use caution when working around the

I house: Improve ventilation when painting byscheduling indoor painting for times whenwindows can be left open and by using fans.Take frequent fresh air breaks when painting;

Iavoid painted rooms for several days.

Before renovating a home built before1978, take precautions to avoid lead paintexposure. Do not use a belt-sander, propanetorch, heat gun, dry scraper, or dry sandpaper

I to remove lead-based paint because theseactions generate unacceptable amounts oflead dust and fumes.

If you must use pesticides, always read

Ilabels first and follow all precautions andrestrictions. When handling pesticides,take protective measures; follow directionsand wear impermeable gloves, long pants,and long-sleeved shirts. Change clothes

Iand wash your hands immediately afterapplying pesticides. Wash clothes exposed topesticides separately.

• Avoid carbon monoxide poisoning: Never

Ileave a car running in a garage, even withthe garage door open. Keep gas appliancesproperly adjusted. Install and use exhaustfans. Have a trained professional inspect,clean, and tune-up your central heating

Isystem (furnaces, flues, and chimneys)every fall. Install carbon monoxide detectorsthroughout your home.

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...Steps You Can Take to

I Help Control Heart Diseaseand StrokeA healthy lifestyle is the best way to preventheart disease and stroke. In addition,older adults should limit their contact withenvironmental risk factors and encouragelocal governments to take action to reduceenvironmental hazards.

• Promote Active Heat Health Watch/WamingSystems: These systems can help identifywhen a heat-related threat is likely, alertresidents, and provide assistance to at-riskindividuals.

• Ensure that Air Quality Index forecasts arepublicized and followed: EPA's Air QualityIndex is an index for reporting daily air quality.See www.epa.gov/airnow.

Promote public transit options that reducetraffic and air pollution: Public transit isthe best way to alleviate road congestion, airpollution, and stress.

• Locate parks, bike paths, and trails awayfrom major roads: Physical activity is oneof the best ways to lower your risk for heartdisease and stroke. Exercise away from roadsand traffic pollution.

Control Your Mojor Risk Fadors for HeartDisease and StrokeThe environment is just one factor that influencesa person's susceptibility to heart disease andstroke. The most important steps you can take toreduce risk factors for heart disease and strokeinclude:

• Avoid smoke from tobacco• Schedule time for regular physical activity 30

minutes per day at least 5 days a week• Follow the 2005 Dietary Guidelines for

Americans• See your health care provider regularly to

screen for and treat high blood pressure,diabetes, and hyperlipidemia (elevated levelsof lipids in the bloodstream)

ResourcesEnvironmental Protection AgencyAir Quality Index: http://airnow.gov/

Indoor Air Quality: http://www.epa.gov/iaq/

Lead: http://www.epa.gov!lead/

Painting: http://www.epa.gov/iaq/homes/hip-painting.html

Pesticides: http://www.epa.gov/pesticides/

Smoke Free Homes and Cars: http://www.epa.gov/smokefree/

Health and Human ServicesDietary Guidelines: http://www.health.gov/DietaryGuidelines/

Centers for Disease Control and Prevention',' Heart Disease: http://www.cdc.gov/HeartDisease/

Physical Fitness Guidelines:http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html

Federal Emergency ManagementAdministration:Extreme Heat: http://www.fema.gov/hazard/heat!index.shtm

National Weather Servicehttp://www.nws.noaa.gov/om/brochures/heaCwave.shtml

American Heart Associationhttp://\IW'MI.americanheart.org/

Health Effects Institutehttp://www.healtheffects.org/about.htm

Learn MoreThe EPA Aging Initiative works to protect thehealth of older adults through the coordinationof fesearch, prevention strategies, and publiceducation on environmental factors. For moreinformation, or to join the EPA Aging InitiativelistselV, visit: www.epa.gov/aging.

Endnotes1 Kung HC, Hoyert DL., Xu J, Murphy SL Deaths: final data for2005. National Vrtal Statistics Reports. 2oo8;56{1O).

2 U.s. Environmental Protection Agency. Air Quality Guide forParticle Pollution. http//www.epa.gov/aimow//aqi3:1.pdf

3 US. Environmental Protection Agency. Regulation andManagement of Pesticide Poisonings. 1999. http://www.epa.gov/pesticides/safety/healthcare/handbook/lndex l.pdf

4 U.s. Environmental Protection Agency. Air Quality Criteria forCarbon Monoxide, EPA 6DO-P-99-D01 F. Research Triangle Park,NC: u.s. Environmental Protection Agency, Office Research andDevelopment, National Center for Environmental Assessment.June-2000.

5 Peters, A., S. von Klot, M. Heier,!. Trentinaglia, H. Ines, A.Hormann, H.E. Erich, H. loweL MExposure to Traffic and the Onsetof Myocardial Infarction.~ The New England Journal of Medicine.Oct 21, 2004. 351 (17): 1TIl-30.

1~liill1!I~~Pratectlllg Ill, Hf!(lltiJof Older Amrrirnlls

Publication Number EPA lOO-F-09-043