Is There a Relationship Between Air Pollutants and Heart Rate Variability? An Integrative Review Wellington Rui Andrade de Assis Junior, Camilo Dias Seabra Pereira

Abstract

Cardiovascular disease (CVD) is the main cause of death due to non-contagious diseases, causing about 31% of premature deaths worldwide in 2016. In Brazil, CVDs correspond to 27% of the total number of deaths, being the main cause of deaths in the Brazilian population since the 60s. Air pollution is identified as one of the factors that increase the risk of developing these diseases, being classified as the tenth largest risk factor for death on a global scale. The autonomic nervous system (ANS), through its parasympathetic and sympathetic pathways, exerts control over the cardiovascular system, allowing the detection of small cardiac alterations. Thus, heart rate variability (HRV) reflects fluctuations in the duration of intervals (RR) of the electrocardiogram (ECG), which are influenced by the sympathetic and parasympathetic nervous system. This method is a non-invasive form of autonomic assessment and can be analyzed both in the time domain and in the frequency domain. Thus, the purpose of this study is to investigate whether there is a relationship between air pollutants and heart rate variability. For this, an integrative literature review was carried out using secondary sources, through a bibliographical survey in the databases: Google Scholar; LILACS, MEDLINE and PubMed, Scielo and Scopus. For the eligibility of the articles, some selection criteria were considered, such as; inclusion criteria: we considered studies published in the last five years (2019 to 2023), in any language and with a quantitative and qualitative approach, being excluded: repeated articles, secondary studies and gray literature. For the final sample of this review, 106,003 records were found. Searching the databases identified a total of 19 full-text studies that were screened for eligibility and met the inclusion criteria. After analyzing the selected works, there was a relationship between obesity, as well as heart and systemic diseases; exposure to atmospheric pollutants, such as ozone, zinc and particulate matter suspended in the atmosphere and heart rate variability. In view of this, and considering its cost-benefit ratio, its wide range of applications and the ease of use of the technique, HRV proves to be an effective clinical tool for interpreting the functioning of the ANS and, thus, assessing the health of individuals exposed to air pollution.