Polycyclic aromatic hydrocarbons and development of respiratory and cardiovascular diseases in workers

Leachi, Helenize Ferreira Lima; Marziale, Maria Helena Palucci; Martins, Júlia Trevisan; Aroni, Patricia; Galdino, Maria José Quina; Ribeiro, Renata Perfeito

doi:10.1590/0034-7167-2018-0965

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (3) • 2020 • https://doi.org/10.1590/0034-7167-2018-0965 copy

Polycyclic aromatic hydrocarbons and development of respiratory and cardiovascular diseases in workers

Hidrocarburos policíclicos aromáticos y desarrollo de enfermedades respiratorias y cardiovasculares en trabajadores

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to identify the scientific evidence on the development of cardiovascular and respiratory diseases due to workplace contamination by polycyclic aromatic hydrocarbons.

Methods:

integrative literature review. The search for primary articles was held in October 2017 in the Medical Literature Analysis and Retrieval System Online (through Pubmed), Web of Science and Latin American and Caribbean Literature in Health Sciences (LILACS).

Results:

the 16 studies analyzed showed that exposure to polycyclic aromatic hydrocarbons was associated with cardiovascular diseases, such as increased blood pressure, heart rate variation, and ischemic heart disease; and respiratory disorders, such as decreased lung function, chronic obstructive pulmonary disease, asthma, wheeze, coughing, pulmonary wheezing, chest tightness, effort dyspnea, and sore throat.

Conclusions:

polycyclic aromatic hydrocarbons cause deleterious effects on the cardiovascular and respiratory systems through mutations and cellular inflammation, being a risk to exposed individuals.

Descriptors:
Workers; Polycyclic Aromatic Hydrocarbons; Volatile Organic Compounds; Cardiovascular Diseases; Respiratory Diseases

Database	Crossings
Medline	(((((((((((((((((((((((((((((((((((((((((((((Tract Diseases, Respiratory) OR Tract Disease, Respiratory) OR Respiratory Tract Disease) OR Diseases, Respiratory Tract) OR Disease, Respiratory Tract) OR Occupational Asthmas) OR Occupational Asthma) OR Asthmas, Occupational) OR Respiration Disorder) OR Disorders, Respiration) OR Disorder, Respiration) OR Myocardial Infarcts) OR Infarcts, Myocardial) OR Infarct, Myocardial) OR Myocardial Infarct) OR Heart Attacks) OR Heart Attack) OR Strokes, Cardiovascular) OR Stroke, Cardiovascular) OR Cardiovascular Strokes) OR Cardiovascular Stroke) OR Myocardial Infarctions) OR Infarctions, Myocardial) OR Infarction, Myocardial) OR Diseases, Cardiovascular) OR Disease, Cardiovascular) OR Cardiovascular Disease) OR Pregnancy Complication, Cardiovascular) OR Complication, Cardiovascular Pregnancy) OR Cardiovascular Pregnancy Complication) OR Cardiovascular Pregnancy Complications) OR Pregnancies, Cardiovascular Complications) OR Pregnancy, Cardiovascular Complications) OR Complications, Cardiovascular Pregnancy) OR Infections, Cardiovascular) OR Infection, Cardiovascular) OR Cardiovascular Infection) OR Cardiovascular Infections) OR Pregnancy Complications, Cardiovascular) OR Cardiovascular Diseases) OR Myocardial Infarction) OR Respiration Disorders) OR Asthma, Occupational) OR Respiratory Tract Diseases)) AND (((((((((((((((((((Organic Compounds, Volatile) OR Compounds, Volatile Organic) OR Aromatic Hydrocarbons) OR Hydrocarbons, Polycyclic) OR Polycyclic Hydrocarbons) OR Cyclic Hydrocarbons) OR Hydrocarbons, Aromatic Polycyclic) OR Aromatic Polycyclic Hydrocarbons) OR Polycyclic Hydrocarbons, Aromatic) OR Hydrocarbons, Polynuclear Aromatic) OR Aromatic Hydrocarbons, Polynuclear) OR Polynuclear Aromatic Hydrocarbons) OR Hydrocarbons, Polycyclic Aromatic) OR Aromatic Hydrocarbons, Polycyclic) OR Volatile Organic Compounds) OR Hydrocarbons, Aromatic) OR Hydrocarbons, Cyclic) AND Polycyclic Aromatic Hydrocarbons) OR Hydrocarbons))) AND workers
WoS	(((((((((((((((((((((((((((((((((((((((((((((Tract Diseases, Respiratory) OR Tract Disease, Respiratory) OR Respiratory Tract Disease) OR Diseases, Respiratory Tract) OR Disease, Respiratory Tract) OR Occupational Asthmas) OR Occupational Asthma) OR Asthmas, Occupational) OR Respiration Disorder) OR Disorders, Respiration) OR Disorder, Respiration) OR Myocardial Infarcts) OR Infarcts, Myocardial) OR Infarct, Myocardial) OR Myocardial Infarct) OR Heart Attacks) OR Heart Attack) OR Strokes, Cardiovascular) OR Stroke, Cardiovascular) OR Cardiovascular Strokes) OR Cardiovascular Stroke) OR Myocardial Infarctions) OR Infarctions, Myocardial) OR Infarction, Myocardial) OR Diseases, Cardiovascular) OR Disease, Cardiovascular) OR Cardiovascular Disease) OR Pregnancy Complication, Cardiovascular) OR Complication, Cardiovascular Pregnancy) OR Cardiovascular Pregnancy Complication) OR Cardiovascular Pregnancy Complications) OR Pregnancies, Cardiovascular Complications) OR Pregnancy, Cardiovascular Complications) OR Complications, Cardiovascular Pregnancy) OR Infections, Cardiovascular) OR Infection, Cardiovascular) OR Cardiovascular Infection) OR Cardiovascular Infections) OR Pregnancy Complications, Cardiovascular) OR Cardiovascular Diseases) OR Myocardial Infarction) OR Respiration Disorders) OR Asthma, Occupational) OR Respiratory Tract Diseases)) AND (((((((((((((((((((Organic Compounds, Volatile) OR Compounds, Volatile Organic) OR Aromatic Hydrocarbons) OR Hydrocarbons, Polycyclic) OR Polycyclic Hydrocarbons) OR Cyclic Hydrocarbons) OR Hydrocarbons, Aromatic Polycyclic) OR Aromatic Polycyclic Hydrocarbons) OR Polycyclic Hydrocarbons, Aromatic) OR Hydrocarbons, Polynuclear Aromatic) OR Aromatic Hydrocarbons, Polynuclear) OR Polynuclear Aromatic Hydrocarbons) OR Hydrocarbons, Polycyclic Aromatic) OR Aromatic Hydrocarbons, Polycyclic) OR Volatile Organic Compounds) OR Hydrocarbons, Aromatic) OR Hydrocarbons, Cyclic) AND Polycyclic Aromatic Hydrocarbons) OR Hydrocarbons))) AND workers
LILACS	((Hidrocarbonetos Cíclicos) OR (Hidrocarbonetos Aromáticos) OR (Hidrocarbonetos) OR (Hidrocarbonetos Aromáticos Policíclicos) OR (Compostos Orgânicos Voláteis) OR (Hidrocarbonetos Policíclicos) OR (Hidrocarbonetos Policíclicos Aromáticos))AND((Doenças Cardiovasculares) OR (Sistema Cardiovascular) OR (Fenômenos Fisiológicos Cardiovasculares) OR (Fenômenos Fisiológicos Circulatórios e Respiratórios) OR (Infarto do Miocárdio) OR (Complicações Cardiovasculares na Gravidez) OR (Doenças Respiratórias) OR (Infecções Respiratórias) OR (Doença Pulmonar Obstrutiva Crônica) OR (Asma Ocupacional) OR (Sistema Circulatório) OR (Doenças das Vias Respiratórias) OR (Doenças do Aparelho Respiratório) OR (Doenças do Sistema Respiratório) OR (Doenças do Trato Respiratório) OR (Doença Respiratória) OR (Doença do Aparelho Respiratório) OR (Doença do Sistema Respiratório) OR (Doença do Trato Respiratório) OR (Infecções das Vias Respiratórias) OR (Infecções do Trato Respiratório Superior) OR (Infecções do Aparelho Respiratório) OR (Infecções das Vias Respiratórias Superiores) OR (Infecções das Vias Aéreas Superiores) OR (Infecções do Sistema Respiratório) OR (Infecções do Sistema Respiratório Superior) OR (Infecções do Trato Respiratório) OR (Obstrução Crônica do Fluxo Respiratório) OR (Obstrução do Fluxo Respiratório Crônico) OR (Doença Obstrutiva Crônica das Vias Aéreas) OR (Doença Obstrutiva Crônica do Pulmão) OR (Doença Obstrutiva Crônica Pulmonar))

Year/ Country/ Database	Title	Type of study/Level of scientific evidence	Objective	Main results
2017 China Medline	Effects of coke oven emissions and benzo[a]pyrene on blood pressure and electrocardiogram in coke oven workers⁽¹³13 Yang K1, Jiang X, Cheng S, Chen C, Cao X, Tu B. Effects of coke oven emissions and benzo[a]pyrene on blood pressure and electrocardiogram in coke oven workers. J Occup Health. 2017;59(1):1-7. doi: http://dx.doi.org/10.1539/joh.15-0264-OA http://dx.doi.org/10.1539/joh.15-0264-OA... ⁾.	Descriptive study Level of evidence: 6	To evaluate the adverse effects of occupational exposures to coke oven emissions and benzo[a]pyrene on the prevalence of hypertension and abnormal electrocardiogram (ECG) in coke workers.	Significant increase in blood pressure levels of the exposed group compared to those in the control group. Exposure to benzo[a]pyrene was a risk factor for hypertension in coke oven workers, indicating that exposure may increase the prevalence of cardiovascular disease or affect blood pressure.
2014 China Medline	Association of plasma IL-6 and Hsp 70 with HRV at different levels of PAHs metabolites⁽¹⁴14 Ye J, Zhu R, He X, Feng Y, Yang L, Zhu X et al. Association of Plasma IL-6 and Hsp 70 with HRV at Different Levels of PAHs Metabolites. PLoS ONE. 2014;9(4):e92964. doi: http://dx.doi.org/10.1371/journal.pone.0092964 http://dx.doi.org/10.1371/journal.pone.0... ⁾.	Longitudinal study Level of evidence: 4	Characterize how PAH can induce systemic inflammation and stress response, contributing to altered cardiac autonomic function.	Dose-response relationships between urinary PAH and interleukin-6 metabolites and interleukin-6 indices and heart rate variation were observed. An interleukin-6 effect on heart rate variation was found in groups of metabolites with high levels of PAH, while high levels of heat shock protein (Hsp70) may have a protective effect on heart rate variation in groups with low-level of PAH metabolites.
2012 Algeria Medline	Occupational exposure to petroleum products and respiratory health⁽¹⁵15 Sekkal S, Haddam N, Scheers H, Poels KL, Bouhacina L, Nawrot TS et al. Occupational exposure to petroleum products and respiratory health: a cross sectional study from Algeria. J Occup Environ Med. 2012;54(11):1382-8. doi: http://dx.doi.org/10.1097/JOM.0b013e31825fa6c9 http://dx.doi.org/10.1097/JOM.0b013e3182... ⁾.	Longitudinal study Level of evidence: 4	To investigate the impact of long-term occupational exposure to PAH on respiratory health.	Aerial exposure to hydrocarbons was low. Respiratory and nasal symptoms were significantly more frequent among exposed subjects than among controls.
2011 China Medline	Respiratory health and lung function in Chinese restaurant kitchen workers⁽¹⁶16 Wong TW, Wong AH, Lee FS, Qiu H. Respiratory health and lung function in Chinese restaurant kitchen workers. Occup Environ Med. 2011;68(10):746-52. doi: http://dx.doi.org/10.1136/oem.2010.059378 http://dx.doi.org/10.1136/oem.2010.05937... ⁾.	Descriptive study Level of evidence: 6	Analyze and measure concentrations of pollutants such as air VOCs in Chinese restaurant kitchens using different types of stove and assess their influence on workers’ respiratory health.	The median concentrations of fine particles and volatile compounds were higher in gas-fuelled kitchens than in electricity-run kitchens. Workers using electric stoves had significantly better lung function than their gas-use counterparts. Wheeze, cough and sore throat were more prevalent in workers who used gas in the kitchen.
2010 Canada Medline	Chronic and acute effects of coal tar pitch exposure and cardiopulmonary mortality among aluminum smelter workers⁽¹⁷17 Friesen MC, Demers PA, Spinelli JJ, Eisen EA, Lorenzi MF, Le ND. Chronic and acute effects of coal tar pich exposure and cardiopulmonary mortality among aluminum smelter workers. Am J Epidemiol. 2010;172(7):790-9. doi: http://dx.doi.org/10.1093/aje/kwq208 http://dx.doi.org/10.1093/aje/kwq208... ⁾.	Longitudinal study Level of evidence: 4	To analyze the effects of acute and chronic exposure to PAH on cardiopulmonary mortality.	Mortality from ischemic heart disease was associated with cumulative benzo[a]pyrene exposure. A monotonic tendency with chronic exposure to benzo[a]pyrene and acute myocardial infarction was observed .The stronger associations observed during employment suggest that risk may not persist after exposure cessation.
2006 China Medline	Increased risk of chronic obstructive pulmonary diseases in coke oven workers: interaction between occupational exposure and smoking⁽¹⁸18 Hu Y, Chen B, Yin Z, Jia L, Zhou Y, Jin T. Increased risk of chronic obstructive pulmonary diseases in coke oven workers: interaction between occupational exposure and smoking. Thorax. 2006;61(4):290-5. doi: http://dx.doi.org/10.1136/thx.2005.051524 http://dx.doi.org/10.1136/thx.2005.05152... ⁾.	Descriptive study Level of evidence: 6	To explore the dose-response relationship between exposure to coke oven emissions, PAH and chronic obstructive pulmonary disease, and to assess interaction with smoking.	The interaction between exposure to the coke oven and smoking in chronic obstructive pulmonary disease was significant. The risk of chronic obstructive pulmonary disease in those with the highest cumulative exposure to coke oven and smoking was 58-fold compared with non-smokers not exposed to coke oven.
2004 Norway Medline	Respiratory symptoms and airflow limitation in asphalt workers⁽¹⁹19 Randem BG, Ulvestad B, Burstyn I, Kongerud J. Respiratory symptons and airflow limitation in asphalt workers. Occup Environ Med. 2004;61(4):367-9. doi: http://dx.doi.org/10.1136/oem.2002.006114 http://dx.doi.org/10.1136/oem.2002.00611... ⁾.	Descriptive study Level of evidence: 6	To evaluate the occurrence of respiratory symptoms and signs of airflow limitations in a group of asphalt workers exposed to PAH.	The Forced expiratory volume and forced vital capacity ratio was significantly lower in asphalt workers than in controls. Symptoms of eye irritation, chest tightness, shortness of breath on exertion, chest wheezing, physician diagnosed asthma and chronic obstructive pulmonary disease were significantly more prevalent among the asphalt workers.
2003 Netherlands Medline	Polycyclic aromatic hydrocarbons and fatal ischemic heart disease⁽²⁰20 Burstyn I, Kromhout H, Partanen T, Svane O, Langård S, Ahrens W et al. Polycyclic Aromatic Hydrocarbons and fatal ischemic heart disease. Epidemiol. 2005;16(6):744-50.⁾.	Longitudinal study Level of evidence: 4	To analyze the relationship between exposure to PAH and mortality from systemic heart disease.	The cumulative and average exposure indices for benzo[a]pyrene were positively associated with mortality from ischemic heart disease (IHD). The results confirm the hypothesis that occupational exposure to PAH causes fatal IHD and demonstrates a consistent exposure-response relation for this association.
1993 France Medline	Mortality from lung cancer and cardiovascular diseases among stainless-steel producing workers⁽²¹21 Moulin JJ, Wild P, Mantout B, Fournier-Betz M, Mur JM, Smagghe G. Mortality from lung cancer and cardiovascular diseases among stainless-steel producing workers. Cancer Causes Control. 1993;4(2):75-81.⁾.	Longitudinal study Level of evidence: 4	To investigate a possible risk of lung cancer in relation to exposure to chromium compounds, PAH and silica. To examine the role of heat exposure in mortality from cardiovascular diseases.	Among the exposed individuals, no lung cancer, cardiovascular disease or ischemic heart disease was identified.
2017 Sweden Web of Science	Early markers of cardiovascular disease are associated with occupational exposure to polycyclic aromatic hydrocarbons⁽²²22 Alhamdow A, Lindh C, Albin M, Gustavsson P, Tinnerberg H, Broberg K. Early markers of cardiovascular disease are associated with occupational exposure to polycyclic aromatic hydrocarbons. Sci Rep. 2017;7:9426. doi: http://dx.doi.org/10.1038/s41598-017-09956-x http://dx.doi.org/10.1038/s41598-017-099... ⁾.	Descriptive study Level of evidence: 6	To assess occupational exposure to PAH between chimney sweeps by measuring urine metabolites and identifying work tasks that may be associated with increased exposure and to estimate the risk of cardiovascular disease.	Blood pressure (BP), urinary PAH metabolites and serum biomarkers (C-reactive protein, homocysteine, gamma-glutamyltransferase, cholesterol, HDL, LDL and triglycerides) were measured. Chimney sweeps had up to 7 times higher concentrations of PAH metabolites in urine than controls. Compared with controls, chimney sweeps had increased homocysteine, cholesterol, and HDL. PAH exposure among chimney sweeps resulted in elevated levels of markers for CVD risk. These findings stress the need to reduce occupational exposure to PAH.
2016 China Web of Science	Polycyclic aromatic hydrocarbons exposure and lung function decline among coke-oven workers: a four-year follow up study⁽²³23 Wang S, Bai Y, Deng Q, Chen Z, Dai J, Li X et al. Polycyclic aromatic hydrocarbons exposure and lung function decline among coke-oven workers: a four-year follow up study. Environ Res. 2016;150:14-22. doi: http://dx.doi.org/10.1016/j.envres.2016.05.025 http://dx.doi.org/10.1016/j.envres.2016.... ⁾.	Longitudinal study Level of evidence: 4	To investigate the quantitative relationships of urinary PAH metabolites with decreased lung function among coke oven workers.	Higher levels of baseline PAH exposure may lead to a further decline in lung function over a four-year follow-up.
2016 China Web of Science	Polycyclic aromatic hydrocarbon exposure, miR 146a rs2910164 polymorphism, and heart rate variability in coke oven workers⁽²⁴24 Deng Q, Guo H, Deng N, Zhang W, Li X, Deng H et al. Polycyclic aromatic hydrocarbon exposure, miR-146ª rs2910164 polymorphism, and heart rate variability in coke oven workers. Environ Res. 2016;148:277-84. doi: http://dx.doi.org/10.1016/j.envres.2016.04.014 http://dx.doi.org/10.1016/j.envres.2016.... ⁾.	Descriptive study Level of evidence: 6	To investigate the influences of four simple nucleotide polymorphisms in heart rate variability (HRV) and its modifying effects on the associations between exposure to PAH.	Coke oven workers with rs2910164 CC genotype had significant lower HRV. Considering the crucial role of automatic cardiac dysfunction in the pathogenesis of cardiovascular diseases, the occupational population exposed to PAH with miR-146a rs2910164 CC genotype may be at increased risk for developing cardiovascular diseases.
2016 China Web of Science	Exposure to polycyclic aromatic hydrocarbons, plasma cytokines, and heart rate variability⁽²⁵25 Yang B, Deng Q, Zhang W, Feng Y, Dai X, Feng W et al. Exposure to polycyclic aromatic hydrocarbons, plasma cytokines, and heart rate variability. Sci Rep. 2016;6:19272. doi: http://dx.doi.org/10.1038/srep19272 http://dx.doi.org/10.1038/srep19272... ⁾.	Case-control study Level of evidence: 4	To examine differences in plasma cytokine concentrations among coke oven workers and community residents.	The results indicated that PAH exposure was associated with plasma cytokines. Higher cytokines were associated with decreased heart rate.
2016 China Web of Science	Polycyclic aromatic hydrocarbons - associated microRNAs and heart rate variability in coke oven workers⁽²⁶26 Huang S, Deng Q, Feng J, Zhang X, Dai X, Li L et al. Polycyclic aromatic hydrocarbons, associated MicroRNAs and heart rate variability in coke oven workers. J Occup Environ Med. 2016;58(1):e24-31. doi: http://dx.doi.org/10.1097/JOM.0000000000000564 http://dx.doi.org/10.1097/JOM.0000000000... ⁾.	Case-control study Level of evidence: 4	To assess the association between PAH-related microRNAs (miRNAs) and heart rate variability indices in coke oven workers.	MiR-24-3p, miR-27a-3p, miR-142-5p and miR-320b were negatively associated with successive differences between adjacent normal NN intervals (RMSSD). MiR-142-5p and miR-320b were also negatively associated with the standard deviation of all normal to normal NN intervals (SDNN). MiR-24-3p, miR-27a-3p and miR-320b interacted significantly with multiple PAH metabolites and influenced heart rate variability indices. In conclusion, plasma miRNAs might act as potential biomarkers for the adverse effect of PAH exposure on the cardiovascular system.
2011 USA Web of Science	Cardiac autonomic dysfunction from occupational exposure to polycyclic aromatic hydrocarbons⁽²⁷27 Lee MS, Magari S, Christiani DC. Cardiac autonomic dysfunction from occupational exposure to polycyclic aromatic hydrocarbons. Occup Environ Med. 2011;68(7):474-8. doi: http://dx.doi.org/10.1136/oem.2010.055681 http://dx.doi.org/10.1136/oem.2010.05568... ⁾.	Longitudinal study Level of evidence: 4	To investigate the association between PAH and heart rate variability in boilermakers.	Occupational exposure to PAH is associated with altered cardiac autonomic function. Acute exposure to PAH may be an important predictor of cardiovascular disease risk in the work environment.
2003 USA Web of Science	Mortality from obstructive lung diseases and exposure to polycyclic aromatic hydrocarbons among asphalt workers⁽²⁸28 Burstyn I, Boffetta P, Heederik D, Partanen T, Kromhout H, Svane O et al. Mortality from obstructive lung diseases and exposure to polycyclic aromatic hydrocarbons among asphalt workers. Am J Epidemiol [Internet]. 2003[cited 2018 Nov 18];158(5):468-78. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12936902 https://www.ncbi.nlm.nih.gov/pubmed/1293... ⁾.	Longitudinal study Level of evidence: 4	The relationships between mortality from non-malignant respiratory diseases and PAH.	The results show that PAH exposures, originating mainly from coal tar and possibly from bitumen fume, may have contributed to mortality from obstructive lung diseases among asphalt workers.

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[1] Corresponding author: Helenize Ferreira Lima Leachi. E-mail: nizeflima@hotmail.com