Outdoor particulate matter (PM) and associated cardiovascular diseases in the Middle East
Zeina Nasser 1, 2  
Wissam Nasser 4
Elias Elias 5
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Free University of Brussels, Brussels, Belgium (Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health)
Lebanese University, Beirut, Lebanon (Clinical and Epidemiological Research Laboratory (LCER), Doctorate School of Sciences and Technology)
Lebanese University, Beirut, Lebanon (Clinical and Epidemiological Research Laboratory (LCER), Faculty of Pharmacy)
Ministry of Public Health, Beirut, Lebanon (Epidemiological Surveillance Unit)
American University of Beirut, Beirut, Lebanon (Department of Surgery, Division of Neurosurgery)
Int J Occup Med Environ Health 2015;28(4):641–661
Air pollution is a widespread environmental concern. Considerable epidemiological evidence indicates air pollution, particularly particulate matter (PM), as a major risk factor for cardiovascular diseases (CVD) in the developed countries. The main objective of our review is to assess the levels and sources of PM across the Middle East area and to search evidence for the relationship between PM exposure and CVD. An extensive review of the published literature pertaining to the subject (2000–2013) was conducted using PubMed, Medline and Google Scholar databases. We reveal that low utilization of public transport, ageing vehicle fleet and the increasing number of personal cars in the developing countries all contribute to the traffic congestion and aggravate the pollution problem. The annual average values of PM pollutants in the Middle East region are much higher than the World Health Organization 2006 guidelines (PM2.5 = 10 μg/m3, PM10 = 20 μg/m3). We uncover evidence on the association between PM and CVD in 4 Middle East countries: Iran, Kingdom of Saudi Arabia, Qatar and the United Arab Emirates. The findings are in light of the international figures. Ambient PM pollution is considered a potential risk factor for platelet activation and atherosclerosis and has been found to be linked with an increased risk for mortality and hospital admissions due to CVD. This review highlights the importance of developing a strategy to improve air quality and reduce outdoor air pollution in the developing countries, particularly in the Middle East. Future studies should weigh the potential impact of PM on the overall burden of cardiac diseases.
Zeina Nasser   
Lebanese University, Doctorate School of Sciences and Technology, Clinical and Epidemiological Research Laboratory (LCER), Rafic Hariri Campus, Hadath, Beirut 6573-14, Lebanon