Cardiovascular and metabolic effects of long-term exposure to traffic noise Göran Pershagen Institute of Environmental Medicine, Karolinska Institutet Center for Occupational and Environmental Medicine, Stockholm County Council Klicka för att lägga till anteckningar

Sympathetic nervous system Potential biological mechanisms behind non-auditory health effects induced by environmental noise exposure Short-term exposure Long-term exposure Stress response: Sympathetic nervous system Endocrine system Annoyance Sleep disturbances Chronic stress Hemodynamic and metabolic effects: Pulse rate ↑ Blood pressure ↑ Cortisol production ↑ Release of free fatty acids ↑ Mobilization of glucose Hypertension Myocardial infarction Stroke Overweight Diabetes Type 2

Cushing’s syndrome (hypercortisolemia) Hypercholesterolemia Rapid weight gain Abdominal obesity Moodiness, irritability, or depression Muscle and bone weakness Memory and attention dysfunction Osteoporosis Diabetes mellitus Hypertension Immune suppression Sleep disturbances

Systematic Review on Cardiovascular and Metabolic Effects of Environmental Noise Elise van Kempen National Institute of Public Health and the Environment, Utrecht, Netherlands Maribel Casas Center for Research in Environmental Epidemiology, Barcelona, Spain Göran Pershagen Karolinska Institutet, Stockholm, Sweden Maria Foraster Swiss Tropical and Public Health Institute, Basel, Switzerland

Systematic Review on Cardiovascular and Metabolic Effects of Environmental Noise Data collection > 500 references Quantitative assessment 57 studies Quality rating Modified GRADE

Relative risk (RR) of hypertension following exposure to noise from different sources in combined analyses of several studies Noise source Number of studies and design* RR per 10 dB (95%CI) Participants (cases) Air traffic 9 CS 1.05 (0.95 – 1.17) 60,121 (9,488) 1 CO 1.00 (0.77 – 1.30) 4,721 (1,346) Road traffic 26 CS 1.06 (1.02 – 1.09) 156,802 (18,690) 0.97 (0.90 - 1.05) 45,271 (3,145) Rail traffic 5 CS 1.05 (0.88 – 1.26) 15,850 (2,059) 0.96 (0.88 – 1.04) Wind turbine 3 CS - 1,856 (NR) *CS=cross-sectional, CO=cohort, CC=case-control, ECO=ecological van Kempen et al. 2017

Relative risk (RR) of ischemic heart disease following exposure to noise from different sources in combined analyses of several studies Noise source Outcome Number of studies and design* RR per 10 dB (95%CI) Participants (cases) Air traffic Prevalence 2 CS 1.07 (0.94 – 1.23) 14,098 (340) Incidence 2 ECO 1.09 (1.04 – 1.15) 9,619,082 (158,975) Mortality 2 ECO, 1 CO 1.05 (1.01 – 1.09) 8,477,956 (41,598) Road traffic 7 CS 1.24 (1.08 – 1.42) 25,682 (1,614) 1 ECO, 4 CC, 3 CO 1.08 (1.02 - 1.15) 330,054 (7,451) 1 CC, 2 CO 1.05 (0.97 – 1.13) 532,268 (6,884) Rail traffic 4 CS 1.18 (0.82 – 1.68) 13,241 (283) Wind turbine 3 CS - 1,856 (NR) *CS=cross-sectional, CO=cohort, CC=case-control, ECO=ecological van Kempen et al. 2017

---- 95% confidence interval ---- linear relation Relative risk (RR) for ischemic heart disease following exposure to road traffic noise in combined analysis of several studies cubic spline ---- 95% confidence interval ---- linear relation van Kempen et al. 2017 2019-01-02 Göran Pershagen

Waist circumference (cm) Increase in BMI and waist circumference in relation to exposure to aircraft noise near Stockholm Arlanda Average increase during 8-10 years of observation BMI 1.09 kg/m2 Waist circumference 4.39 cm Aircraft noise exposure (Lden) BMI (kg/m2) Waist circumference (cm)   β (95% CI) ≥ 50 dB(A) 0.5 (-0.15 – 0.25) 1.34 (0.52 – 2.16) Per 5 dB(A) 0.04 (-0.05 – 0.13) 1.51 (1.13 – 1.89) Model adjusted for sex, age, family history of diabetes, physical activity, tobacco use and psychological distress as well as for individual and area-based socioeconomic status. Eriksson et al. 2014

Waist circumference increase in relation to noise from road traffic and aircraft in Stockholm County Pyko et al. 2017 2 januari 2019 Göran Pershagen

Relative risk (RR) for central obesity in relation to exposure to noise from road traffic, railways and/or aircraft ptrend < 0.01 We observed a clear exposure-response association between the number of traffic noise sources ≥45 dB and risk of central obesity (Figure 3). The OR increased from 1.25 (95% CI 1.08-1.45) among those exposed to one source only to 1.95 (95% CI 1.24-3.05) among those exposed to all three traffic noise sources. RR (95% CI) Pyko et al. 2015

Conclusions Several studies have documented an association between long-term exposure to traffic noise and cardiovascular disease An increasing number of studies suggest that such exposure may also lead to metabolic diseases It appears that current environmental noise guidelines do not fully protect against serious adverse health effects