*Carlos V. Serrano, Jr., Cibele L. Garzillo, Eduardo G. Lima, Fábio G. Pitta, Lucas C. Godoy, Luciana D. N. Janot de Matos, Michael E. Farkouh and Greg J. Evans


Cardiovascular disease (CVD) is the leading cause of death in industrialized countries and air pollution exposure is believed to be a key modifiable risk factor. Although explanations by which pollution leads to CVD remain inconsistent, recent studies suggest that compromise to vascular function are potential pathophysiological mechanisms. The inhalation of ambient particulate matter (PM) is linked to an increased inflammatory status and adverse myocardial and vascular functions. Notably, physical exercise improves the CV risk profile. However, studies indicate that the forceful inhalation, as in intense exercise, of small environmental particles may directly or indirectly result in vascular damage, an early feature of the atherogenic process. The mechanisms responsible for this vascular dysfunction remain unknown. Therefore, a systematic review on vascular dysfunction markers in the setting of outdoor running in poor air quality environment was performed. Inflammatory, thrombotic, oxidative stress and endothelial markers were emphasized. These markers are adversely affected among high-volume runners exposed to an increased inhaled dose of air pollution. This adverse effect may induce vascular dysfunction and stimulate CVD. KEY POINTS  Atherosclerotic coronary artery disease has long been considered a chronic low-grade subclinical systemic inflammatory disease.  Coronary atherosclerosis is the main underlying cause of exercise-related coronary events not only among elderly persons unaccustomed to exercise, but also in adult athletes including marathon runners.  Vascular dysfunction markers are adversely affected among high-volume runners exposed to an increased inhaled dose of air pollution.

Keywords: Air quality; outdoor running; marathon; vascular dysfunction markers; atherosclerosis; coronary artery disease.

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