Article Text

Download PDFPDF

An epidemiological appraisal of the association between heart rate variability and particulate air pollution: a meta-analysis
  1. Nicky Pieters1,
  2. Michelle Plusquin1,
  3. Bianca Cox1,
  4. Michal Kicinski1,
  5. Jaco Vangronsveld1,
  6. Tim S Nawrot1,2
  1. 1Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
  2. 2Department of Public Health, Occupational & Environmental Medicine, Leuven, Belgium
  1. Correspondence to Professor Tim Nawrot, Hasselt University, Agoralaan Gebouw D, 3590 Diepenbeek, Belgium; tim.nawrot{at}


Objective Studies on the association between short-term exposure to ambient air pollution and heart rate variability (HRV) suggest that particulate matter (PM) exposure is associated with reductions in measures of HRV, but there is heterogeneity in the nature and magnitude of this association between studies. The authors performed a meta-analysis to determine how consistent this association is.

Data source The authors searched the Pubmed citation database and Web of Knowledge to identify studies on HRV and PM.

Study selection Of the epidemiologic studies reviewed, 29 provided sufficient details to be considered. The meta-analysis included 18667 subjects recruited from the population in surveys, studies from patient groups, and from occupationally exposed groups.

Data extraction Two investigators read all papers and computerised all relevant information.

Results The authors computed pooled estimates from a random-effects model. In the combined studies, an increase of 10 μg/m3 in PM2.5 was associated with significant reductions in the time-domain measurements, including low frequency (−1.66%, 95% CI −2.58% to −0.74%) and high frequency (−2.44%, 95% CI −3.76% to −1.12%) and in frequency-domain measurements, for SDNN (−0.12%, 95% CI −0.22% to −0.03%) and for rMSSD (−2.18%, 95% CI −3.33% to −1.03%). Funnel plots suggested that no publication bias was present and a sensitivity analysis confirmed the robustness of our combined estimates.

Conclusion The meta-analysis supports an inverse relationship between HRV, a marker for a worse cardiovascular prognosis, and particulate air pollution.

  • Heart rate variability
  • air pollution
  • meta-analysis
  • cardiac function

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:


  • Funding The research on air pollution and health at Hasselt University is supported by a grant from the Flemish Scientific Fund (FWO/G.0873.11), tUL-impuls financing and Hasselt University Bijzonder OnderzoeksFonds (BOF). MK has a PhD fellowship of the Research Foundation—Flanders (FWO).

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.