How Does Air Pollution in Rustavi Damage the Circulatory System?

The verified statistics of circulatory system diseases in Rustavi exists only for the past three years. According to these statistics, the number of new cases of this group of diseases is increasing; and the total amount of new cases during the past three years makes the 8% of the population of Rustavi.

This figure is probably higher than the mentioned statistics since part of the new disease cases of Rustavi is included in the database of the capital – Tbilisi, because due to the proximity and anticipation of better medical services part of the citizens of Rustavi go to Tbilisi for disease diagnosis or treatment.

The National Center for Disease Control (NCDC) of Georgia is the authority that collects the statistics of diseases throughout Georgia. However, the authority does not hold information on what part/percentage of the population of Rustavi goes to Tbilisi every year for receiving healthcare services and, hereby, what percentage is excluded from the final annual statistics of Rustavi.

The Importance of the Topic

According to the WHO data, exposure to air pollution is estimated to cause 7 million premature deaths and result in the loss of millions more healthy years of life.

Among other things, air pollution damage includes reduced lung function, respiratory infections and aggravated asthma. In adults, air pollution causes ischaemic heart disease and stroke.

In the framework of this article, we looked for the number of new cases of cardiovascular diseases among citizens above 18 years old in Rustavi over the last three years.

Diseases of the Circulatory System in Rustavi

According to the latest General Population Census of 2014, the population of Rustavi is 125 103; out of them 59, 859 are male and 65, 244 – female.

According to the NCDC data, new cases of circulatory system diseases in Rustavi in the 18+ age group in 2020 were – 2912; in 2021 – 3919; an in 2022 (preliminary data) – 3111.

Among the diseases of this system, statistically the most common was “essential (primary) hypertension”: 1485 cases in 2020; 1988 – in 2021; 1708 – in 2022.

“Cactus Media” referred to the person responsible for public information in NCDC in order to find out, why does only one type of circulatory system disease outnumber the others; and whether the easy detection of this disease is one of the reasons for its dominance in the statistics?

NCDC provided the following answer – “The structure of the circulatory system diseases is represented with 60% of essential hypertension because of the high prevalence rate of this clinical condition throughout the country. According to the latest data, the prevalence of arterial hypertension in the adult population is 37.7%.

Regarding the process of diagnosis: arterial hypertension is relatively easy to detect, but the difficulty is its assessment in regard to damage to the target organs. The damage status of the target organs (brain, heart, kidney) determines the disease management tactics and the resolution as well”.

Why Only from the 2020 year?

The more data we held about the disease occurrence the better tendency we get. In our case, at least 5 or in the best possible way, 10 years of disease statistics would be preferable.

We were explained by the National Center for Disease Control that during 2012 – 2019 years the Center used an outdated method for data collection, with this method, people were not registered with their ID number, for instance, if a person applied to the five different clinics his/her date would be included in calculation five times, hence this method could not provide the correct data.

The Center updated the data collection method from 2020, in compliance with World Health Organization standards, and is now using the ID number to register new cases. Accordingly, in our study, we only used verified data from 2020-2021 years and so-called “preliminary data” of 2022, which will be corrected later by the Center.

Environmental and Health Policy in Rustavi

The head of the Public Health Center in Rustavi, David Ishkhneli, has been in this position for nine months. This Center is implementing programs, funded by the NCDC, in the Kvemo Kartli region.

According to Ishkhneli, when he took over, there was no specific plan for Rustavi for improving environmental and health problems.

We had an interview with Ishkhneli last year as well within the framework of preparing a similar profile article about the correlation between air pollution and respiratory diseases.

Ishkhneli says, that he put together a group of young people, competent in these fields, who will work on these issues as interns and cooperate with the Ministry of Environmental Protection and Agriculture, as well as with the polluting enterprises and even control their activity.

In regard to funding this project, Ishkhneli depends on Rustavi City Hall, consequently, the idea will be implemented only with the financial support of Rustavi City Hall. According to Ishkhneli, he met the Mayor of Rustavi several times, who is willing to improve the air quality in the city.

On February 21 of the current year, we asked Ishkhneli about the progress of his plans and as he informed us, the City Hall had not yet financed his idea about creating an environmental department.

The Opinion of the Head of the Rustavi Central Hospital

The Central Hospital of Rustavi is a modernized multidisciplinary complex of the main and oldest medical institution of the city. The head and active doctor at the same time – Papuna Bakhtadze tells us the polluted air of Rustavi, along with the bad nutrition, causes irreparable damage to the health of the population, including the increase in cardiovascular diseases.

Bakhtadze believes, that when it comes to finding the solution to this situation the Ministry of Environmental Protection and Agriculture is the one who plays a crucial and decisive role:

“the Ministry of Environmental Protection and Agriculture should take action – instead of chasing the small markets, they should pay more attention to the large enterprises, that destroy the environment. The filters must be installed and the situation should be regulated. We need to prevent new cases as much as possible. What worries everyone is dust everywhere.

You may wash the balcony in the evening, however, it needs to be washed in the morning once again. In the morning, I go out to the balcony, look at the Mtkvari valley and see how reddish-yellow smoke comes from the chemical plant – the chemical result of the nitrogen oxides process. We should make Chemical and Cement plants install filtration systems. Everything is completely white on the side of Gardabani.

Main Sources of Pollution in Rustavi

According to the “2020-2022 Action Plan on Improvement Ambient Air Quality in Rustavi”, published on the website of the Ministry of Environmental Protection and Agriculture, there are 50 sources of emissions in Rustavi – 47 of them are located on “old Rustavi” and 3 of them – in “new Rustavi”.

Most of them are metallurgical, chemical, mineral and other industrial objects.

In 2019, the number of particulate matter, emitted from these enterprises amounted to more than 14 000 tons. And the largest polluters are responsible for 97% of these emissions.

According to the Action Plan, the mass of emitted particulate matter should have been reduced by about 7 times. However, in the informational material, published by the civil movement “Gavigudet”, we read that the mass of emitted particulate matter is reduced only by 5, 705 tons (around 40%).

As we also read in the 2022 report of the performance of the Action Plan, despite the fact, that 64 inspections of 44 objects were carried out, this is the result of violations from the large enterprises.

Collecting and Interpreting the Air Quality Data by the National Environmental Agency – monthly vs hourly exceeding and how this data is reflected in the reports

For monitoring the air quality in Rustavi there is only one background automatic station, which is located far from the industrial zone and cannot reflect the comprehensive data about the level of the pollution.

The air quality portal – air.gov.ge shows that the hourly rate of the particulate matter often exceeds the permitted value.

However, there is a big difference between daily and monthly average rates, which are reflected in the daily and monthly reports of the National Environmental Agency: for instance, on a day of a hot month, the rate of one of the pollutants might exceed the norm during the peak hours and later, because of the ease of the traffic or other reasons, it might return to a regulated norm again. Hence, while calculating the monthly average it may not show the exceed, and this does not mean that generally there are no exceeding on this location.

“It is good to have the average data, however, more attention should be paid to the exceeding on an hourly basis. If I am exposed to polluted air during the whole day, it does not benefit me to breathe clean air only at night” – says Giorgi Djibuti chemist and assistant professor at Tbilisi State University.

There also are cases, when we see the high concentrations of the polluters in the monthly reports also. For instance, in August 2022, particulate matter concentrations were exceeding the limited value every day each hour.

New Scientific Evidence – a Meta-analysis

On August 2, 2022, the research – “The Impact of Fine Particulate Matter 2.5 on the Cardiovascular System: a Review of the Invisible Killer” was published in the journal Nanomaterials [Basel]. The research includes an explanation of the biological mechanism of how PM2.5 affects the human cardiovascular system, how it reaches the central nervous system, and how it could cause chronic and irreversible health conditions in case of constant presence.

Composition and Sources of PM2.5

There are ultrafine or/and coarse particulate matter types, which have a diameter of less than 0.1, 2.5 or 10 micrometers.

The smaller the particle, the more harmful it is, as it has the ability to easily intrude deep in the lungs, transfer to the blood and harm the organism.

Long-term exposure to particulate matter raises the risks of developing cardiovascular, respiratory diseases and lung cancer.

PM2.5 consists of three main components: primary particles (elemental carbon); secondary particles (organic aerosols), and nitrate and sulfate particles.

The primary 2.5 is released into the environment both by natural means (soil erosion, dust storms, forest fires, volcanic eruptions), and human activities (agriculture and waste incineration, biomass combustion, wood burning, road dust, cigarette smoke, cooking process, construction, fossil fuel burning, home heating, industrial activities, waste of mechanical wear of objects, the activity of energy-powered facilities, sea salt and transport).

Secondary PM2.5 is emitted as a result of the chemical reaction of products with low volatility with the organic and inorganic precursors. The vehicle exhaust or the coal combustion residue reacts with the moisture in the air and sunlight and produces additional particles.

The combination of the chemical composition of PM2.5 varies according to the geographic regions, climate, areas of human activity and nearby pollutants. As a result of agricultural activity, PM2.5 mostly consists of mostly silicon and aluminum.

In the rural area, air pollution is caused by the high density, traffic jams, high concentrations of secondary aerosols (ammonium, nitrates and sulfates), high rate of elemental and organic carbon combustion, and globally, the high rate of globalization. In industrial areas, there are high concentrations of zinc, iron and palladium in the air.

Biological Mechanisms that Connect PMs and Cardiovascular Diseases

Exposure to PM2.5 leads to cardiovascular diseases with multiple, interdependent chain of events. The presence of PMs in the cardiovascular system causes:

1) oxidative stress and systemic inflammation. oxidative stress and systemic inflammation is one of the main mechanisms by which PM2.5 increases the risk of cardiovascular diseases. Inhalation of this pollutant causes oxidative stress in various types of cells of the respiratory tract, leading to many adverse events, including inflammation.

Inhaled PM2.5 activates a number of inflammatory mediators in the lungs. These activated cells induce the secretion of adhesion molecules, which by itself promotes the binding of white bold cells and platelets and systemic blood coagulation.

The fact, that high concentrations of PM2.5 in the blood is associated with the occurrence of hypercoagulation markers and thrombin was known with the previously published studies as well.

2) direct entry to the systemic circulation of the body – due to the small size, PM2.5 is capable of easily entering the lungs, reaching the heart and other organs and causing adverse health conditions. According to a number of epidemiological studies, PM2.5 is associated with decreased venous thrombosis and plasma clotting time.

Long-term exposure to PM2.5 is also correlated with high blood pressure. It may also cause myocardial infarction and stroke.

3) disorders of the autonomic nervous system – Long-term exposure to high concentrations of PM2.5 it may cause the pollutant to penetrate into the autonomic nervous system and increase the likelihood of arrhythmia and other cardiovascular diseases.

Acceleration of the pulse and heart rhythm disturbance are two major factors in death from heart-related problems.

Recommendations for the Population

The relevant agencies should provide information to the population, that it is not recommended to be outside during peak hours, when the traffic is intense.

For those, who travel by car, it is better to keep car windows closed. The car should have a good air circulation system to filter the air.

It is not recommended to stay outside for a long time during those days when air pollution is at a high level; windows at home should be kept closed. It is advisable to use indoor air conditioning and filtration systems. The circulation of clean air reduces the risks of developing cardiovascular diseases.

In the case of indoor air pollution, physical activity outside – in the parks – is the best solution. If we have to stay in the condition of indoor pollution it is preferable to wear a face mask to reduce the risks for PMs to enter the body.

Face mask N95 is also a good way for avoiding PMs from entering our bodies. Despite the fact that N95 protects us from PMs with 95% effectiveness, it cannot protect us from other harmful substances. In this case, it is preferable to use activated carbon to avoid harmful substances. These warnings also apply to cyclists, especially in town, where the air pollution rate is high.

The article was prepared by “Cactus Media” in cooperation with “Gavigudet” in the framework of USAID Civil Society Engagement Program, funded by the United States Agency for International Development (USAID).

The content of this article is the sole responsibility of “Cactus Media” and do not necessarily reflect the views of USAID, the United States Government, or EWMI.