Risk factors for coronary heart disease in miners with anthracosilicosis

Introduction. There are data on the effects of dust on the respiratory system and the cardiovascular system. The main measures for preventing diseases of the circulatory system aimed to identify and eliminate risk factors. However, the prevalence of risk factors for coronary heart disease among coal mine workers with anthracosilicosis has not been sufficiently studied, determining the study's relevance.

The study aimed to learn the frequency of risk factors for coronary heart disease in coal industry workers with anthracosilicosis.

Materials and methods. We examined 269 miners working in conditions of dustiness exceeding the maximum permissible concentration by ten or more times: 139 miners with a previously established diagnosis of anthracosilicosis and 130 miners of the control group without dust pathology of the lungs. All of them underwent a comprehensive clinical, instrumental, and laboratory examination of the respiratory and cardiovascular systems to detect anthracosilicosis and coronary heart disease, as well as to assess its risk factors.

Results. In miners with anthracosilicosis, coronary heart disease was 3.5 times more common (30.94%) than in the control group (8.46%). We have identified a high incidence of coronary heart disease in the age group of 45 and more years and with the experience of working in dust conditions of 20 and more years. In miners with anthracosilicosis combined with coronary heart disease, arterial hypertension was 1.6 times more common (58.14%) than without concomitant coronary heart disease — 35.42%. Miners with a combination of anthracosilicosis and coronary heart disease were three times more likely (20.93%) than those without coronary heart disease (6.25%) to have a metabolic syndrome. According to the Tanner index, significant risk factors for coronary heart disease were the presence of an andromorphic constitutional-morphological type and the formation of a complication of anthracosilicosis — respiratory failure. The evaluation of biochemical blood tests showed that the most significant markers of coronary heart disease risk were hyperhomocysteinemia, increased levels of C-reactive protein, fibrinogen, and soluble fibrin-monomer complexes.

Conclusions. We found that the most significant risk of developing coronary heart disease in miners is 45 years and older.  

There are also other risk factors: work experience in harmful working conditions of 20 years or more; the presence of arterial hypertension; metabolic syndrome; andromorphic constitutional-morphological type according to the Tanner index. Risk factors are respiratory failure, hyperhomocysteinemia, hyperfibrinogenemia, increased soluble fibrin-monomer complexes, and C — reactive protein. It is necessary to consider all risks in developing programs of medical and preventive measures for employees of the coal industry.

Ethics. The examination of patients was under the ethical standards of the Bioethical Committee of the Research Institute of the CPGPP, developed by the Helsinki Declaration of the World Association "Ethical Principles of Conducting Scientific Medical Research with Human Participation" as amended in 2013. Also, the "Rules of Clinical Practice in the Russian Federation," approved by Order of the Ministry of Health of the Russian Federation No. 266 of 19.06.2003. All the persons surveyed gave informed consent to participate in the study.

1. Popova A.Yu. Working conditions and morbidity in the Russian Federation. Meditsina truda i ekologiya cheloveka. 2015; (3): 7–13 (in Russian).

2. Babanov S.A. Occupational respiratory diseases. Samara: OOO "Ofort"; 2018 (in Russian).

3. Lai Z., Wang X., Tan H., Huang Y., Lu C. Effect of underground work on cardiovascular system in coal miners. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2015; 40(10): 1103–8 https://doi.org/10.11817/j.issn.1672-7347.2015.10.008

4. Kojima S., Michikawa T., Ueda K., Sakamoto T., Matsui K., Kojima T. et al. Asian dust exposure triggers acute myocardial infarction. Eur Heart J. 2017; 38(43): 3202–8. https://doi.org/10.1093/eurheartj/ehx509

5. Pope C.A., Muhlestein J.B., Anderson J.L., Cannon J.B., Hales N.M., Meredith K.G. et al. Short-Term Exposure to Fine Particulate Matter Air Pollution Is Preferentially Associated With the Risk of ST-Segment Elevation Acute Coronary Events J Am Heart Assoc. 2015; 4(12): e002506. https://doi.org/10.1161/JAHA.115.002506

6. Landen D.D., Wassell J.T., McWilliams L., Patel A. Coal dust exposure and mortality from ischemic heart disease among a cohort of U.S. coal miners. Am J Ind Med. 2011; 54(10): 727–33. https://doi.org/10.1002/ajim.20986

7. Davydova E.V. Diagnosis of cardiopathy through rhythmocardiography and echocardiography in occupational diseases. Med. truda i prom. ekol. 2008; (10): 20–4 (in Russian).

8. Mikhailova N.N., Bugaeva M.S., Bondarev O.I., Shavtsova G.M. Systemic morphological changes associated with the dynamics of pneumoconiosis. Meditsina v Kuzbasse. 2017; 16(4): 68–73 (in Russian).

9. Zelko I.N., Zhu J., Ritzenthaler J.D., Roman J. Pulmonary hypertension and vascular remodeling in mice exposed to crystalline silica. Respir res. 2016; 17: 160. https://doi.org/10.1186/s12931-016-0478-5

10. Zhi C.X., Liu X.Y., Pan H.W., Li G.F., Li Z.H., Zhao Y.Z. et al. Association between dust exposure and the risk of hypertension of male coal miners in Henan Province. Zhonghua Yu Fang Yi Xue Za Zhi. 2019; 53(6): 597-602. https://doi.org/10.3760/cma.j.issn.0253-9624.2019.06.011

11. Yen C.-M., Lin C.-L., Lin M.-C., Chen H.-Y., Lu N.-H, Kao C.-H. Pneumoconiosis increases the risk of congestive heart failure. Medicine (Baltimore). 2016; 95(25): e3972. https://doi.org/10.1097/MD.0000000000003972

12. Karabaeva R.Zh., Akynzhanova S., Karabalin S.K. The functional state of the vascular endothelium in coal miners. Vestnik VGMU. 2007; 6(3): 32–6 (in Russian).

13. Shen C.-H., Lin T.-Y., Huang W.-Y., Chen H.-J., Kao C.-H. Pneumoconiosis Increases the Risk of Peripheral Arterial Disease: a Nationwide Population-Based Study. Medicine (Baltimore). 2015; 94(21): e911. https://doi.org/10.1097/MD.0000000000000911

14. Filimonov S.N., Gorbatovsky Ya.A., Stankevich N.G. Assessment of the significance of some risk factors for the prevention of ischemic heart disease in miners with dusty lung pathology. Meditsina v Kuzbasse. 2006; (S5): 115–7 (in Russian).

15. Maksimov S.A., Skripchenko A.E., Artamonova G.V. Role of healthy worker effect in epidemiology of arterial hypertension of miners. Ekologiya cheloveka. 2015; (9): 15–20 (in Russian).

16. Maksimov S.A., Tabakaev M.V., Chigisova A.N., Artamonova G.V. Results of the complex risk factor assessment for the coronary heart disease in working population. Gigiena i sanitariya. 2018; 97(4): 310–4. https://doi.org/10.18821/0016-9900-2018-97-4-310-314 (in Russian)

17. Chigisova A.N., Ogarkov M.Y., Maksimov S.A. Comprehensive assessment of risk factors of arterial hypertension in coal miners. Sotsial’nye aspekty zdorov’ya naseleniya. 2018; (3): 8. https://doi.org/10.21045/2071-5021-2018-61-3-8 (in Russian)

18. Izmerov N.F. ed. Occupational pathology: national guidelines. Moscow: GEOTAR-Media; 2011 (in Russian).

19. Filimonov S.N., Panev N.I., Korotenko O.Yu., Evseeva N.A., Danilov I.P., Zatsepina O.V. Prevalence of somatic pathology in coal mine workers with occupational respiratory diseases. Med. truda i prom. ekol. 2019; 59(6): 381–4. https://doi.org/10.31089/1026-9428-2019-6-381-384 (in Russian)

20. Ekimovskih A.V., Churlyaev Yu.A., Epifantseva N.N., Kan S.L., Dantsiger D.G., Redkokasha L.Yu. Mechanisms of vascular endothelial dysfunction in miners. Sibirskiy meditsinskiy zhurnal (Tomsk). 2013; 28(3): 28–34 (in Russian).

21. Panev N.I. Immunoinflammatory mechanisms and endothelial dysfunction in the development of atherosclerosis in miners with dusty lung pathology. Meditsinskaya immunologiya. 2017; 19(S): 291–2 (in Russian).

22. Zakharenkov V.V., Panev N.I., Mikhailova N.N., Gorokhova L.G., Fomenko D.V., Bugaeva M.S. et al. Medical and biological study of the development of occupational dust lung disease. Byulleten’ fiziologii i patologii dykhaniya. 2013; (48): 16–21 (in Russian).

23. Vlasenko M.V., Bobrov S.V. Early markers of hypoxia in patients having respiratory system diseases caused by dust. Med. truda i prom. ekol. 2011; (10): 10–2 (in Russian).

24. Filimonov S.N., Zakharenkov V.V., Panev N.I., Bourdein A.V., Danilevskaya L.A., Epifantseva N.N. Hemostasis disorders in coal miners. Med. truda i prom. ekol. 2009; (9): 22–5 (in Russian).

25. Tuleta I., França C.N., Wenzel D., Fleischmann B., Nickenig G., Werner N. et al. Intermittent Hypoxia Impairs Endothelial Function in Early Preatherosclerosis. Adv Exp Med Biol. 2015; 858: 1–7. https://doi.org/10.1007/5584_2015_114

26. Gorbunov N.S., Chikun V.I., Gorbunov D.N., Zalevskiy A.A., Russkikh A.N., Mishanin M.N. et al. Body type features in men died of heart pathology. Sibirskoye meditsinskoye obozreniye. 2015; (1): 55–9 (in Russian).