Previous Project

Ultra II: "Exposure and risk assessment for fine and ultrafine particles in ambient air - ULTRA II" (1997 - 2004)

Study objective:
To improve knowledge on human exposure to particulate matter of different sizes and of different chemical composition in Europe, and to evaluate the associated health risk with focus on respiratory and cardiovascular health outcomes.

Specific aims:

  • To assess the size distribution and elemental composition of ambient air particles including ultrafine particles.
  • To assess the association between exposure to fine and ultrafine particles and cardiovascular health endpoints such as angina pectoris symptoms, heart rate variability, heart rate, ST-segment changes, arrhythmia and blood pressure.
  • To assess the association between exposure to fine and ultrafine particles and respiratory health endpoints such as respiratory symptoms, lung function parameters inflammatory reactions in the lung monitored by clara cell protein (CC16).

Study design:

Panel study including about 60 participants per study center conducted over a period of 6 month with repeated clinical examinations every 2 weeks.

Study population:
Free living people at the age of 50 or older with coronary artery disease. Study participants had to meet the following criteria:
Self report of doctor diagnosed condition such as coronary heart disease, stable angina pectoris, past myocardial infarction, percutaneous transluminal coronary angioplastie, or coronary by-pass surgery, non-Smokers and able to perform spriometry.
People with fresh (less than three month) cardiac events (MI, stroke, by-pass, PTCA), instable angina pectoris (according to NYHA criteria), diabetes mellitus and dementia were not included in the study.

Study areas:
Erfurt (Germany), Helsinki (Finnland), Amsterdam (The Netherlands).

Study methods:
Health assessment:
Health effects were assessed in bimonthly clinical examinations. During the clinical visits electrocardiography (ECG) was recorded with a Holter monitor, the autonomous nervous system was stimulated by paced breathing (parasympathetic stimulation), standing up from supine position (sympathetic stimulation) and an exercise challenge. The examination included further blood pressure measurements and a lung function test. Urine samples were taken at each visit. Daily symptoms and medication use were recorded during the winter 1998/99.

Assessment of ambient particulate air pollution:
In addition to standard air hygiene measurements PM2.5 and PM10, number concentrations of particles in size ranges 0.01-0.1 µm, 0.1-1µm, 1-2.5µm, and total number concentrations of particles up to 2.5µm were measured daily to determine particle exposure. Furthermore, data on elemental composition and blackness of PM2.5 were collected.

Study period:
Field phase: October 1998 until April 1999 (Erfurt).
Data management: Mai 1999 until December 1999
Analyses: January 2000 until 2001
End of funding: December 2000

Current status:
Completed. Information on the project can be obtained at

Helmholtz Zentrum München, Institute of Epidemiology: Joachim Heinrich (PI), Annette Peters, Angela Ibald-Mulli, Thomas Tuch, Gabriele Wölke
Helmholtz Zentrum München, Institute of Inhalation Biology: Wolfgang Kreyling

Landbouwuniversiteit Wageningen, Humane Epidemiologie en Gezondheidsleer:
Bert Brunekreef (PI), Gerard Hoek, Jeroen de Hartog

National Public Health Institute, Unit of Environmental Epidemiology
Juha Pekkanen (PI and Coordinator), Kirsi Timonen, Pekka Tiittanen, Timo Lanki

European Union (1996-1999)
Helmholtz Zentrum München - Institute of Epidemiology

Related Publications:

  • de Hartog JJ, Lanki T, Timonen KL, Hoek G, Janssen NAH, Ibald-Mulli A, Peters A, Heinrich J, Tarkiainen TH, van Grieken R, van Wijnen JH, Brunekreef B, Pekkanen J. (2009)Associations between PM2.5 and Heart Rate Variability Are Modified by Particle Composition and Beta-Blocker Use in Patients with Coronary Heart Disease.
    Environ Health Perspect 117(1):105-111
  • Lanki T, Hoek G, Timonen KL, Peters A, Tiittanen P, Vanninen E, Pekkanen J (2008)
    Hourly variation in fine particle exposure is associated with transiently increased risk of ST segment depression.
    Occup Environ Med 65, 782-786
  • Timonen KL, Vanninen E, de Hartog J, Ibald-Mulli A, Brunekreef B, Gold DR, Heinrich J, Hoek G, Lanki T, Peters A, Tarkiainen T, Tiittanen P, Kreyling W, Pekkanen J. (2006)
    Effects of ultrafine and fine particulate and gaseous air pollution on cardiac autonomic control in subjects with coronary artery disease: the ULTRA study.
    J Expo Sci Environ Epidemiol 2006; 16 [4], 332-341
  • Lanki T, de Hartog JJ, Heinrich J, Hoek G, Janssen NA, Peters A, Stölzel M, Timonen KL, Vallius M, Vanninen E, Pekkanen J (2006)
    Can we identify sources of fine particles responsible for exercise-induced ischemia on days with elevated air pollution? The ULTRA study.
    Environ Health Perspect. 2006 May;114(5):655-60.
  • Ibald-Mulli A, Timonen KL, Peters A, Heinrich J, Wölke G, Lanki T, Buzorius G, Kreyling WG, De Hartog JJ, Hoek G, ten Brink H Pekkanen J. (2004)
    Effects of particulate air pollution on blood pressure and heart rate in subjects with cardiovascular disease: a multicenter approach.
    Environ Health Perspect. 2004; 112 [3], 369-377
  • Timonen KL, Hoek G, Heinrich J, Bernard A, Brunekreef B, de Hartog J, Hameri K, Ibald-Mulli A, Mirme A, Peters A, Tiittanen P, Kreyling WG Pekkanen J. (2004)
    Daily variation in fine and ultrafine particulate air pollution and urinary concentrations of lung Clara cell protein CC16.
    Occup Environ Med  2004; 61 [11], 908-914
  • de Hartog JJ, Hoek G, Peters A, Timonen KL, Ibald-Mulli A, Brunekreef B, Heinrich J, Tiittanen P, van Wijnen JH, Kreyling W, Kulmala M Pekkanen J. (2003)
    Effects of fine and ultrafine particles on cardiorespiratory symptoms in elderly subjects with coronary heart disease: the ULTRA study.
    Am J Epidemiol. 2003; 157 [7], 613-623
  • Wichmann HE, Peters A (2000)
    Epidemiological evidence of the effects of ultrafine particle exposure.
    Philosophical Transactions of the Royal  Society A; 2000; 358:2751-2769 .

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