A study published Nov. 1 in the American Journal of Cardiology shows Utah's air pollution leads to a 13 percent increase in hospitalizations, likely because the microscopic soot and dust released by automobiles and industry prevents the heart from maintaining adequate circulation.

"That ought to be a concern to anybody with heart failure. It also should be of concern to all of us," said C. Arden Pope, a study author whose prior work has linked pollution increases to lung illnesses and increases in heart attacks. Heart failure occurs when the heart can't pump enough blood, and can be caused by heart attacks.

Still, the environmental epidemiologist at Brigham Young University, who wrote this month's article with researchers and doctors at Intermountain Healthcare, said he's optimistic about the findings.

With heart disease being the leading cause of death in Utah, "anytime you can find a risk factor that's controllable, it's sort of good news," Pope said. "The bad news is that we do have episodes where our air quality is quite poor. . . . We have made some success. It's not clean enough."

John Nemelka knows. The 56-year-old heart-failure patient takes about 40 pills a day for his weak and damaged heart muscle and an inherited disorder that puts him at risk for sudden death. He estimates he stayed indoors five to seven times last winter during inversions.

"When I start gasping for air, that's when I turn around and go back in the house," said the West Jordan man, who has a pacemaker and is awaiting a heart transplant. "When it [the heart] just doesn't work properly, the least little bit of inversion and problems in breathing all affect your heart."

Dale Renlund, medical director of the heart-failure program at Intermountain Medical Center and co-author of the study, said he is now telling heart-failure patients to stay indoors during "yellow" and "red" air-quality days.

"What's been surprising is that many of them have already known this, that when the air pollution is bad they don't feel quite as well," Renlund said. "They will say, 'You didn't need a study to tell me that.' "

He said air pollution is one factor among many that exacerbate heart-failure symptoms. Eating pickles, french fries and other salty foods - which makes the body retain fluid and the heart work harder - is worse.

The study covers hospitalizations from 1994 to 2006 at American Fork, Alta View, LDS and McKay-Dee hospitals as well as the now-closed Cottonwood. Researchers compared the 2,628 heart-failure cases with their exposure to levels of PM 2.5 - the tiny particles released by fuel combustion.

The study found that an increase of 10 micrograms of PM 2.5 per cubic meter of air - a common occurrence, according to researchers - resulted in a 13 percent increase in heart-failure hospitalizations. Hospitalizations were higher for elderly patients and patients who had been previously hospitalized.

There was a lag of two weeks between exposure to pollution and hospitalization. That's because it typically takes time for heart-failure patients to seek medical care for symptoms like shortness of breath, dry, hacking cough and fatigue, said Benjamin Horne, study author and Intermountain Medical Center cardiovascular researcher.

"That's a huge burden of risk on the population in general," said Horne.

Brian Moench, president of Utah Physicians for a Healthy Environment, is familiar with the study and said it reinforces the "profound influence" even short-term exposure to air pollution has on health. The group hopes to usher through several public-policy changes, including reducing the freeway speed limit to 55 mph, retrofitting or replacing diesel-fueled school buses and cracking down on drivers and auto mechanics who bypass pollution controls on diesel trucks.

Last year, Gov. Jon Huntsman Jr. included air quality as one of his top three priorities after meeting with Moench's group. While Huntsman's spokeswoman said it remains a top concern, Moench said: "I haven't heard that kind of statement or rhetoric from him this year. I'd certainly like to hear that.

"The biggest bottleneck in terms of making real progress is the Legislature," he continued. "Unfortunately, I think their bias has been so consistently dominated by the idea we need to protect business. That's shortsighted on their part. Business is hurt when the air quality is poor."

hmay@sltrib.com