Air pollution and cardiovascular disease: the Paul Wood Lecture, British Cardiovascular Society 2021

Abstract

Air pollution is associated with up to 8.8 million excess deaths worldwide each year and is a major contributor to the global burden of disease. Cardiovascular conditions are the predominant cause for air pollution-related deaths and there is an urgent need to address the silent pandemic of air pollution on cardiovascular health. Air pollution exposure is associated with acute events like acute coronary syndrome and stroke, and with chronic conditions, such as atherosclerosis and heart failure. Several potential mechanisms have been proposed that link particle inhalation to cardiovascular disease including oxidative stress and inflammation, changes in autonomic balance and neuroendocrine regulation and the particle translocation into the circulation itself. This, in turn, can cause endothelial, vasomotor and fibrinolytic dysfunction and increased thrombogenicity and blood pressure which are implicated in the mediation of adverse cardiovascular events. Certain interventions can help mitigate these adverse effects. At an individual level, this includes the use of a facemask and indoor air purification systems. At an environmental level, interventions reducing the generation or release of combustion-derived pollutants are key and include public health policies to facilitate active transport, cleaner sources of energy and reductions in vehicular and fossil fuel emissions. In this review, we summarise the key pathways and mechanisms that draw together how air pollution can lead to adverse cardiovascular effects, as well as explore potential interventions to reduce the burden of air pollution-induced cardiovascular morbidity and mortality.

Association of Environmental Factors with Age-Related Macular Degeneration using the Intelligent Research in Sight Registry

“…Environmental pollutants increase the risk of developing cardiovascular disease, lung cancer, and other diseases [36][37][38] . We found that environmental pollution also contributes to the risk of developing AMD-two pollutants, ozone and nitrogen dioxide, significantly increased this risk.…”

The global impact of stroke in 2022

“…Increasing studies suggest air quality is an important determinant of cardiovascular health, including both ischaemic heart disease and stroke. [7][8][9] Further evidence of this association is provided in a paper by Ho et al in this issue. 10 They performed a nationwide population-based analysis of all ischaemic stroke cases reported to the Singapore Stroke Registry between 2009 and 2018.…”

“…However, how important syphilis really is in stroke risk, particularly with the more widespread use of antibiotics, remains unclear. To to answer this question Chang et (9) to determine the risk of new ischaemic stroke after syphilis infection. 12 In 1585 patients with syphilis, 3.8% developed new onset ischaemic stroke, and compared to controls syphilis was associated with a higher risk of ischaemic stroke with a hazard ratio of 1.35 (1.01-1.80).…”

Heartbeat: long-term outcomes in patients with symptomatic coronary artery spasm

“…Air pollution is a major contributor to cardiovascular disease (CVD) risk, as summarised in a review article by Joshi, Miller and Newby in this issue. 9 Potential mechanisms for the association between air pollution and CVD are discussed (figure 4). Prevention of air pollution related CVD can occur at the individual level, through use of masks and indoor air purification systems, and at the environmental level, through reduction in combustion-derived air pollutants.…”

“…Air pollution is a major contributor to cardiovascular disease (CVD) risk, as summarised in a review article by Joshi, Miller and Newby in this issue 9. Potential mechanisms for the association between air pollution and CVD are discussed (figure 4).…”