Exposome in ischaemic heart disease: beyond traditional risk factors

Abstract

Ischaemic heart disease represents the leading cause of morbidity and mortality, typically induced by the detrimental effects of risk factors on the cardiovascular system. Although preventive interventions tackling conventional risk factors have helped to reduce the incidence of ischaemic heart disease, it remains a major cause of death worldwide. Thus, attention is now shifting to non-traditional risk factors in the built, natural, and social environments that collectively contribute substantially to the disease burden and perpetuate residual risk. Of importance, these complex factors interact non-linearly and in unpredictable ways to often enhance the detrimental effects attributable to a single or collection of these factors. For this reason, a new paradigm called the ‘exposome’ has recently been introduced by epidemiologists in order to define the totality of exposure to these new risk factors. The purpose of this review is to outline how these emerging risk factors may interact and contribute to the occurrence of ischaemic heart disease, with a particular attention on the impact of long-term exposure to different environmental pollutants, socioeconomic and psychological factors, along with infectious diseases such as influenza and COVID-19. Moreover, potential mitigation strategies for both individuals and communities will be discussed.

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“…Increasingly, researchers and policymakers have begun to explore the interactions between multiple components of the exposome on the risk of CVD. 15,86 This is vitally important because exposures are not experienced in isolation and, especially now due to climate change, these interactions between exposures may be changing in complex ways with unforeseen consequences. Additionally, as the world explores climate change mitigation and adaptation strategies, considering the potential impacts on other exposures and health is vital to maximize potential cobenefits.…”

“…Integrated approaches that incorporate multiple exposures and their aggregate effects defined as the exposome have been proposed by us and others. 32,86,[130][131][132] Addressing that the sum totality of exposures is a departure from the current one exposure at a time framework to the simultaneous examination of multiple exposures is necessary as the impact of many aggregate exposures may not be linear or additive. 80 The integration of climate, environmental, social, and health data into common platforms and the use of machine learning and artificial intelligence to explore climate and human health effects provides an unprecedented opportunity for Health Impact Assessment (HIA) and policy.…”

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“…Moreover, some chronic stress-related pathways such as inflammatory response, glucose and lipid homeostasis, and coagulation have been identified [24]. At the same time, a growing interest in the concept of "exposome" is arising in the field of preventive cardiology to underline the importance of non-traditional risk factors in the development/progression of atherosclerosis [25,26] and in connected clinical chronic condition (e.g. diabetes) [27].…”

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