Links between chronic exposure to outdoor air pollution and cardiovascular diseases: a review

Abstract

Acute exposure to air pollution is associated with an increasing risk of death and cardiovascular disorders. Nonetheless, the impact of chronic exposure to air pollution on the circulatory system is still debated. Here, we review the links of chronic exposure to outdoor air pollution with mortality and most common cardiovascular diseases, in particular during the coronavirus disease 2019 event (COVID-19). We found that recent studies provide robust evidence for a causal effect of chronic exposure to air pollution and cardiovascular mortality. In terms of mortality, the strongest relationship was noted for fine particulate matter, nitrogen dioxide, and ozone. There is also increasing evidence showing that exposure to air pollution, mainly fine particulate matter and nitrogen dioxide, is associated with the development of atherosclerosis, hypertension, stroke, and heart failure. However, available scientific evidence is not strong enough to support associations with cardiac arrhythmias and coagulation disturbances. Noteworthy, for some pollutants, the risk of negative health effects is high for concentrations lower than the limit values recommended by the European Union and Word Health Organization. Efforts to diminish exposure to air pollution and to design optimal methods of air pollution reduction should be urgently intensified and supported by effective legislation and interdisciplinary cooperation.

Environmental and socioeconomic determinants of heart failure

“…Shah et al [29] in their meta-analysis suggest that air pollutants, such as PMs, carbon monoxide, sulfur dioxide, and NO 2 , have a harmful impact on the circulatory system and increase morbidity and mortality due to HF. Another recent systematic review based on robust evidence indicates that chronic exposure to the abovementioned air pollutants has a negative impact on cardiovascular morbidity and mortality [30]. More recent studies seem to agree with the aforementioned systemic review [31,32].…”

Association of joint exposure to various ambient air pollutants during adolescence with blood pressure in young adulthood

“…Studies have shown that various air pollutants can influence BP via several mechanisms. A major potential mechanism is that gaseous and particulate air pollutants include some soluble components through the lung into the bloodstream, inducing oxidative stress and systemic inflammation, which in turn influences endothelial dysfunction and thus hemodynamic imbalance, ultimately resulting in arterial remodeling 12,37,38 . Circulating levels of superoxide (8‐hydroxy‐2′‐deoxyguanosine) and pro‐inflammatory mediators (C‐reactive protein, interleukin‐6, interleukin‐8, and tumor necrosis factor ‐α) have been documented to be associated with ambient air pollutants exposure levels 12,39,40 .…”

Mitigating the impact of air pollution on dementia and brain health: Setting the policy agenda

“…Also, increases in concentrations of beta amyloid and tau proteins associated with plaque build-up and neurofibrillary tangles in dementia seem to be sensitive to PM 2.5 (e.g., Alemany et al, 2021;Calderón-Garcidueñas et al, 2016;Costa et al, 2020). Nevertheless, the time course and contingencies between the mechanisms underlying direct brain health effects and indirect effects through cardiopulmonary impacts need to be elucidated more clearly, alongside differentiating the toxicological effects of specific PM 2.5 components and size fractions (de Bont et al, 2022;Konduracka and Rostoff, 2022). Finally, increased awareness of what aspects of brain and cognitive health are at greater risk is key, as well as knowing at what exposure dose levels and which stages in the life course are critical (Shehab and Pope, 2019).…”