Use of an Exposome Approach to Understand the Effects of Exposures From the Natural, Built, and Social Environments on Cardio-Vascular Disease Onset, Progression, and Outcomes

Abstract

Obesity, diabetes, and hypertension have increased by epidemic proportions in recent years among African Americans in comparison to Whites resulting in significant adverse cardiovascular disease (CVD) disparities. Today, African Americans are 30% more likely to die of heart disease than Whites and twice as likely to have a stroke. The causes of these disparities are not yet well-understood. Improved methods for identifying underlying risk factors is a critical first step toward reducing Black:White CVD disparities. This article will focus on environmental exposures in the external environment and how they can lead to changes at the cellular, molecular, and organ level to increase the personal risk for CVD and lead to population level CVD racial disparities. The external environment is defined in three broad domains: natural (air, water, land), built (places you live, work, and play) and social (social, demographic, economic, and political). We will describe how environmental exposures in the natural, built, and social environments "get under the skin" to affect gene expression though epigenetic, pan-omics, and related mechanisms that lead to increased risk for adverse CVD health outcomes and population level disparities. We also will examine the important role of metabolomics, proteomics, transcriptomics, genomics, and epigenomics in understanding how exposures in the natural, built, and social environments lead to CVD disparities with implications for clinical, public health, and policy interventions. In this review, we apply an exposome approach to Black:White CVD racial disparities. The exposome is a measure of all the exposures of an individual across the life course and the relationship of those exposures to health effects. The exposome represents the totality of exogenous (external) and endogenous (internal) exposures from conception onwards, simultaneously distinguishing, characterizing, and quantifying etiologic, mediating, moderating, and co-occurring risk and protective factors and their relationship to disease. Specifically, it assesses the biological mechanisms and underlying pathways through which chemical and non-chemical environmental Juarez et al. The Exposome and Cardiovascular Disease exposures are associated with CVD onset, progression and outcomes. The exposome is a promising approach for understanding the complex relationships among environment, behavior, biology, genetics, and disease phenotypes that underlie population level, Black: White CVD disparities.

The Association of Toxoplasma gondii IgG and Cardiovascular Biomarkers

“…Lifestyle factors are well-known contributors to adverse cardiovascular outcomes, but environmental and microbial factors are less well studied. Our results add to the literature on the cardiovascular disease exposome [ 44 ] and suggest that T. gondii and potentially other parasites must be considered as a factor when assessing the risk of cardiovascular disease. The effects of T. gondii , combined with other cardiovascular disease comorbidities, could have an immense effect on specific populations.…”

Adopting a “Compound” Exposome Approach in Environmental Aging Biomarker Research: A Call to Action for Advancing Racial Health Equity

“…2005 ; Non and Gravlee 2015 ). When considering “race-based” disparities, it becomes even more important to avoid simplified reductionist approaches to identifying exposures, given that disparities exist across all domains of the exposome (e.g., physical-chemical, social, lifestyle) ( Juarez et al. 2020 ; Senier et al.…”

Integrating Environment and Aging Research: Opportunities for Synergy and Acceleration

“…Differential individual resilience may also relate to lifetime exposures to contaminants and other environmental stressors. This is an essential component of the Exposome concept in which there is consideration of cumulative impacts of exposure to contaminants and other environmental stressors ( Wild, 2012 ; Wild et al, 2013 ; Juarez et al, 2014 ; Cifuentes et al, 2019 ; Juarez et al, 2020a ). Often it appears that early life exposures may have more severe effects both for the immature organism and over that individual’s lifespan.…”