The Environment and Cardiovascular Disease in Children

Abstract Toxic environmental exposures can cause cardiovascular disease (CVD) in infants and children, and environmental exposures in early life can initiate pathophysiologic processes that increase CVD risk across the life span and result in disease and premature death. Early intervention strategies are therefore of great importance. Air pollution is a major CVD risk factor. PM2.5 air pollution increases risk for atrial fibrillation, ventricular arrhythmias, myocardial infarction, stroke, and CVD death, and it also increases risk for hypertension, insulin resistance, and type 2 diabetes. Lead causes hypertension, cardiac arrhythmias, coronary heart disease, stroke, and peripheral arterial disease. Methyl mercury is associated with hypertension, cardiac arrhythmias, atherosclerosis, myocardial infarction, and CVD mortality. Chronic cadmium exposure results in increased blood pressure, increased risk of coronary artery disease, peripheral arterial disease, stroke, and CVD death. Chronic arsenic exposure increases risk for atherosclerosis, hypertension, peripheral arterial disease, and ischemic heart disease. Chronic exposure to cobalt increases risk for cardiomyopathy. Acute thallium exposure causes hypotension, bradycardia, and death. Dioxins and dioxin-like polychlorinated biphenyls increase CVD risk by acting as endocrine disruptors, and per- and polyfluorinated substances have similar effects. Prenatal exposures to halogenated solvents appear to increase risk of congenital heart disease. Finally, chronic exposure to noise can increase risk for ischemic heart disease by increasing risk for hypertension.