Pollution and the Heart

ardiovascular diseases are the world's leading cause of disability and death.Such diseases were responsible in 2019 for an estimated 18.6 million deaths globally and 957,000 deaths in the United States. 1,2reat gains have been made in reducing the incidence of cardiovascular disease and related mortality in high-income countries.Identification of risk factors such as tobacco use, hypertension, dyslipidemia, physical inactivity, and diabetes in large, prospective, multiyear epidemiologic studies has been key.Recognition of these risk factors has increased awareness of cardiovascular diseases, enhanced early detection, and guided treatment and prevention.These advances have contributed to more than a 50% decline in mortality from cardiovascular disease in the United States since 1950. 3ollution -unwanted material released into the environment by human activity -is another important yet often overlooked risk factor for cardiovascular disease (Fig. 1). 4 The Global Burden of Disease (GBD) study estimates that pollution was responsible for 9 million deaths worldwide in 2019, 61.9% of which were due to cardiovascular disease, including ischemic heart disease (31.7%) and stroke (27.7%) (Fig. 2A). 1 These numbers, large as they are, almost certainly undercount the full contribution of pollution to the global burden of cardiovascular disease because they are based on only a subset of environmental risk factors. 4ntil now, pollution reduction has received scant attention in programs for cardiovascular disease control and has been largely absent from guidelines regarding the prevention of cardiovascular diseases, which have focused almost exclusively on individual behavioral and metabolic risk factors. 5This is an important omission, since incorporation of pollution reduction into cardiovascular disease prevention could save millions of lives.In this review, we summarize current evidence linking pollution to cardiovascular disease and suggest evidence-based strategies for disease prevention.We discuss strategies for reducing exposure to pollution in individual persons but argue that lasting prevention of pollution-related cardiovascular disease can be achieved only through government-supported interventions on a societal scale that control pollution at its source and encourage a rapid transition to clean energy.We note that these actions will also slow the pace of climate change and will thus produce a double benefit.Only through a multipronged strategy that combines pollution prevention with control of individual risk factors can the global epidemic of cardiovascular disease be contained. A ir Pollu tionAir pollution is a complex mixture that varies in concentration and composition according to time and place and is greatly influenced by weather. 5,6It includes particulate and gaseous primary pollutants such as nitrogen oxides (NO x ), sulfur dioxide, and carbon monoxide, which are released directly into the atmosphere, as