Research Links Pollution to Cardiovascular Disease

Pollution was responsible for nine million deaths worldwide in 2019, 5.1 million of which were due to cardiovascular disease, says a review article recently published in The New England Journal of Medicine.

In the article, researchers from University Hospitals, Case Western Reserve University and Boston College discuss evidence linking pollution and cardiovascular disease.

The researchers say that while the numbers seem high, they likely underestimate the full contribution of pollution to the global burden of cardiovascular disease, as they are based on a subset of known environmental risk factors. Attributing health effects to pollutants can be complex, the researchers say, given pollution's presence everywhere in the environment and the expanding list of chemicals associated with effects on human health.

The researchers say their overarching goal is to persuade all physicians of the importance of considering pollution as a risk factor when working with their patients to prevent and control cardiovascular disease.

“Until now, prevention of cardiovascular diseases has focused almost exclusively on individual behavioral and metabolic risk factors,” says Sanjay Rajagopalan, MD, Chief of Cardiovascular Medicine at University Hospitals. “Pollution reduction has received scant attention in programs for cardiovascular disease control and has been largely absent from guidelines.”

Acknowledging Pollution as a Risk Factor

The first step in preventing pollution-related cardiovascular disease is to emphasize the role of pollution in disease prevention programs, medical education and clinical practice, and acknowledge that pollution is a major, potentially preventable risk factor for cardiovascular disease, the researchers say.

The article also addresses the direct link between environmental pollutants like air pollution and contribution to climate change.

“One of the important takeaways from 26th UN Climate Change Conference is that the efforts to cut emissions, adapt to climate threats and deal with health problems are often carried out independently,” Dr. Rajagopalan says. “By keeping the focus on health effects of pollutants, many of which are exacerbated by and contribute to climate change, there is a much higher chance of engagement by stakeholders.”

Helping Patients Understand

The researchers cite several ways in which physicians can help their patients understand the environmental aspects of risk.

“Physicians can qualitatively assess exposure risk in patients when relevant, assess individual susceptibility, and provide guidance on pollution avoidance,” Dr. Rajagopalan says. “Patients at very high risk, for instance, include individuals with pre-existing atherosclerotic cardiovascular disease, diabetes or chronic kidney disease, or individuals in special demographic categories, including the elderly and transplant recipients.”

The global epidemic of cardiovascular disease can only be contained through a multipronged strategy that combines pollution prevention with control of individual risk factors, the researchers say.

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