Groundbreaking Review of Air Pollution’s Effect on Cardiometabolic Risk Published in Lancet Diabetes Endocrinology

Innovations in Cardiovascular Medicine & Surgery | February 2024

Sanjay Rajagopalan, MD

A research team led by Sanjay Rajagopalan, MD, Chief of Cardiovascular Medicine for University Hospitals Harrington Heart & Vascular Institute, and the Herman K. Hellerstein, MD, Chair in Cardiovascular Research has published an important new systematic review of the epidemiological evidence and mechanistic underpinnings linking air pollution with cardiometabolic risk.

The review details dose response of air pollution and incident type 2 diabetes, short-term exposure to air pollution associated with insulin resistance, the link between obesity and air pollution, as well as the relationship between air pollution and diabetes-related mortality, among other topics. Globally, 20% or more of type 2 diabetes may relate to air pollution exposure.

Importantly, the research team also provides a mechanistic model for better understanding these relationships.

“Understanding of the pathways by which air pollution might contribute to the risk of heart and metabolic problems, while still evolving, have been refined over the past decade,” Dr. Rajagopalan writes. “Conceptually, these pathways could be viewed as primary initiating pathways that are localized in the airways and lungs, and might comprise oxidative stress, ion channel or receptor activation, and inflammation; systemic transduction of metabolic effects through release of biological intermediates; autonomic imbalance; hypothalamic–pituitary–axis activation; nanoparticles or pollutants reaching the circulation or transmitted via neurological pathways; and effector mechanisms in insulin responsive organs.”

The team also outlines approaches to improve awareness of the harmful effects of air pollution and details personal, community, governmental and policy interventions to help mitigate the growing global public health risk it poses.