Placing a spotlight on how physical environments can have unique consequences on physical health, an expert position paper published Dec. 9 in the European Heart Journal, recommends that cardiovascular disease patients should avoid being outside in rush hour traffic, and that there should be a reduction of air pollution exposure and a decrease in use of fossil fuels.

Led by David Newby, MD, FACC, British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, UK, on behalf of the European Society of Cardiology, the expert consensus document explores the mechanisms and relationships between ambient air pollution and cardiovascular disease.

Regarded as a major issue for the global community, air pollution has a wide-ranging and hazardous effect on human health, with the Global Burden of Disease study attributing it to 3.1 million all-cause and all-age deaths in 2010. Ranked ninth among the greatest modifiable disease risk factor – above low physical activity, a high-sodium diet, high cholesterol and drug use – air pollution accounts for 3.1 percent of global disability-adjusted life years, an index that measures the time spent in states of reduced health.

Newby and his colleagues detail everything from the composition and concentration of the pollutants themselves to the short- and long-term effects on mortality. In addition they summarize the effects of air pollution on a broad group of cardiovascular ailments, including coronary artery disease, heart failure, cardiac arrhythmias and arrest, cerebrovascular disease, venous thromboembolism, atherosclerosis, inflammation, thrombosis, systemic vascular dysfunction, and more.

In light of the findings presented in the report, a number of advisory tips are presented to reduce personal and peer exposure to airborne pollutants: traveling by walking cycling and public transportation, avoiding inefficient burning for domestic heating, avoiding streets with high traffic intensity while walking or cycling, exercising in parks and gardens, limit time spent outdoors during highly polluted periods, particularly for infants and the elderly, and installing ventilation systems with filtration for homes in high-pollution areas.

Ultimately Newby and his co-authors conclude that “there is now abundant evidence that air pollution contributes to the risk of cardiovascular disease and associated mortality, underpinned by credible evidence of multiple mechanisms that may drive this association. In light of this evidence, efforts to reduce exposure to air pollution should urgently be intensified, and supported by appropriate and effective legislation. Health professionals, including cardiologists, have an important role to play in supporting educational and policy initiatives as well as counselling their patients. Air pollution should be viewed as one of several major modifiable risk factors in the prevention and management of cardiovascular disease. Further research should explore the optimal methods of air pollution reduction and document the effects of this on the incidence of cardiovascular disease and related mortality in order to pressurize policy makers to intensify the efforts required for effective legislation on air pollution reduction.”

Keywords: Aged, Air Pollution, Arrhythmias, Cardiac, Atherosclerosis, Cholesterol, Consensus, Coronary Artery Disease, Counseling, Diet, Fossil Fuels, Heart Failure, Incidence, Inflammation, Quality-Adjusted Life Years, Risk Factors, Sodium, Venous Thromboembolism, Walking

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