In recent years, air pollution and its impact on people's health has become a significant issue on the global health agenda. Nine of 10 people worldwide breathe polluted air, which disproportionately affects those living in low-resource settings. Air pollution is a major contributor to the global burden of disease, with an estimated 9% of all deaths in 2017 attributable to outdoor and household air pollution. Household air pollution is mainly a concern in low-income countries where polluting fuels (coal, wood, agricultural residue and animal dung) are used for cooking and heating.

While the impacts of air pollution on respiratory diseases is widely recognized and immediately understood, 40% of the estimated 4.9 million deaths attributable to air pollution in 2017 are due to cardiovascular diseases. Globally, more than 30% of cardiovascular disease deaths were attributable to air pollution – more than 3 million deaths every year — and air pollution was the 5th highest ranking risk factor for mortality, with more attributable deaths than elevated LDL-C, high body mass index, physical inactivity or alcohol use.

How Are They Linked?

Air pollution is a complex and dynamic mixture of numerous compounds in gaseous and particle form, originating from diverse sources, subject to atmospheric transformation and varying over space and time. Three common air pollutants, particulate matter, ozone and nitrogen dioxide (NO2), are the focus of most monitoring programs, communication efforts, health impact assessments and regulatory efforts.

Evidence for impacts on cardiovascular disease is most consistent for particulate matter, which is responsible for the vast majority of the disease burden via its impacts on ischemic heart disease and stroke, as well as lung cancer, chronic obstructive pulmonary disease (COPD), lower respiratory infections, type 2 diabetes, and pregnancy outcomes and related infant mortality. Ozone is mainly associated with exacerbation of respiratory disease, with COPD incidence and mortality, and with metabolic effects. NO2 is often used as an indicator of traffic-related air pollution. Chronic exposure to NO2 is associated with incident childhood asthma, while short-term variability is associated with exacerbation of asthma and increased daily mortality counts.

Addressing the Challenge

Just as it affects all systems of the body, air pollution requires a multisystem and multisectoral response. The health sector as a whole, which bears the impact of air pollution, can provide much-needed support for ministries of environment, energy and transportation, which are traditionally responsible for mitigation efforts.

The World Heart Federation (WHF) is advocating for senior decision-makers in national, regional and global governmental institutions to make air pollution-related heart disease a priority and to identify interventions to reduce air pollution and its impact on noncommunicable diseases.

Health care providers can play several important roles now. These actions can be taken alongside the structural actions needed to mitigate air pollution and ultimately reduce harmful exposures.

1. Advocate for air pollution mitigation as a health measure.
2. Provide patients with personal measures to reduce exposures and associated risk at the individual level.
3. Integrate air pollution into disease management approaches.

The WHF, through its Air Pollution Expert Group, is working with the World Health Organization to increase the development and use of clinical guidelines and toolkits on air pollution and cardiovascular disease to ensure its members are equipped to counsel their patients on the risks of air pollution, while also supporting educational and policy initiatives to reduce air pollution exposure.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Scientific Session Newspaper 2020, ACC Annual Scientific Session, acc20, ACC International, Risk Factors, Cholesterol, LDL, Global Health, Environmental Pollutants, Sedentary Behavior, Body Mass Index, Air Pollution

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