In a new review article, published today in The New England Journal of Medicine, researchers from University Hospitals (UH), Case Western Reserve University and Boston College discuss evidence linking pollution and cardiovascular disease. The research team highlights strategies for reducing individual exposure to pollution, and the importance of government-supported interventions encouraging clean energy.

The researchers note that pollution was estimated to be responsible for 9 million deaths worldwide in 2019, 5.1 million of which were due to cardiovascular disease. They explain that while these numbers are high, they likely undercut the full contribution of pollution to the global burden of cardiovascular disease, as they are based on a subset of known environmental risk factors. Attribution of health effects to pollutants can be complex, given their ubiquitous presence in the environment and the expanding list of chemicals associated with human health effects. 

“Until now, prevention of cardiovascular diseases has focused almost exclusively on individual behavioral and metabolic risk factors,” said Sanjay Rajagopalan, chief of cardiovascular medicine and the Herman K. Hellerstein, MD, Chair in Cardiovascular Research at UH Harrington Heart & Vascular Institute, and director of the Case Cardiovascular Research Institute at the Case Western Reserve School of Medicine. “Pollution reduction has received scant attention in programs for cardiovascular disease control and has been largely absent from guidelines.”

Philip J. Landrigan, director of the Program for Global Public Health and the Common Good, director of the Global Observatory on Pollution and Health, and professor of biology at the Schiller Institute for Integrated Science and Society at Boston College, collaborated with Rajagopalan on the review. The researchers emphasize that 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.

The article provides an overview of the cardiometabolic health effects of pollutants for physicians, and outlines strategies for reducing pollution exposure. The researchers explain that 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 article also addresses the direct link between environmental pollutants like air pollution and contribution to climate change. This is especially important given that this paper comes at the heels of the 26th UN Climate Change Conference (COP 26) in Glasgow, Scotland.

“One of the important takeaways from COP26 is that the efforts to cut emissions, adapt to climate threats and deal with health problems are often carried out independently,” Rajagopalan said. “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.”

The researchers note many ways in which individual physicians can bring the environmental lens to their patients. 

“Physicians can qualitatively assess exposure risk in patients when relevant, assess individual susceptibility, and provide guidance on pollution avoidance,” Rajagopalan said. “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 team explains that physicians can take collective action through professional societies to persuade elected officials to reduce pollution levels for all patients across the United States. They emphasize that the most effective of these actions will be a massive, rapid shift away from fossil fuels to clean, renewable energy, with the added benefit of slowing the rate of climate change.

Prevention of pollution-related cardiovascular disease through a large-scale transition from fossil fuels to clean, renewable energy will not only reduce cardiovascular disease and associated deaths, but also benefit humanity by slowing the rate of climate change. The research team concludes that the global epidemic of cardiovascular disease can only be contained through a multipronged strategy that combines pollution prevention with control of individual risk factors.


This article was originally published Nov. 10, 2021.