Understanding the Cardiovascular and Metabolic Health Effects of Air Pollution in the Context of Cumulative Exposomic Impacts

Exposomic Determinants of Atherosclerosis: Recent Evidence

PURPOSE OF REVIEW

The exposome refers to the total environmental exposures a person encounters throughout life, and its relationship with human health is increasingly studied. This non-systematic review focuses on recent research investigating the effects of environmental factors-such as air pollution, noise, greenspace, neighborhood walkability, and metallic pollutants-on atherosclerosis, a major cause of cardiovascular disease.

RECENT FINDINGS

Studies show that long-term exposure to airborne particulate matter can impair endothelial function and elevate adhesion molecule levels, leading to vascular damage. Nighttime traffic noise also negatively impacts endothelial health. On the other hand, living in areas with more greenspace and better neighborhood walkability is linked to reduced arterial stiffness, suggesting protective cardiovascular effects. Mechanisms involved include oxidative stress, inflammation, and sympathetic activation from air pollution and noise. Metallic pollutants, including lead, cadmium, and arsenic, are linked to early signs of atherosclerosis through mechanisms involving oxidative stress. However, the effects of specific pollutants and their interactions remain incompletely understood. There is a growing need to mitigate harmful environmental exposures, such as air pollution and noise, while promoting beneficial ones like greenspace, to improve cardiovascular health. Emerging technologies like remote sensing and artificial intelligence can help further our understanding of how the exposome influences cardiovascular outcomes. More research is necessary to clarify the impact of specific pollutants as well as their interactions and how they contribute to atherosclerosis.

Inhaling Poor Health: The Impact of Air Pollution on Cardiovascular Kidney Metabolic Syndrome

Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution imposes most of its risk through proximate cardiovascular kidney and metabolic (CKM) etiologies. Indeed, there is compelling evidence linking air pollution to the genesis of insulin resistance, type 2 diabetes, hypertension, and other risk factors. Air pollution frequently coexists with factors such as noise, with levels and risks influenced substantially by additional factors such as social determinants and natural and built environment features. Persistent disparities regarding the impact and new sources of air pollution, such as wildfires attributable to climate change, have renewed the urgency to better understand root sources, characterize their health effects, and disseminate this information for personal protection and policy impacts. In this review, we summarize evidence associating air pollution with cardiovascular health, the impact of air pollution on CKM health, and how interactions with other exposures and personal characteristics may modify these associations. Finally, we discuss new integrated approaches to capture risk from air pollution in the context of an exposomic framework.

Environmental Impacts on Cardiovascular Health and Biology: An Overview

Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.