The Present and Future
JACC State-of-the-Art Review
Air Pollution and Cardiovascular Disease: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2018.07.099Get rights and content
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Abstract

Fine particulate matter <2.5 μm (PM2.5) air pollution is the most important environmental risk factor contributing to global cardiovascular (CV) mortality and disability. Short-term elevations in PM2.5 increase the relative risk of acute CV events by 1% to 3% within a few days. Longer-term exposures over several years increase this risk by a larger magnitude (∼10%), which is partially attributable to the development of cardiometabolic conditions (e.g., hypertension and diabetes mellitus). As such, ambient PM2.5 poses a major threat to global public health. In this review, the authors provide an overview of air pollution and health, including assessment of exposure, impact on CV outcomes, mechanistic underpinnings, and impact of air pollution reduction strategies to mitigate CV risk. The review concludes with future challenges, including the inextricable link between air pollution and climate change, and calls for large-scale trials to allow the promulgation of formal evidence-based recommendations to lower air pollution–induced health risks.

Key Words

blood pressure
coronary artery disease
environment
insulin resistance
particulate matter
type 2 diabetes mellitus

Abbreviations and Acronyms

ACS
acute coronary syndrome
AQG
air quality guidelines
CI
confidence interval
CV
cardiovascular
DALYs
disability-adjusted life years
HAP
household air pollution
HR
hazard ratio
MI
myocardial infarction
PM
particulate matter
ROS
reactive oxygen species
UI
uncertainty interval

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This work was funded by National Institutes of Health grants 5R01ES019616-07 and 1R01ES026291 (to Drs. Rajagopalan and Brook). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.