Environmental Exposures and Cardiovascular Disease: ESC Consensus Statement Calls for Urgent Action
Environmental risk factors such as air pollution, noise, heat, chemical contamination, and light pollution are increasingly recognized as important contributors to cardiovascular disease but remain underrepresented in clinical guidance and prevention strategies.
A new ESC consensus statement, co-authored by Thomas F. Lüscher, brings together current evidence on their cardiovascular impact and outlines priorities for research and action. The statement expands beyond air pollution to include climate change-related exposures, urban heat islands, and chemical pollutants, highlighting shared biological mechanisms including oxidative stress, inflammation, endothelial dysfunction, and circadian disruption. These pathways contribute to coronary artery disease, stroke, heart failure, arrhythmias, and hypertension, even at levels below current regulatory standards.
The document introduces the exposome framework to capture the cumulative lifetime burden of environmental exposures and emphasizes increased vulnerability in children, older adults, socioeconomically disadvantaged populations, and patients with existing cardiovascular disease. It also identifies key priorities for future research, including improved exposure assessment, mechanistic studies, and evaluation of preventive interventions, while calling for coordinated action across clinical practice, urban planning, and public policy to promote healthier environments. Cardiologists are encouraged to engage in advocacy and prevention efforts to help translate this evidence into meaningful cardiovascular health benefits.
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Florian A. Wenzl