Since the beginning of the 21st century, air pollution has emerged as a potential modifiable risk factor for cardiovascular disease based on findings from large population-based studies. The parts of the body that are most affected are those that depend on a constant supply of oxygen such as the brain and heart. In particular, the increased concentration of pollutants and microparticles from the burning of fossil fuels, wood and biomass for heat production, vehicle traffic, electricity generation and forest fires has been associated with an increased likelihood of acute coronary heart disease and coronary heart disease.
The Global Burden of Disease (GBD) study estimated that air pollution is responsible for 9 million deaths worldwide in 2019, with almost two-thirds of deaths due to heart attacks and strokes. In fact, these numbers may underestimate the true size of the problem, and limiting exposure to air pollution so far is not included in cardiovascular disease prevention goals.
On the occasion of these recent data, the Doctors of the Therapeutic Clinic of the Medical School of the National and Kapodistrian University of Athens Alexandros Briasoulis (Assistant Professor of Cardiology) and Thanos Dimopoulos (Rector of EKPA) summarize the latest developments in the field of .
Air pollution is a heterogeneous mixture of particles (nitrogen oxides, sulfur dioxide, carbon monoxide, lead and other heavy metals, hydrocarbons and other industrial chemicals, ozone, suspended solids with a diameter of less than depending on the geographical location, time and weather conditions found both indoors and outdoors. The origin of the pollutants is mainly from the burning of fossil fuels for energy production, the burning of coal but also biomass as well as wood and other materials in domestic stoves for the production of heat and of course from cigarette smoke.
According to the World Health Organization, air pollution is the fourth leading cause of disease and death worldwide, especially in areas with pollution levels above 10 μg per cubic millimeter. In fact, an important source of danger is air pollution indoors. Deaths attributed to air pollution are expected to increase, especially in areas with high levels of pollutants such as Southeast Asia. The most dangerous pollutants for cardiovascular health are airborne particles less than 2.5 μm in size and ozone. The impact of air pollutants on cardiovascular health is exacerbated by biological risk factors (age, hypertension, diabetes, obesity, etc.), smoking, socioeconomic status and climate change.
In particular, rising temperatures lead to a higher risk of fire, higher electricity generation requirements, ozone formation and ultimately the production of suspended microparticles. The main pathogenetic mechanisms include the induction of oxidative stress and inflammation which in turn lead to the formation, spread and destabilization of atherosclerotic plaques.
Without a doubt, the first step in tackling the problem is the recognition of air pollution as a major cardiovascular risk factor by health professionals, scientific societies and public health organizations. There is also an urgent need to significantly reduce the combustion of fossil fuels, biomass, wood, especially indoors for the production of electricity and heat and the use of renewable, environmentally friendly energy sources.
From the point of view of patients but also those who are at high risk of cardiovascular diseases, the intra-domestic air pollution (fireplaces, coal burning, smoking) should be significantly reduced, the use of air conditioning and special air filters should be preferred, the movement to areas of high air pollution at peak hours and use a face mask in case of exposure to high levels of pollutants. In addition, exercise, maintaining a healthy body weight and primary prevention of cardiovascular disease under the guidance of a family doctor are strategies to mitigate the risk caused by air pollution.
In conclusion, recognizing the negative impact of air pollution on cardiovascular health and taking personal and collective measures to avoid overexposure can be measures to prevent cardiovascular disease.
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