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Münzel, T.* ; Sørensen, M.* ; Lelieveld, J.* ; Landrigan, P.J.* ; Kuntic, M.* ; Nieuwenhuijsen, M.* ; Miller, M.R.* ; Schneider, A.E. ; Daiber, A.*

A comprehensive review/expert statement on environmental risk factors of cardiovascular disease.

Cardiovasc. Res. 121:26 (2025)

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Cardiovascular disease (CVD) is the leading cause of mortality globally, with over 20 million deaths each year. While traditional risk factors-such as hypertension, diabetes, smoking, and poor diet-are well-established, emerging evidence underscores the profound impact of environmental exposures on cardiovascular health. Air pollution, particularly fine particulate matter (PM2.5), contributes to approximately 8.3 million deaths annually, with over half attributed to CVD. Similarly, noise pollution, heat extremes, toxic chemicals, and light pollution significantly increase the risk of CVD through mechanisms involving oxidative stress, inflammation, and circadian disruption. Recent translational and epidemiological studies show that chronic exposure to transport noise increases the risk of myocardial infarction, stroke, and heart failure. Air pollution, even below regulatory thresholds, promotes atherosclerosis, vascular dysfunction, and cardiac events. Novel threats such as micro- and nano-plastics are emerging as contributors to vascular injury and systemic inflammation. Climate change exacerbates these risks, with heatwaves and wildfires further compounding the cardiovascular burden, especially among vulnerable populations. The cumulative effects of these exposures-often interacting with behavioural and socioeconomic risk factors-are inadequately addressed in current prevention strategies. The exposome framework offers a comprehensive approach to integrating lifelong environmental exposures into cardiovascular risk assessment and prevention. Mitigation requires systemic interventions including stricter pollution standards, noise regulations, sustainable urban design, and green infrastructure. Addressing environmental determinants of CVD is essential for reducing the global disease burden. This review calls for urgent policy action and for integrating environmental health into clinical practice to safeguard cardiovascular health in the Anthropocene.

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