Environmental cardiology: redefining cardiovascular risk in the Anthropocene
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By
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Mark Abela
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Victor Aboyans
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December 23, 2025
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0 min
Environmental Exposures and Cardiovascular Risk: Insights from Recent Studies
Overview
Recent studies highlight significant associations between environmental factors such as air pollution, green space exposure, and genetic susceptibility with cardiovascular disease (CVD) outcomes. Increased particulate matter and air pollutants elevate risks of heart failure, ventricular arrhythmias, atrial fibrillation, coronary artery disease, and myocardial infarction, while green spaces and forestation confer protective effects.
Background
Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide. Emerging evidence suggests that environmental exposures, including air pollution and residential surroundings, play a critical role in modulating cardiovascular risk. Genetic predisposition further interacts with environmental factors to influence disease incidence and severity. Understanding these complex relationships is essential for developing targeted prevention strategies.
Data Highlights
| Study | Population | Exposure | Outcome | Effect Size |
|---|---|---|---|---|
| Tang et al. | 437,656 UK Biobank participants | Residential green space | Incident heart failure | HR 0.87 (0.84–0.91) |
| Święczkowski et al. | Poland, 400 million person-years | PM2.5 increase 10 µg/m3 | CVD mortality | RR 1.023 (1.012–1.035) |
| Cheng et al. | 491,305 UK Biobank participants | PM2.5 air pollution + genetic risk | Ventricular arrhythmias | HR 4.51 (3.66–5.65) highest risk group |
| Kurasz et al. | 252,566 hospitalized for AF in Poland | PM2.5 increase 10 µg/m3 | AF admissions | 1.13% increase per 10 µg/m3 |
| Li et al. | 34,481 Chinese participants | PM2.5 increase 10 µg/m3 | Coronary artery disease | HR 1.28 (1.19–1.37) |
| Chen et al. | 452,693 UK Biobank participants | PM2.5 sulphates + genetic risk | Myocardial infarction | Increased risk with high PM2.5 and PRS |
| Brown et al. | 28 studies, >41 million individuals | PM2.5 increase 10 µg/m3 | CVD incidence | HR 1.16 (1.09–1.24) |
Key Findings
- Residential green space and natural environments are inversely associated with incident heart failure, independent of physical activity.
- Increases in PM2.5, NO2, and carbon monoxide levels correlate with higher cardiovascular mortality and morbidity.
- Genetic susceptibility amplifies the adverse cardiovascular effects of air pollution, notably increasing risks of ventricular arrhythmias and myocardial infarction.
- Air pollution exposure is linked to increased hospital admissions for atrial fibrillation, with sex and regional differences in vulnerability.
- Proximity to major roads and airports influences coronary artery disease risk and myocardial ischemia.
- Cardiometabolic risk factors such as LDL cholesterol and systolic blood pressure mediate part of the cardiovascular risk associated with PM2.5 exposure.
Clinical Implications
Clinicians should consider environmental exposures, including air pollution and residential green space, as important modifiable risk factors in cardiovascular disease prevention. Genetic risk stratification may help identify individuals at heightened vulnerability to environmental insults. Public health interventions targeting air quality improvement and urban planning to increase green spaces could reduce cardiovascular morbidity and mortality.
Conclusion
Environmental factors, particularly air pollution and natural surroundings, significantly impact cardiovascular health, with genetic predisposition modulating individual risk. Integrating environmental and genetic data offers a comprehensive approach to cardiovascular risk assessment and prevention.
References
- Tang et al. 2024 -- Associations of residential green space and natural environment with heart failure
- Święczkowski et al. 2024 -- AIR-MIND study on exposome and cardiovascular mortality in Poland
- Cheng et al. 2024 -- Air pollution, genetic susceptibility, and ventricular arrhythmias risk
- Kurasz et al. 2024 -- Air quality and acute atrial fibrillation risk in Poland
- De Potter et al. 2024 -- Residential exposome and coronary obstruction risk
- Li et al. 2024 -- PM2.5 exposure, cardiometabolic pathways, and coronary artery disease
- Chen et al. 2024 -- PM2.5 components, genetic susceptibility, and myocardial infarction risk
- Brown et al. 2024 -- Neighbourhood factors and incident cardiovascular disease: meta-analysis
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