Clinical Scorecard: Cardiovascular Risk in the Anthropocene: A New Perspective on Environmental Influences

At a Glance

Key Highlights

• Residential green space and natural environment exposure inversely associated with incident heart failure and cardiovascular mortality.
• Air pollution components (PM2.5, PM10, NO2, NOX, SO2, BaP) increase risks of ventricular arrhythmias, atrial fibrillation, coronary artery disease, and myocardial infarction, especially in genetically susceptible individuals.
• Neighborhood factors including air pollution, noise, socioeconomic deprivation, and proximity to major roads or airports significantly influence cardiovascular disease incidence.

Guideline-Based Recommendations

Diagnosis

• Consider environmental exposure history including air pollution and residential factors in cardiovascular risk assessment.
• Incorporate genetic risk profiling (polygenic risk scores) to identify individuals at higher risk when exposed to environmental pollutants.

Management

• Promote increased residential green space and natural environment exposure as a preventive strategy against heart failure and CVD.
• Implement interventions to reduce exposure to air pollutants (PM2.5, NO2, SO2, BaP) to lower cardiovascular event risk.
• Address neighborhood-level socioeconomic and environmental factors as part of comprehensive cardiovascular risk reduction.

Monitoring & Follow-up

• Monitor air quality indices and individual exposure levels in high-risk populations.
• Track cardiovascular outcomes in populations with high genetic susceptibility and environmental pollutant exposure.

Risks

• Increased cardiovascular mortality and morbidity associated with elevated air pollution levels.
• Synergistic amplification of cardiovascular risk in individuals with high genetic susceptibility exposed to poor air quality.
• Higher vulnerability to air pollution-induced atrial fibrillation in females and in less urbanized or high GDP areas.

Patient & Prescribing Data

Large cohorts including UK Biobank participants, Polish nationwide population, Chinese adults with cardiometabolic risk factors

Environmental and genetic risk factors should be integrated into personalized cardiovascular risk management; reducing pollutant exposure and enhancing green space access may complement pharmacologic therapies.

Clinical Best Practices

• Incorporate environmental exposure assessment into cardiovascular risk stratification protocols.
• Use polygenic risk scores alongside environmental data to identify high-risk individuals for targeted prevention.
• Advocate for public health policies aimed at reducing air pollution and increasing urban green spaces.
• Consider sex and regional differences in vulnerability to air pollution when planning clinical and public health interventions.

References

• Tang et al. - Residential green space and heart failure risk
• Święczkowski et al. - AIR-MIND study on exposome and cardiovascular mortality
• Cheng et al. - Air pollution, genetic susceptibility, and ventricular arrhythmias
• Kurasz et al. - Air quality and acute atrial fibrillation risk
• De Potter et al. - Residential exposome and coronary obstruction
• Li et al. - PM2.5 exposure, cardiometabolic pathways, and CAD risk
• Chen et al. - PM2.5 components, genetic susceptibility, and myocardial infarction
• Brown et al. - Neighborhood and environmental factors on incident CVD