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Environmental factors in cardiovascular disease
Kristen E. Cosselman, Ana Navas-Acien and Joel D. Kaufman
Abstract | Environmental exposure is an important but underappreciated risk factor contributing tothe development and severity of cardiovascular disease (CVD). The heart and vascular system arehighly vulnerable to a number of environmental agentsambient air pollution and the metals arsenic, cadmium,andlead are widespread and the mostextensively studied. Like traditional risk factors, such as smoking and diabetes mellitus, these exposures advance disease and mortality via augmentation or initiation of pathophysiological processes associated with CVD, including bloodpressure control, carbohydrate and lipid metabolism, vascular function, and atherogenesis. Although residence in highly polluted areas is associated with high levels of cardiovascular risk, adverse effects on cardiovascular health also occur at exposurelevels below current regulatory standards. Considering the widespread prevalence of exposure, even modest contributions to CVD risk can have a substantial effect on population health. Evidencebased clinical and publichealth strategies aimed at reducing environmental exposures from current levels could substantially lower the burden of CVDrelated death and disability worldwide.
Cosselman, K.E. etal. Nat. Rev. Cardiol. 12, 627642 (2015); published online 13 October 2015; http://dx.doi.org/10.1038/nrcardio.2015.152
Web End =doi:10.1038/nrcardio.2015.152
Introduction
The incidence of the most common cardiovascular diseases (CVDs) represents the culmination of chronic processes involving complex interactions between risk factors that can and cannot be modified. The majority of instances of CVD can be attributed to modifiable risk factors, and should be considered preventable.1 Despite considerable advances in prevention, diagnosis, and treatment, CVD remains the leading cause of death, both in the USA and worldwide.2 Prevalence in low-income and middle-income countries is rising dramatically, as economic development and rapid, unplanned u
rbanization increase exposure to risk factors.1
Traditionally, efforts to prevent CVD have focused on modifiable behaviours governed by the individual. Tobacco use, physical inactivity, obesity, and a poor diet contribute to known risk factors for CVD, such as hypertension, diabetes mellitus, and the development of atherosclerosis.1 Exposure to environmental pollutants, over which the individual often has little control, also has an important role in the development and severity of CVD. The heart and vascular system are highly vulnerable to a variety of environmental agents, including tobacco smoke, solvents, pesticides, and other inhaled or ingested pollutants, as well as extremes in noise and temperature.3 Most...