Pollution and the Heart

Microplastics and nanoplastics increase major adverse cardiac events in patients with myocardial infarction

Microplastics and nanoplastics (MNPs) have implicated in cardiovascular disease in preclinical studies. Our objective is to investigate the relationship between MNPs in the coronary arteries and major adverse cardiac events (MACE) in patients with myocardial infarction (MI).We conducted a prospective observational study involving patients undergoing coronary angiography for MI. Coronary blood samples were analyzed for the presence of MNPs using pyrolysis-gas chromatography-mass spectrometry. A total of 142 patients were enrolled, with 110 completing a 31.5-month follow-up. Among them, 48 (43.6 %) had detectable polystyrene, 79 (71.8 %) had polyethylene, 105 (95.4 %) had polyvinyl chloride (PVC), and 68 (61.8 %) had polyamide 66 in their coronary blood. PVC concentration was higher in patients who experienced MACE. Furthermore, PVC levels were positively associated with proinflammatory factors (IL-1β, IL-6, IL-18, and TNF-α), and associated with higher odds of MACE (OR: 1.090, 95 %CI: 1.032-1.1523, P = 0.002). Notably, for each 10-unit increase in PVC, there was a 1.374-fold increase in the risk of MACE (OR=2.374, 95 %CI: 1.366-4.128, P = 0.002). Additionally, we collected blood and thrombus samples from an additional 21 MI patients, finding that PVC levels in coronary thrombi were positively correlated with inflammatory markers and monocyte/macrophage infiltration.

Composite socio-environmental risk score for cardiovascular assessment: An explainable machine learning approach

Background

Cardiovascular disease (CVD) is the leading global cause of death, with socio-environmental factors significantly influencing morbidity and mortality. Understanding these factors is essential for improving risk assessments and interventions.

Objective

To develop and evaluate the predictive power of a composite socio-environmental (SE) cardiovascular risk score in forecasting major adverse cardiovascular events (MACE) among patients, considering both traditional and novel socio-environmental risk factors.

Methods

A Survival Random Forest (RSF) model was used to create a composite socio-environmental (SE) cardiovascular risk score using 22 census-tract level variables from 62,438 patients in the CLARIFY registry undergoing coronary artery calcium (CAC) scoring. A Cox Proportional Hazard (CPH) model was then applied to assess the association between the SE-MACE risk score and MACE in a hold-out test set. SHapley Additive exPlanations (SHAP) values were used to identify variable importance.

Results

The study included 62,438 individuals (mean age 59.6 years, 53.2 % female, 87.7 % White). Hypertension (55.4 %), diabetes (15.7 %), and dyslipidemia (72.3 %) were common, with a median CAC score of 168. The RSF model showed a concordance index of 0.58, with significant factors including smoking prevalence, insurance status, and median household income impacting cardiovascular risk. The SE-MACE risk score was robustly associated with MACE (HR, 1.21 [95 % CI, 1.11-1.32]), independent of clinical variables and the CAC score. Kaplan-Meier analysis highlighted clear risk stratification across SE-MACE score quartiles.

Conclusion

The SE-MACE risk score effectively incorporates socio-environmental factors into cardiovascular risk assessment, identifying individuals at higher risk for MACE and supporting the need for holistic assessment frameworks. Further validation in diverse settings is recommended to confirm these findings.

Spatiotemporal evolution and risk thresholds of PM2.5 components in China from the human health perspective

PM2.5 is a significant global public health hazard, with its components closely linked to various fatal diseases, thereby significantly increasing mortality rates. This study analysed the spatiotemporal evolution of PM2.5-related mortality and death rates in China using risk attribution methods based on PM2.5-component and population data. The study used a LightGBM model based on Bayesian and SHAP algorithms to identify the concentration thresholds at which the components of PM2.5 affect mortality. The results showed that from 2001 to 2022, the mortality rates influenced by the 5 PM2.5 components showed a consistent downward trend, decreasing by 101,000-529,000, with a mean annual decrease of 2.2-4.6 %. The relative importance of organic matter (OM), nitrate (NO3-) and ammonium (NH4+) in influencing mortality increased by 6.3, 17.4 and 4 % respectively, while the relative importance of black carbon (BC) and sulphate (SO42-) in influencing mortality decreased rapidly to approximately 2 %. The contribution of OM and SO42- to mortality exceeded 30 %, with thresholds of 8.6-10.3 and 9.6-10.5 μg/m3, respectively. The thresholds for the effects of NO3-, NH4+, and BC on mortality were 6.8-9.4, 3.4-6, and 1.8-3.5 μg/m3, respectively. This study provides effective insights for policymakers to help formulate targeted air pollution control measures and optimise public health interventions to support human health and sustainable societal development.

CVOT summit report 2024: new cardiovascular, kidney, and metabolic outcomes

The 10th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on December 5-6, 2024. This year, discussions about cardiovascular (CV) and kidney outcome trials centered on the recent findings from studies involving empagliflozin (EMPACT-MI), semaglutide (STEP-HFpEF-DM and FLOW), tirzepatide (SURMOUNT-OSA and SUMMIT), and finerenone (FINEARTS-HF). These studies represent significant advances in reducing the risk of major adverse cardiovascular events (MACE) and improving metabolic outcomes in heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), and obstructive sleep apnea (OSA). The congress also comprised sessions on novel and established therapies for managing HFpEF, CKD, and obesity; guidelines for managing CKD and metabolic dysfunction-associated steatotic liver disease (MASLD); organ crosstalk and the development of cardio-kidney-metabolic (CKM) syndrome; precision medicine and person-centered management of diabetes, obesity, cardiovascular disease (CVD) and CKD; early detection of type 1 diabetes (T1D) and strategies to delay its onset; continuous glucose monitoring (CGM) and automated insulin delivery (AID); cardiovascular autonomic neuropathy (CAN) and the diabetic heart; and the role of primary care in the early detection, prevention and management of CKM diseases. The contribution of environmental plastic pollution to CVD risk, the increasing understanding of the efficacy and safety of incretin therapies in the treatment of CKM diseases, and the latest updates on nutrition strategies for CKM management under incretin-based therapies were also topics of interest for a vast audience of endocrinologists, diabetologists, cardiologists, nephrologists and primary care physicians, who actively engaged in online discussions. The 11th CVOT Summit will be held virtually on November 20-21, 2025 ( http://www.cvot.org ).

Causal association between PM2.5 and metabolic syndrome in the Chinese elderly population-insights from a cohort study of CHARLS

Existing evidence suggests that the components of metabolic syndrome (MS) are sensitive to PM2.5, especially in the elderly population, and related results targeting different regions and populations are inconsistent. This study aims to quantify the risk of association between PM2.5 and MS components in the elderly population, as well as the moderating effect of physical exercise (PE) for this association. Biochemical data, demographic data and health behavior data were obtained from CHARLS dataset in 2011 and 2015, and the individual information was matched to obtain the two-wave panel data. We match meteorological data by region to obtain population exposure indicators. Subsequently, the directed acyclic graphs was used to control confonding, then instrumental variable method and fixed effects model were employed to evaluate the causal relationship between PM2.5 and MS components and the moderating effect of PE. A total of 6125 individuals were included. The prevalence of MS was 34.5% and 32.9% in 2011 and 2015 respectively. The instrumental variable probit regression indicated that high concentration PM2.5 exposure (coefPM2.5 = 0.007, P < 0.001) may increase the risk of MS, and PM2.5 had a significant impact on the components of MS, with a positive impact on waist circumference (WC) (coef = 0.052, P < 0.001) and systolic blood pressure (SYS) (coef = 0.214, P < 0.001), and with a negative impact on high-density lipoprotein cholesterol (HDL-C) (coef = - 0.030, P = 0.021), Triglyceride (TG) (coef = - 0.275, P = 0.048) and diastolic blood pressure (DIA) (coef = - 0.030, P = 0.007). Specifically, for each 1 SD increase in PM2.5 exposure, HDL-C decreased by 0.57 mg/dL, TG decreased by 5.29 mg/dL, DIA decreased by 0.57 mmHg, waist circumference increased by 1.001 cm, and SYS increased by 4.11 mmHg. Additionally, low-intensity physical exercise may alleviate the effect of PM2.5 on WC and SYS, while the high intensity exercise may increase the effect of PM2.5 on WC. Exposure to PM2.5 is associated with the occurrence of MS in the elderly population, and has a significant impact on the components of MS in different directions. The moderating effect of physical activity on PM2.5 and MS varies by component. These results may provide scientific support for the prevention and treatment of MS in the elderly.

Prenatal Exposure to Air Pollution and Pediatric Biliary Atresia: A Nationwide Population-Based Cohort Study

INTRODUCTION

Biliary atresia (BA) is a serious pediatric liver disease and the leading cause of liver transplants in children. Although its cause is unknown, prior research suggests air pollution may influence childhood diseases. This study examines the potential association between prenatal air pollution exposure and BA incidence.

METHODS

This nationwide, longitudinal matched case-control study used data from the National Health Insurance Research Database in Taiwan. BA cases were identified using ICD codes in children who underwent the Kasai procedure or liver transplantation. Controls, matched by age, index month, and gender, were selected at a 1:10 ratio. Multivariable logistic regression models, adjusted for potential confounders (age, gender, maternal age, delivery mode, and preterm birth), were utilized to assess the association between individual air pollutants (PSI, SO2, CO, O3, PM2.5, PM10, NO, NO2, and NOx) and BA. Quartiles of cumulative air pollutant amounts were analyzed for dose-dependent effects.

RESULTS

A total of 1,663,737 first-time pregnancies were identified from 2004 to 2016. After excluding 8,523 newborns due to congenital neonatal defects, 1,655,214 individuals remained. Among them, a cohort of 253 BA patients was identified. After adjusting for multiple confounders, no significant associations were found between prenatal exposure to air pollutants and BA risk. Quartile analysis of cumulative air pollutant exposure also indicated no dose-response relationship with BA risk for each air pollutant.

CONCLUSION

This population-based study found no statistically significant association between prenatal air pollution exposure and the risk of BA in newborns in Taiwan.

Environmental Hypertensionology and the Mosaic Theory of Hypertension

Hypertension is a multifactorial condition influenced by the intricate interplay of biological and genetic determinants. The growing field of Environmental Hypertensionology endorses the outsized role of environmental factors in the pathogenesis and exacerbation of hypertension. It provides a clinical approach to address these factors at the individual and societal levels. Environmental stressors contributing to blood pressure levels can be viewed within the mosaic model of hypertension, which offers a comprehensive framework for understanding blood pressure regulation through its connection with multiple other nodes causally related to the pathogenesis of hypertension. This review synthesizes growing evidence supporting the impact of several factors in the physical environment and adverse stressors embedded in key provisioning systems, including air, noise, and chemical pollution, along with aspects of the built environment, green spaces, food systems, on the global burden of hypertension. Although many factors may not be directly in the causal cascade of hypertension, the web of connections between many behooves an understanding of the important nodes for intervention. Public health strategies emphasizing the redesign of environments present an unprecedented opportunity to enhance global hypertension control rates. Future research should thus focus on integrating environmental risk assessment and interventions into clinical practice, optimizing urban planning, and public policy to achieve meaningful reductions in the global burden of hypertension. By understanding hypertension as a mosaic of interconnected causes, healthcare professionals are better equipped to individualize treatment, combining lifestyle interventions and multiple drug classes to target environmental and genetic factors driving high blood pressure.

Risk factors for cardiovascular diseases: the focus on primary prevention

Views on the etiopathogenesis of atherosclerosis are subject to evolution. In addition to the classic well-known risk factors, new ones related to mental state, social life and environment are being discovered. Both acute and chronic stress stimulate inflammatory processes. Due to the change in lifestyle and eating habits, the accumulation of risk factors in childhood is an increasing problem. Knowledge of risk factors allows for effective primary prevention of cardiovascular diseases. The effectiveness of prevention increases when the activities cover the largest possible part of the society, and access to a doctor is easy. Therefore, government programs are being implemented offering patients easier access to diagnostics of cardiovascular diseases at the level of primary health care, which enables faster identification of people at the greatest cardiovascular risk. Easier access to primary care and a good doctor-patient relationship improve patient compliance. In this situation, the importance of the family doctor as a key link in the diagnosis, prevention and treatment of cardiovascular diseases is increasing.

Environmental sustainability in cardiovascular practice: current challenges and future directions

Cardiovascular disease is the leading cause of morbidity and mortality worldwide, with a substantial amount of health-care resources targeted towards its diagnosis and management. Environmental sustainability in cardiovascular care can have an important role in reducing greenhouse gas emissions and pollution and could be beneficial for improving health metrics and societal well-being and minimizing the cost of health care. In this Review, we discuss the motivations and frameworks for sustainable cardiovascular care with an emphasis on the reduction of the climate-related and environmental effects of cardiovascular care. We also provide an overview of greenhouse gas emissions related to the provision of health care, including their measurement and quantification, carbon accounting, carbon disclosures and climate effects. The principles of life-cycle assessment, waste prevention and circular economics in health care are discussed, and the emissions associated with various sectors of cardiovascular care as well as the rationale for prevention as a powerful approach to reduce these emissions are presented. Finally, we highlight the challenges in environmental sustainability and future directions as applicable to cardiovascular practice.

The mediating role of air pollution in the relationship between greenspace and cardiorespiratory admissions in Brazil

Urban greenspaces have long been recognized for their potential to enhance environmental quality and public health. Despite the well-documented direct benefits of greenspaces, the mediating role of air pollution in the relationship between greenspaces and health outcomes remains less explored in low- and middle-income countries. This study investigates the mediating role of air pollution in the relationship between greenspace and cardiorespiratory admissions in Brazil. This study analyzed 26,724,624 hospitalizations for respiratory and circulatory diseases between 2008 and 2018. Greenspace was assessed using the Normalized Difference Vegetation Index (NDVI), while air pollution exposure was estimated using PM2.5 concentration data retrieved from satellite-based reanalysis models. Employing a mediation analysis framework, we explored the direct and indirect effects of greenspace on cardiorespiratory admissions, with PM2.5 serving as the mediator. Our findings revealed that air pollution partially mediates the relationship between greenspace and health outcomes, with some regional variations observed. In Southeastern Brazil, over half of the greenspace effect on respiratory admissions was mediated by PM2.5 (52.9%), with an even higher proportion for circulatory admissions (77.1%). In contrast, the North showed minimal mediation for respiratory and circulatory admissions, while the Northeast exhibited negligible mediation for both. The South had mixed results, with a slight negative mediation for respiratory and minimal positive mediation for circulatory admissions. The Midwest displayed negligible mediation effects across both types of admissions. This study demonstrates the region-specific impacts of greenspace on health outcomes in Brazil, with vegetation playing a crucial role in mitigating pollution-related health risks in highly urbanized areas like the Southeast. Conversely, in regions with extensive vegetation and episodic pollution events (e.g., the North) or limited greenspace (e.g., the Northeast), the health benefits are smaller or nonexistent. Brazil's diverse landscape offers a unique context for advancing global research on greenspace and health, highlighting the need for tailored public health strategies that consider regional environmental and social factors.

Explainable machine learning models enhance prediction of PFAS bioactivity using quantitative molecular surface analysis-derived representation

The extensive use of per- and polyfluoroalkyl substances (PFAS) in industrial and consumer products poses health risks due to their toxicity. Computational toxicology approaches, particularly quantitative structure-activity relationship (QSAR) models are essential for predicting PFAS bioactivity. However, established QSAR models including machine learning-based ones with traditional molecular descriptors such as constitutional, topological, and geometric descriptors, have limited predictive capability and interpretability. Herein, we proposed a novel machine learning approach that leverages quantitative molecular surface analysis (QMSA) of molecular electrostatic potential. Using QMSA descriptors, five machine learning models (e.g., random forest) achieved outstanding performance, with best accuracy of 0.950 ± 0.017, AUC-ROC of 0.938 ± 0.012, F1-score of 0.734 ± 0.024, and MCC of 0.684 ± 0.111 for five targets (tyrosyl-DNA phosphodiesterase 1 in the absence/presence of camptothecin, ATXN2 protein, transcription factor SMAD3, and transcription factor NRF2), which outperform previously reported models. SHAP analyses revealed that estimated density, molecular volume, positive surface area, and nonpolar surface area were the most important descriptors. These descriptors were deeply involved in PFAS binding to target proteins via non-covalent interactions as evidenced by molecular docking and molecular dynamics simulations. Our results demonstrated that QMSA descriptors-based machine learning models are capable of predicting PFAS toxicity with extraordinary performance and interpretability. This study provides a novel machine learning framework for the high-throughput and cost-effective screening of high-risk emerging PFAS in aquatic environments. By identifying the contaminants that should be prioritized for regulation and treatment among the growing number of PFAS, our work aids in water quality monitoring and risk assessment, and guides decision-making in aquatic environmental management. Furthermore, this work enhances our understanding of the molecular mechanisms involved in PFAS bioactivity.

Spatial analysis of air pollutant exposure and its association with metabolic diseases using machine learning

BACKGROUND

Metabolic diseases (MDs), exemplified by diabetes, hypertension, and dyslipidemia, have become increasingly prevalent with rising living standards, posing significant public health challenges. The MDs are influenced by a complex interplay of genetic factors, lifestyle choices, and socioeconomic conditions. Additionally, environmental pollutants, particularly air pollutants (APs), have attracted increasing attention for their potential role in exacerbating these MDs. However, the impact of APs on the MDs remains unclear. This study introduces a novel machine learning (ML) pipeline, an Algorithm for Spatial Relationships Analysis between Exposome and Metabolic Diseases (ASEMD), to analyze spatial associations between APs and MDs at the prefecture-level city scale in China.

METHODS

The ASEMD pipeline comprises three main steps: (i) Spatial autocorrelation between APs and MDs is evaluated using Moran's I statistic and Local Indicators of Spatial Association (LISA) maps. (ii) dimensionality reduction and spatial similarities identification between APs and MDs clusters using Principal Component Analysis (PCA), k-means clustering, and Jaccard index calculations, further validated through spatial maps. (iii) AP exposure is adjusted by demographic and lifestyle confounders to predict MDs using machine learning models (e.g., eXtreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), LightGBM, and Multi-Layer Perceptron (MLP)). SHAP values are employed to identify key adjusted APs that are linked to MDs. Model performance is evaluated through 10-fold cross-validation using five different metrics. The data utilized include CHARLS (2015) and meteorological data (2013-2015).

RESULTS

Significant spatial correlations were found between APs and the prevalence of diabetes, dyslipidemia, and hypertension, with higher prevalence rates observed in alignment with elevated APs concentrations. By adjusting for demographic and lifestyle confounders, APs effectively predicted the risk of developing MDs (AUROC=0.890, 0.877, 0.710 for diabetes, dyslipidemia, and hypertension, respectively). The results showed that C O , P M 2.5 , and A Q I were strongly correlated with diabetes, whereas N O 2 , P M 2.5 , and P M 10 were significantly associated with dyslipidemia. For hypertension, C O , O 3 , and A Q I were mostly correlated. Sensitivity analyses across different regions and different types of APs underscored the robustness of our conclusions.

CONCLUSION

The ASEMD pipeline successfully integrates ML models, epidemiological methods, and spatial analysis techniques, providing a robust framework for understanding the complex interactions between APs and MDs. We also identified specific APs, including P M 10 , C O , and S O 2 , as being strongly linked to higher rates of diabetes, dyslipidemia, and hypertension in central and northern cities. Future region-specific public health strategies or interventions, especially in those areas with high pollutant levels, are needed to mitigate air pollution's impact on metabolic health.

Wildfire Air Pollution and Rates of Cardiovascular Events and Mortality in Northern California in 2018

BACKGROUND

We examined the association between acute cardiovascular disease (CVD) events and wildfire air pollution in California in 2018.

METHODS

The study included adult (≥18 years) members of Kaiser Permanente Northern California, an integrated health care system. Outcomes included CVD events (hospitalizations for acute myocardial infarction, heart failure, or stroke, and CVD death) and death from any cause. Fine particulate air pollution (particulate matter <2.5 microns in diameter; PM2.5) exposure was assessed in categories (Good <12 μg/m3, Moderate 12-34 μg/m3, High ≥35 μg/m3) and continuously. Poisson time series regression was used to model daily event rates during July 1 to December 31, 2018, using a spline to adjust for long-term time trends. We calculated rate ratios (RR) to estimate the association between wildfire air pollution and daily rate of CVD events and deaths.

RESULTS

Our study included 3.2 million adults with a total follow-up of 587.9 million person-days. High PM2.5 concentrations during the Mendocino Complex wildfire in July to August was associated with an increased rate of CVD events (RR, 1.231 [95% CI, 1.039-1.458]) and death (RR, 1.358 [95% CI, 1.128-1.635]) compared with Good PM2.5 concentrations. In contrast, there was no evidence of increased risk during the Camp wildfire in November (RR for CVD events, 0.966 [95% CI, 0.894-1.044]; RR for all-cause mortality, 0.985 [95% CI, 0.904-1.074] High versus Good PM2.5 concentrations).

CONCLUSIONS

There was some evidence of increased rates of CVD events and death during wildfires, but results were inconsistent. With ongoing climate change, large wildfires are a pressing public health concern and future work is needed to understand differences in health outcomes by wildfire.

Global, regional and national burdens of cardiovascular disease attributable to secondhand smoke from 1990-2019: an age-period-cohort analysis

BACKGROUND

Over the past three decades, significant disparities in the global burden of cardiovascular disease (CVD) have been observed, particularly CVD attributed to secondhand smoke. However, a comprehensive understanding of global trends and their interaction with secondhand smoke remains inadequate.

METHODS

Using Global Burden of Disease data (1990-2019), an age-period-cohort analysis examined temporal trends in CVD mortality among secondhand smoke-exposed populations, considering age, period and cohort interactions.

RESULTS

Over the 30-year period, the global number of CVD deaths attributed to secondhand smoke increased substantially, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), representing a 38.4% increase (95% UI: 26.8%-49.5%). In 2019, CVD accounted for 45.9% of all deaths attributable to secondhand smoke among both sexes globally. Among these CVD deaths, ischaemic heart disease predominated, accounting for 66.4% of cases, compared with stroke. The distribution by sex revealed a slightly lower percentage of males (46.5%) than females (53.5%). Age-period-cohort models show overall global decline in CVD mortality due to secondhand smoke over 30 years, with regional, sex and subtype variations. Notably, a higher Sociodemographic Index (SDI) correlated with a greater reduction in mortality, exhibiting a significant 39.1% decrease in high SDI areas (95% UI: 35.6%-42.3%), in stark contrast to the minimal change observed in low SDI areas (0.1%, 95% UI: -52.4%-62.2%).

CONCLUSIONS

This study highlights the importance of considering secondhand smoke as a modifiable CVD risk. Further research is needed to understand disparities in CVD burden across development levels, sexes and subtypes.

Developmental Toxicity and Cardiotoxicity of N, N-Dimethylaniline in Zebrafish Embryos

N, N-Dimethylaniline is an important chemical intermediate and an important metabolite of the pesticide Fenaminosulf. It is widely used in chemical production, but there is an extreme paucity of environmental risk assessments for N, N-dimethylaniline.: In this study, the cardiotoxicity of continuous exposure to N, N-dimethylaniline (20, 40, and 80 μg/mL) for 72 h was evaluated using zebrafish embryos.: The study found that N, N-dimethylaniline not only exhibits developmental toxicity to zebrafish embryos, leading to abnormalities such as pericardial edema, yolk sac edema, and spinal curvature, but also induces oxidative stress, lipid accumulation, and apoptosis, particularly affecting the heart region. Cardiac function indicators such as pericardial area, sinus venosus (SV) and bulbar artery (BA) distance, heart rate, and red blood cell (RBC) rate were all significantly altered due to exposure to N, N-dimethylaniline, with impaired cardiac morphology and structure and the downregulation of gene expression related to heart development and function (myl7, vmhc, myh6, bmp4, tbx2b, and has2).: The research findings suggest that the heart may be the potential target organ for the toxic effects of N, N-dimethylaniline, providing a scientific basis for the rational use of this compound and environmental protection. Furthermore, it enhances public awareness of the safety of substances that may degrade to produce N, N-dimethylaniline during their use.

Deep Learning Analysis of Google Street View to Assess Residential Built Environment and Cardiovascular Risk in a U.S. Midwestern Retrospective Cohort

AIMS

Cardiovascular disease (CVD) is a leading global cause of mortality. Environmental factors are increasingly recognized as influential determinants of cardiovascular health. Nevertheless, a finer-grained understanding of the effects of the built environment remains crucial for comprehending CVD. We sought to investigate the relationship between built environment features, including residential greenspace and sidewalks, and cardiovascular risk using street-level imagery and deep learning techniques.

METHODS

This study employed Google Street View (GSV) imagery and deep learning techniques to analyze built environment features around residences in relation to major adverse cardiovascular events (MACE) risk. Data from a Northeast Ohio cohort were utilized. Various covariates, including socioeconomic and environmental factors, were incorporated in Cox Proportional Hazards models.

RESULTS

Of 49,887 individuals included, 2,083 experienced MACE over a median follow-up of 26.86 months. Higher tree-sky index and sidewalk presence were associated with reduced MACE risk (HR: 0.95, 95% CI: 0.91-0.99, and HR: 0.91, 95% CI: 0.87-0.96, respectively), even after adjusting for demographic, socioeconomic, environmental, and clinical factors.

CONCLUSIONS

Visible vertical greenspace and sidewalks, as discerned from street-level images using deep learning, demonstrated potential associations with cardiovascular risk. This innovative approach highlights the potential of deep learning to analyze built environments at scale, offering new avenues for public health research. Future research is needed to validate these associations and better understand the underlying mechanisms.

Microplastics in the bloodstream can induce cerebral thrombosis by causing cell obstruction and lead to neurobehavioral abnormalities

Human health is being threatened by environmental microplastic (MP) pollution. MPs were detected in the bloodstream and multiple tissues of humans, disrupting the regular physiological processes of organs. Nanoscale plastics can breach the blood-brain barrier, leading to neurotoxic effects. How MPs cause brain functional irregularities remains unclear. This work uses high-depth imaging techniques to investigate the MPs within the brain in vivo. We show that circulating MPs are phagocytosed and lead these cells to obstruction in the capillaries of the brain cortex. These blockages as thrombus formation cause reduced blood flow and neurological abnormalities in mice. Our data reveal a mechanism by which MPs disrupt tissue function indirectly through regulation of cell obstruction and interference with local blood circulation, rather than direct tissue penetration. This revelation offers a lens through which to comprehend the toxicological implications of MPs that invade the bloodstream.

Exposomic Determinants of Atherosclerosis: Recent Evidence

PURPOSE OF REVIEW

The exposome refers to the total environmental exposures a person encounters throughout life, and its relationship with human health is increasingly studied. This non-systematic review focuses on recent research investigating the effects of environmental factors-such as air pollution, noise, greenspace, neighborhood walkability, and metallic pollutants-on atherosclerosis, a major cause of cardiovascular disease.

RECENT FINDINGS

Studies show that long-term exposure to airborne particulate matter can impair endothelial function and elevate adhesion molecule levels, leading to vascular damage. Nighttime traffic noise also negatively impacts endothelial health. On the other hand, living in areas with more greenspace and better neighborhood walkability is linked to reduced arterial stiffness, suggesting protective cardiovascular effects. Mechanisms involved include oxidative stress, inflammation, and sympathetic activation from air pollution and noise. Metallic pollutants, including lead, cadmium, and arsenic, are linked to early signs of atherosclerosis through mechanisms involving oxidative stress. However, the effects of specific pollutants and their interactions remain incompletely understood. There is a growing need to mitigate harmful environmental exposures, such as air pollution and noise, while promoting beneficial ones like greenspace, to improve cardiovascular health. Emerging technologies like remote sensing and artificial intelligence can help further our understanding of how the exposome influences cardiovascular outcomes. More research is necessary to clarify the impact of specific pollutants as well as their interactions and how they contribute to atherosclerosis.

Polyvinyl chloride (PVC), its additives, microplastic and human health: Unresolved and emerging issues

Polyvinyl chloride (PVC), a commonly used plastic across Europe, poses a number of risks at various stages of its life cycle. The carcinogenicity of PVC monomer, the need to use high number and volume of problematic additives, the easiness of fragmentation compared to other thermoplastics, the high volume of use in everyday products and the resulting extent to which European population is potentially exposed to both microplastics and chemicals and, finally, continuous problems during waste management, have raised concerns about impacts of PVC on human health and the environment for decades. As far back as in 2000, the European Commission recognized that PVC causes a wide range of serious problems for the environment and human health. More recently, in April 2022, PVC and its additives were included in the European Union's Restrictions Roadmap, and the European Chemicals Agency's investigation ruled that, to limit the use of some additives and to minimize releases of PVC microparticles, regulatory action would be necessary. Additionally, the Global Plastics Treaty discussions emphasise a need to ensure that plastics that remain in the economy are free of hazardous chemicals, including hazardous polymers. In this paper, we reviewed the available data on PVC microplastic, additives, the end of life options of products made of PVC, and how they all are connected. It is crucial to consider this polymer within the broader context of chemical pollution and circular economy, acknowledging that changes in how we manage our resources are necessary to achieve the goal for a truly non-toxic environment in the future.

Climate Change and Cardiovascular Disease: Who Is Vulnerable?

Climate change involves a shift in earth's climate indicators over extended periods of time due to human activity. Anthropogenic air pollution has resulted in trapping heat, contributing to global warming, which contributes to worsening air pollution through facilitating oxidizing of air constituents. It is becoming more evident that the effects of climate change, such as air pollution and ambient temperatures, are interconnected with each other and other environmental factors. While the relationship between climate change components and cardiovascular disease is well documented in the literature, their interaction with one another along with individuals' biological and social risk factors is yet to be elucidated. In this review, we summarize that pathophysiological mechanisms by ambient temperatures directly affect cardiovascular health and describe the most vulnerable subgroups, defined by age, sex, race, and socioeconomic factors. Finally, we provide guidance on the importance of integrating climate, environmental, social, and health data into common platforms to inform researchers and policies.

Air pollution and venous thromboembolism: current knowledge and future perspectives

Air pollution, comprising a variable mixture of gaseous and solid particulate material, represents a serious, unmet, global health issue. The Global Burden of Disease study reported that 12% of all deaths occurring in 2019 were related to ambient air pollution, with particulate matter often considered to be the leading cause of harm. As of 2024, over 90% of the world's population are exposed to excessive amounts of particulate matter, based on WHO maximum exposure level guidelines. A substantial body of evidence supports a link between air pollution and cardiovascular disease, with around half of ambient pollution-related deaths thought to be secondary to cardiovascular causes. A possible association between particulate matter and venous thromboembolism has been less clear, but in the past decade, several studies have added to the available literature. In this Review, we discuss the current epidemiological evidence linking air pollution to the development of venous thrombotic events. We consider mechanisms promoting a thromboinflammatory phenotype in these individuals, including platelet dysfunction, dysregulated fibrinolysis, and enhanced thrombin generation. Given the relevance to global health, we also discuss possible strategies required to mitigate the impact of air pollution on human health worldwide.

Ambient pollution at hip fracture units and impact on mortality and post-operative delirium: A hormetic effect?

There is increasing awareness of the deleterious effects of ambient pollution. The World Health Organisation (WHO) has recently advocated new safe limits of annual exposure for the three pre-dominant pollutants: fine particulate matter (PM2.5), coarse particulate matter (PM10) and nitrogen dioxide; namely 5μg/m3, 15μg/m3 and 10gμ/m3 respectively. Both the USA and UK have recently implemented news standards which are lower than their current values, but still exceed those espoused by WHO. The WHO thresholds are challenging targets. It remains to be determined the proportion of secondary healthcare institutions located in zones with mean ambient pollutant levels in excess of the WHO limits and the impact this has on patients treated at these centres. This is particularly so for elderly patients who are theoretically most vulnerable to the adverse sequel of pollutant exposure. Using the UK National Hip Fracture Database and Defra Data (Department of Environmental, Food & Rural Affairs) we determined the annual mean PM2.5 PM10 and nitrogen dioxide exposure for all the units treating senescent hip fracture patients. We correlated these ambient pollutant levels with all-cause 30-day mortality and incidence of post-operative delirium for hip fracture patients. The vast majority (96%) of hip fracture units were located in zones where mean PM2.5 levels exceeded that required by the WHO guidance. A sizeable proportion also had annual mean exposures that surpassed the WHO PM10 (14.8%) and nitrogen dioxide (63%) recommended thresholds. There was no difference in 30-day mortality between hip fracture patients treated at units located in areas where pollutant titres were subliminal to the WHO guidance levels and those treated at centres where WHO thresholds were exceeded. By way of contrast patients admitted to institutions with mean ambient PM10 and nitrogen dioxide concentrations that surpassed the WHO limits had a lower risk of post-operative delirium compared to those at centres where the mean levels did not breach the WHO limit. For PM10 the relative risk was 0.89 CI:0.82-0.92 (p<0.0001) and that for nitrogen dioxide 0.92 CI: 0.89-0.94 (p<0.0001). The WHO target is ambitious as it relates to healthcare institutions. The majority are in areas that exceed WHO recommended limits. This does not appear to impact upon mortality for hip fracture patients. The decrease in incidence in post-operative delirium in areas of higher exposure raises, again in an epidemiological study, the possibility of the enigmatic phenomenon of hormesis, an adaptive response whereby low-dose exposure to a noxious agent or physiological stress enhances future physiological function.

The Association Between Air Pollution Exposure and White Blood Cell Counts: A Nationwide Cross-Sectional Survey in South Korea

Background: The effect of air pollution, a major global health issue, on the immune system, particularly on white blood cell (WBC) counts, remains underexplored. Methods: This study utilized data from 54,756 participants in the Korean National Health and Nutrition Examination Survey to investigate the effects of short- (day of examination and 7-day averages), mid- (30- and 90-day averages), and long-term (one-, three-, and five-year averages) air pollutant exposure on WBC counts. We assessed exposure to particulate matter (PM10, PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO). Results: Linear regression with log-transformed WBC counts, adjusted for confounders, showed that PM10 was positively associated with long-term exposure, PM2.5 was negatively associated with short- and mid-term exposures, SO2 was consistently negatively associated with short- and mid-term exposures, NO2 and CO were positive across most periods, and O3 was negatively associated with short- and mid-term exposures. Logistic regression analysis confirmed these findings, showing that short- and mid-term exposure to PM10, PM2.5, and SO2 was negatively associated with the risk of belonging to the high-WBC group, while long-term exposure to PM10, PM2.5, NO2, and CO showed positive associations with risk. Conclusions: Our findings highlight the time- and pollutant-specific associations between air pollution exposure and WBC counts, underscoring air pollution's potential impact on systemic inflammation.

Chronic Exposure to Bioaerosols in PM2.5 from Garbage Stations Accelerates Vascular Aging via the NF-κB/NLRP3 Pathway

The fine particulate matter (PM2.5) in air pollution is a critical risk factor influencing human health. Our study included 8144 participants and showed that the risk of major adverse cardiovascular events increases by 35% (HR, 1.35; 95% CI, 1.14-1.60) for participants with the highest quartile to PM2.5 exposure as compared to those with lowest quartile. Bioaerosols, as an important environmental exposure in PM2.5, can induce systemic chronic inflammation leading to vascular aging. Thus, the effects of bioaerosols are investigated from household garbage stations in PM2.5 on vascular aging, and the underlying mechanisms are explored. In vivo, chronic exposure to bioaerosols upregulated senescence marker expression levels while causing vascular dysfunction and remodeling. In vitro, bioaerosol exposure induced decreased proliferation, G0/G1 arrest, and impaired migration of human umbilical vein endothelial cells (HUVECs). Furthermore, a single bacterium (AS22a) from the bioaerosol community was isolated and demonstrated that it upregulated inflammatory factors and accelerated cell senescence and vascular aging by activating the NF-κB/NLRP3 signaling pathway, which may serve as a primary mechanism underlying vascular aging induced by bioaerosols in PM2.5. These findings suggest that high levels of bioaerosols in household garbage stations may adversely affect cardiovascular health.

Construction of an adverse outcome pathway for the cardiac toxicity of bisphenol a by using bioinformatics analysis

Bisphenol A (BPA), a common endocrine disruptor, has shown cardiovascular toxicity in several epidemiological studies, as well as in vivo and in vitro experimental studies. However, the related adverse outcome pathway (AOP) of BPA toxicity remains unraveled. This study aimed to develop an AOP for the cardiac toxicity of BPA through bioinformatics analysis. The interactions among BPA, genes, phenotypes, and cardiac toxicity were retrieved from several databases, including the Comparative Toxicogenomics Database, Computational Toxicology, DisGeNet, and MalaCards. The target genes and part of target phenotypes were obtained by Venn analysis and literature screening. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis were performed for target genes by using the DAVID online analysis tool to obtain other target phenotypes. AOP hypotheses from BPA exposure to heart disease were established and evaluated comprehensively by a quantitative weight of evidence (QWOE) method. The target genes included ESR2, MAPK1, TGFB1, and ESR1, and the target phenotypes included heart contraction, cardiac muscle contraction, cellular Ca2+ homeostasis, cellular metabolic process, heart development, etc. Overall, the AOP of BPA cardiac toxicity was deduced to be as follows. Initially, BPA bound with ERα/β and then activated the MAPK, AKT, and IL-17 signaling pathways, leading to Ca2+ homeostasis disorder and increased inflammatory response. Subsequently, cardiac function was impaired, causing coronary heart disease, arrhythmia, cardiac dysplasia, and other heart diseases. According to the Bradford-Hill causal considerations, the score of AOP by QWOE was 69, demonstrating a moderate confidence and providing clues on cardiotoxicity-assessment procedure and further studies on BPA.

Impact of air pollution and noise exposure on cardiovascular disease incidence and mortality: A systematic review

Background

The relationship between environmental pollutants, specifically air pollution and noise, and cardiovascular disease is well-recognized. However, their combined effects on cardiovascular health are not fully explored.

Objectives

To review evidence on the correlation between air pollution and noise exposure and cardiovascular disease incidence and mortality.

Methods

Following the PRISMA 2020 guidelines, we identified relevant studies through multiple databases and snowballing. We focused on studies published between 2003 and 2024. Studies were selected based on a PEOS framework, with a focus on exposure to air pollution or noise and clinical cardiovascular outcomes and evaluated for bias using the ROBINS-E tool.

Results

A total of 140 studies met our inclusion criteria. Most studies suggested a consistent association between long-term exposure to air pollutants and an increased risk of cardiovascular diseases, notably ischemic heart disease and stroke. While air pollution was often studied in isolation, the interaction effects between air pollution and noise exposure were less commonly investigated, showing mixed results. The majority of these studies were conducted in Western countries, which may limit the generalizability of the findings to global populations. No studies were found to use time-updated confounders, despite the long durations over which participants were followed, which could influence the accuracy of the results. Moreover, none of the studies incorporated both residential and occupational addresses in exposure assessments, suggesting a need for future studies to include these multiple exposure points to improve measurement precision and accuracy.

Conclusion

Air pollution exposure is increasingly linked to cardiovascular disease risks. Although individual air pollution and noise exposures are recognized as significant risk factors, the combined interaction between these exposures needs further exploration.

Registration

PROSPERO (CRD42023460443).

Aryl-hydrocarbon receptor in smooth muscle cells protect against dioxin induced adverse remodeling of atherosclerosis

Introduction

Environmental exposure to dioxin has been linked to increased myocardial infarction. Smooth muscle cells (SMC) in the coronary vasculature play a critical role in atherosclerotic plaque remodeling due to their phenotypic plasticity, however, the detailed mechanism linking dioxin exposure to adverse SMC modulation is not well understood.

Methods

Single-cell RNA and ATAC sequencing and histological analyses were performed on the aorta from mouse models of atherosclerosis exposed to 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) or control. Primary human coronary artery SMC (HCASMC) treated in culture with TCDD were used to perform RNA-Seq, ATAC-Seq, and functional phenotypic assays. ChIP-Seq was performed with antibodies against Aryl-hydrocarbon receptor (AHR) and TCF21, two of known SMC modulating transcription factors.

Results

Modulated SMC were the most transcriptionally responsive cell type to dioxin in the atherosclerotic aorta. Dioxin accelerated disease phenotype by promoting a modulated SMC phenotype early, resulting in increased lesion size, migration of SMC, and macrophage recruitment to the lesion. We found C3 expressing modulated SMCs to be likely contributing to the increased macrophage recruitment and inflammation. Analysis of the RNA-Seq data from HCASMC treated with TCDD showed differential enrichment of biological pathways related to cell migration, localization, and inflammation. Furthermore, ATAC-Seq data showed a significant activation for pathways regulating vascular development, cell migration, inflammation, and apoptosis. With TCDD treatment, there was also enrichment of AHR ChIP-Seq peaks, while the TCF21 enrichment decreased significantly. The SMC-specific Ahr knockout resulted in increased oxidative stress in SMC, increased lesion size and macrophage content, and loss of SMC lineage cells in the lesion cap when exposed to TCDD, consistent with a more vulnerable plaque phenotype.

Conclusion

Dioxin adversely remodels atherosclerotic plaque by accelerating the SMC- phenotypic modulation, and increasing inflammation and oxidative stress resulting in increased macrophage recruitment and lesion size. Dioxin may adversely affect the SMC phenotype and disease state by affecting the TCF21 occupancy in the open chromatin regions. Furthermore, we observed that SMC-specific deletion of Ahr in mice resulted in worsening of dioxin mediated SMC modulation and atherosclerosis, suggesting that Ahr in SMC confers protection against dioxin by promoting a stable plaque phenotype and reducing dioxin induced oxidative stress.

Summary

Exposure to dioxin, an environmental pollutant present in tobacco smoke and air pollution, accelerates smooth muscle cell modulation, and atherosclerosis.Dioxin exposure leads to inflammatory smooth muscle cell phenotype characterized by complement pathway activation and increased macrophage recruitment to plaqueAryl-hydrocarbon receptor in SMC protects against oxidative stress, and promotes a stable plaque phenotype.

Inhaling Poor Health: The Impact of Air Pollution on Cardiovascular Kidney Metabolic Syndrome

Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution imposes most of its risk through proximate cardiovascular kidney and metabolic (CKM) etiologies. Indeed, there is compelling evidence linking air pollution to the genesis of insulin resistance, type 2 diabetes, hypertension, and other risk factors. Air pollution frequently coexists with factors such as noise, with levels and risks influenced substantially by additional factors such as social determinants and natural and built environment features. Persistent disparities regarding the impact and new sources of air pollution, such as wildfires attributable to climate change, have renewed the urgency to better understand root sources, characterize their health effects, and disseminate this information for personal protection and policy impacts. In this review, we summarize evidence associating air pollution with cardiovascular health, the impact of air pollution on CKM health, and how interactions with other exposures and personal characteristics may modify these associations. Finally, we discuss new integrated approaches to capture risk from air pollution in the context of an exposomic framework.

Air pollutants as modulators of mitochondrial quality control in cardiovascular disease

It is important to understand the effects of environmental factors such as air pollution on mitochondrial structure and function, especially when these changes increase cardiovascular disease risk. Although lifestyle choices directly determine many mitochondrial diseases, increasingly, it is becoming clear that the structure and function of mitochondria may be affected by pollutants found in the atmosphere (e.g., gases, pesticides herbicide aerosols, or microparticles). To date, the role of such agents on mitochondria and the potential impact on cardiovascular fitness is neglected. Here we offer a review of airborne stressors and pollutants, that may contribute to impairments in mitochondrial function and structure to cause heart disease.

Association of urban environments with Atherosclerotic cardiovascular disease: A prospective cohort study in the UK Biobank

Urban environments and cardiovascular health are closely linked, yet only a few specific exposures have been explored in isolation and mostly adopting cross-sectional design. The influence of socioeconomic status and genetic predisposition also remains unclear. Hence, leveraging the UK Biobank data (n = 206,681), we conducted a prospective analysis of 213 urban environmental variables and their association with atherosclerotic cardiovascular disease (ASCVD). The ExWAS and regularized Cox models analyses highlighted air pollution, industrial sites, and complex street networks as primary environmental risk factors. Instead, land-use density of leisure, public services, infrastructure and residential, and drinking water hardness showed a negative association with ASCVD risk. By integrating sparse canonical correlation and mediation analyses, we found distinct urban environment patterns through diverse pathways influence ASCVD. The environment characterized by pollution and complex streets impact ASCVD through adverse mental health (mediation proportion:30.7 %, 95 % CI:22.4 %-44.0 %), while highly-developed community and high-water hardness environment via cardiometabolic status (22.6 %, 95 % CI:19.7 %-26.0 %). Further, we found low socioeconomic status amplifies disadvantaged urban environment effects on ASCVD, yet there were no similar findings for ASCVD genetic predisposition. This research deepened our understanding of city-cardiovascular health links and the role of socioeconomic status, with implications for urban planning and public health interventions.

ACPM Position Statement: Air Pollution and Environmental Justice

The American Lung Association's "State of the Air" 2023 report reveals almost 36% of Americans live with unhealthy levels of air pollution. Studies link air pollution with acute respiratory symptoms and exacerbation of respiratory and cardiovascular diseases. Differential air pollution exposures between white and nonwhite communities are significant components of environmental injustices. Even during the coronavirus disease 2019 (COVID-19) lockdown, when the United States experienced significant decreases in polluting activities, these differences persisted. The American College of Preventive Medicine's Science and Translation Committee conducted a nonsystematic literature review to explore initiatives addressing air pollution as a key component of environmental justice, the state of the science regarding health impacts, and evidence supporting mitigations to reduce those impacts. We recommend advocacy for cleaner energy sources and increasing green space; and increasing research, surveillance, and education and training on linkages between air pollutants and health. We recommend preventive medicine physicians raise awareness about increased risks of cardiovascular disease, cancer, asthma, and reduced lung function with air pollution exposure. Preventive medicine physicians may also educate patients and other practitioners about exposures, and how "conventional" disease prevention strategies may have unintended consequences; and influence healthcare leaders to improve efficiency and reduce emissions. We also recommend physicians utilize social determinants of health Z-Codes to capture environmental factors. Private payers should incorporate pollution exposure data into social determinants of health risk adjustments for Medicare Advantage programs. Medicaid agencies should develop provider recommendations for pediatric populations, and states should finance in-home interventions for asthma.

AI-Facilitated Assessment of Built Environment Using Neighborhood Satellite Imagery and Cardiovascular Risk

BACKGROUND

Built environment affects cardiovascular health, but comprehensive assessment in a scalable fashion, for population health and resource allocation, is constrained by limitations of current microscale measures.

OBJECTIVES

The purpose of this study was to investigate the association between satellite image-based environment and risk of major adverse cardiovascular events (MACE).

METHODS

Using a pretrained deep neural network, features depicting the built environment from Google Satellite Imagery (GSI) around 64,230 patients in Northern Ohio undergoing coronary artery calcium (CAC) scoring were extracted. Elastic net regularized Cox proportional hazards models identified associations of GSI features with MACE risk (defined as myocardial infarction, stroke, heart failure, or death). A composite GSI risk score was constructed using features that demonstrated nonzero coefficients in the elastic net model. We assessed association of this score with MACE risk, after adjusting for CAC scores and the social vulnerability index (SVI). Its interactions with CAC scores were also examined in subgroups.

RESULTS

Adjusting for CAC and traditional risk factors, the GSI risk score was significantly associated with higher MACE risk (HR: 2.67; 95% CI: 1.63-4.38; P < 0.001). However, adding SVI reduced this association to nonsignificance (HR: 1.54; 95% CI: 0.91-2.60; P = 0.11). Patients in the highest quartile (Q4) of GSI risk score had a 56% higher observed risk of MACE (HR: 1.56; 95% CI: 1.32-1.86; P < 0.005) compared with the lowest quartile (Q1). The GSI risk score had the strongest association with MACE risk in patients with CAC = 0. This association was attenuated, but remained significant, with higher CAC.

CONCLUSIONS

AI-enhanced satellite images of the built environment were linked to MACE risk, independently of traditional risk factors and CAC, but this was influenced by social determinants of health, represented by SVI. Satellite image-based assessment of the built environment may provide a rapid scalable integrative approach, warranting further exploration for enhanced risk prediction.

Challenges posed by climate hazards to cardiovascular health and cardiac intensive care: implications for mitigation and adaptation

Global warming, driven by increased greenhouse gas emissions, has led to unprecedented extreme weather events, contributing to higher morbidity and mortality rates from a variety of health conditions, including cardiovascular disease (CVD). The disruption of multiple planetary boundaries has increased the probability of connected, cascading, and catastrophic disasters with magnified health impacts on vulnerable populations. While the impact of climate change can be manifold, non-optimal air temperatures (NOTs) pose significant health risks from cardiovascular events. Vulnerable populations, especially those with pre-existing CVD, face increased risks of acute cardiovascular events during NOT. Factors such as age, socio-economic status, minority populations, and environmental conditions (especially air pollution) amplify these risks. With rising global surface temperatures, the frequency and intensity of heatwaves and cold spells are expected to increase, emphasizing the need to address their health impacts. The World Health Organization recommends implementing heat-health action plans, which include early warning systems, public education on recognizing heat-related symptoms, and guidelines for adjusting medications during heatwaves. Additionally, intensive care units must be prepared to handle increased patient loads and the specific challenges posed by extreme heat. Comprehensive and proactive adaptation and mitigation strategies with health as a primary consideration and measures to enhance resilience are essential to protect vulnerable populations and reduce the health burden associated with NOTs. The current educational review will explore the impact on cardiovascular events, future health projections, pathophysiology, drug interactions, and intensive care challenges and recommend actions for effective patient care.

Urinary Metal Levels and Coronary Artery Calcification: Longitudinal Evidence in the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Exposure to metals, a newly recognized risk factor for cardiovascular disease (CVD), could be related to atherosclerosis progression.

OBJECTIVES

The authors hypothesized that higher urinary levels of nonessential (cadmium, tungsten, uranium) and essential (cobalt, copper, zinc) metals previously associated with CVD would be associated with baseline and rate of change of coronary artery calcium (CAC) progression, a subclinical marker of CVD in MESA (Multi-Ethnic Study of Atherosclerosis).

METHODS

We analyzed data from 6,418 MESA participants with spot urinary metal levels at baseline (2000-2002) and 1 to 4 repeated, continuous measures of CAC over a 10-year period. We used linear mixed-effect models to assess the association of baseline urinary metal levels with baseline CAC and cumulative change in CAC over a 10-year period. Urinary metals (μg/g creatinine) and CAC were log transformed. Models were adjusted for baseline sociodemographic factors, estimated glomerular filtration rate, lifestyle factors, and clinical factors.

RESULTS

At baseline, the median CAC was 6.3 (Q1-Q3: 0.7-58.2). Comparing the highest to lowest quartile of urinary cadmium, CAC levels were 51% (95% CI: 32%, 74%) higher at baseline and 75% (95% CI: 47%, 107%) higher over the 10-year period. For urinary tungsten, uranium, and cobalt, the corresponding CAC levels over the 10-year period were 45% (95% CI: 23%, 71%), 39% (95% CI: 17%, 64%), and 47% (95% CI: 25%, 74%) higher, respectively, with no difference for models with and without adjustment for clinical factors. For copper and zinc, the corresponding estimates dropped from 55% to 33% and from 85% to 57%, respectively, after adjustment for clinical factors. The associations of metals with CAC were comparable in magnitude to those for classical CVD risk factors.

CONCLUSIONS

Exposure to metals was generally associated with extent of coronary calcification at baseline and follow-up. These findings support that metals are associated with the progression of atherosclerosis, potentially providing a novel strategy for the prevention and treatment of atherosclerosis progression.

Micro-nanoplastics and cardiovascular diseases: evidence and perspectives

Emerging evidence indicates that chemical exposures in the environment are overlooked drivers of cardiovascular diseases (CVD). Recent evidence suggests that micro- and nanoplastic (MNP) particles derived largely from the chemical or mechanical degradation of plastics might represent a novel CVD risk factor. Experimental data in preclinical models suggest that MNPs can foster oxidative stress, platelet aggregation, cell senescence, and inflammatory responses in endothelial and immune cells while promoting a range of cardiovascular and metabolic alterations that can lead to disease and premature death. In humans, MNPs derived from various plastics, including polyethylene and polyvinylchloride, have been detected in atherosclerotic plaques and other cardiovascular tissues, including pericardia, epicardial adipose tissues, pericardial adipose tissues, myocardia, and left atrial appendages. MNPs have measurable levels within thrombi and seem to accumulate preferentially within areas of vascular lesions. Their presence within carotid plaques is associated with subsequent increased incidence of cardiovascular events. To further investigate the possible causal role of MNPs in CVD, future studies should focus on large, prospective cohorts assessing the exposure of individuals to plastic-related pollution, the possible routes of absorption, the existence of a putative safety limit, the correspondence between exposure and accumulation in tissues, the timing between accumulation and CVD development, and the pathophysiological mechanisms instigated by pertinent concentrations of MNPs. Data from such studies would allow the design of preventive, or even therapeutic, strategies. Meanwhile, existing evidence suggests that reducing plastic production and use will produce benefits for the environment and for human health. This goal could be achieved through the UN Global Plastics Treaty that is currently in negotiation.

Decreasing levels of atmospheric pollution and simultaneous reduced number of cardiovascular hospital admissions and operations with improved results. Analysis of the Italian National Registries

BACKGROUND

The aim of our study was to determine a correlation between decrease of levels of atmospheric pollution (as determined by air levels of Particulate Matters with a diameter equal or less to 2.5 microns) and reduced number of hospital admissions and operations for patients with common cardiovascular diseases in Italy.

METHODS

We correlated number of hospital admissions and cardiovascular operations and atmospheric levels of PM.2.5 from 2015 to 2019 in Italy. This time interval was chosen because the possibility to analyze data about other established cardiovascular risk factors as reported by the European Union Eurostat.

RESULTS

A statistically significant decrease of hospital admissions for cardiovascular and pulmonary emergencies was registered in Italy from 2015 to 2019 (p<0.01). The number also of cardiovascular operations showed a trend towards reduction with improved 30-days results, without reaching a statistically significant correlation (p =0.10). In the period 2015-2019, there was a steady decrease of atmospheric levels of pM2.5, either in urban or rural areas (p<0.01). The decrease of atmospheric levels of PMs2.5 started in 2010 and continued with a steady trend until the year 2019. In the period 2015-2019 exposure of the Italian population to established risk factors for cardiovascular diseases showed a small increase. The number of admissions and operations for non- cardiovascular and non-pulmonary diseases remained unchanged in the period 2015-2019.

CONCLUSIONS

The findings of our study underline the possibility that decrease of atmospheric pollution may determine almost immediate decrease of cardiovascular and pulmonary diseases.

Diesel exhaust particle extract elicits an oxPAPC-like transcriptomic profile in macrophages across multiple mouse strains

Air pollution is a prominent cause of cardiopulmonary illness, but uncertainties remain regarding the mechanisms mediating those effects as well as individual susceptibility. Macrophages are highly responsive to particles, and we hypothesized that their responses would be dependent on their genetic backgrounds. We conducted a genome-wide analysis of peritoneal macrophages harvested from 24 inbred strains of mice from the Hybrid Mouse Diversity Panel (HMDP). Cells were treated with a DEP methanol extract (DEPe) to elucidate potential pathways that mediate acute responses to air pollution exposures. This analysis showed that 1247 genes were upregulated and 1383 genes were downregulated with DEPe treatment across strains. Pathway analysis identified oxidative stress responses among the most prominent upregulated pathways; indeed, many of the upregulated genes included antioxidants such as Hmox1, Txnrd1, Srxn1, and Gclm, with NRF2 (official gene symbol: Nfe2l2) being the most significant driver. DEPe induced a Mox-like transcriptomic profile, a macrophage subtype typically induced by oxidized phospholipids and likely dependent on NRF2 expression. Analysis of individual strains revealed consistency of overall responses to DEPe and yet differences in the degree of Mox-like polarization across the various strains, indicating DEPe × genetic interactions. These results suggest a role for macrophage polarization in the cardiopulmonary toxicity induced by air pollution.

Long-term exposure to NO2 and PM2.5 and the occurrence of chronic kidney disease among patients with type 2 diabetes in Taiwan

BACKGROUND

Individuals diagnosed with type 2 diabetes (T2D) frequently exhibit chronic kidney disease (CKD) which may be caused by environmental hazards such as exposure to air pollutants. However, limited research has explored the effects of prolonged exposure to air pollutants on CKD development in this population. This study examines the relationship between long-term exposure to air pollutants and CKD incidence in a longitudinal cohort of individuals with type 2 diabetes in Taiwan METHODS: Between 2003 and 2005, we recruited 1316 T2D patients (693 females [52.66 %]; mean age 56.16 ± 8.97 years). Patients were followed until December 31, 2012, with at least two clinical visits. Baseline demographics, medical history, and biomarker levels were collected. The development of CKD was determined by eGFR level < 60 mL/min/1.73 m2. Monthly averages of nitrogen dioxide (NO2) and fine particulate matter [PM ≤ 2.5 μm in aerodynamic diameter (PM2.5)] were acquired from 72 ambient air monitoring stations. The kriging method was employed to estimate the exposure levels to PM2.5, NO2, temperature, and relative humidity in the participants' residential areas. Cox regression with time-dependent covariates regression was applied to assess the impact of long-term exposure to air pollutants and CKD risk.

RESULTS

Of 992 patients with normal renal function at baseline, 411 (41.43 %) experienced CKD occurrence over a median follow-up period of 5.45 years. The incidence of CKD was 93.96 cases per 1000 person-years. In multivariable adjusted models, patients exposed to PM2.5 levels above the third quartile of (>33.44 μg/m3) and NO2 levels above the fourth quartile (>22.55 ppb) were found to have an increased risk of CKD occurrence compared to lower exposure levels.

CONCLUSIONS

This longitudinal study highlights the increased risk of CKD in individuals with type 2 diabetes due to prolonged exposure to NO2 and PM2.5, emphasizing the need for tailored air quality management strategies for this high-risk population.

Short-Term Exposure to Ambient Air Pollution and Antimicrobial Use for Acute Respiratory Symptoms

Importance

Ambient air pollution and antimicrobial resistance pose significant global public health challenges. It is not known whether ambient air pollution is associated with increased consumption of antimicrobials.

Objective

To assess whether a short-term association exists between ambient air pollution levels and antimicrobial consumption among the general population seeking primary care consultations for acute respiratory symptoms.

Design, Setting, and Participants

This 2-stage cross-sectional ecological time series analysis study using data on daily ambient air pollution and antimicrobial consumption was conducted in the 11 largest cities in Catalonia, Spain, from June 23, 2012, to December 31, 2019, among all inhabitants aged 12 years or older. Statistical analysis was performed from November 2022 to December 2023.

Exposures

Daily ambient air pollution (particulate matter of 10 μg/m3 [PM10], particulate matter of 2.5 μg/m3 [PM2.5], and nitrogen dioxide [NO2]).

Main Outcomes and Measures

The main outcome was antimicrobial consumption associated with primary care consultations for acute respiratory symptoms in the 30 days before and after the dispensing of the antimicrobial. Antimicrobial consumption was measured as defined daily doses (DDDs) per 1000 inhabitants per day.

Results

Among 1 938 333 inhabitants (median age, 48 years [IQR, 34-65 years]; 55% female participants), there were 8 421 404 antimicrobial dispensations, with a median of 12.26 DDDs per 1000 inhabitants per day (IQR, 6.03-15.32 DDDs per 1000 inhabitants per day). The median adjusted morbidity score was 2.0 (IQR, 1.0-5.0). For the 1 924 814 antimicrobial dispensations associated with primary care consultations for acute respiratory symptoms, there was a significant correlation between increases of 10 μg/m3 in the concentration of the 3 pollutants studied and heightened antimicrobial consumption at day 0 (PM10: relative risk [RR], 1.01 [95% CI, 1.01-1.02]; PM2.5: RR, 1.03 [95% CI, 1.01-1.04]; NO2: RR, 1.04 [95% CI, 1.03-1.05]). A delayed association emerged between increases in PM2.5 concentration and antimicrobial consumption between day 7 (RR, 1.00 [95% CI, 1.00-1.01]) and day 10 (RR, 1.00 [95% CI, 1.00-1.01]) after exposure.

Conclusions and Relevance

In this 2-stage cross-sectional study using ecological time series analysis, short-term exposure to air pollution was associated with increased antimicrobial use associated with primary care consultations for acute respiratory symptoms in the general population. This finding could contribute to informing policy decisions aimed at reducing air pollution and its associated risks, thereby promoting respiratory health and reducing antimicrobial use.

Carbon emissions and air pollution savings among telehealth visits for cardiology appointments

Background

Climate change has been associated with adverse cardiovascular health, prompting interest in climate mitigation strategies while improving access for cardiovascular patients. We estimated greenhouse gas and air pollution savings from telehealth use in cardiology.

Methods

Using cardiology telehealth visits at a large academic medical center from July 2020 to March 2024, carbon dioxide (CO2), nitrogen oxides (NOx), carbon monoxide (CO), and particulate matter (PM2.5) emissions saved were calculated using U.S. Environmental Protection Agency modeling software. Savings were converted into real-world comparators and differences were assessed by cardiology subspecialty and patient insurance status.

Results

Over 45 months, 14,828 telehealth visits among 9942 patients resulted in savings of 484,152 kg of CO2, 5225 kg of CO, 243,491 g of NOx, and 9091 g of PM2.5 with the total carbon saved equivalent to planting 9070 tree saplings over ten years. CO2 emissions saved per visit (kg) differed significantly by payor (Self-pay 24.99, Medicare 19.67, Medicaid 19.54, Private 17.85, Other 17.37, p = 0.004) and by subspecialty (Interventional 23.79, General 19.08, Heart Failure 18.86, Electrophysiology 17.81, Adult Congenital 16.59, p < 0.001).

Conclusions

Carbon emission and air pollution savings from telehealth in cardiology were substantial, with an estimated 19.06 kg of CO2 saved per visit and total savings over 45 months equivalent to planting over nine thousand trees.

Cardiovascular disease mortality and air pollution in countries with different socioeconomic status

Background

Cardiovascular diseases (CVDs) account for 17.9 million deaths annually. Behavioral risk factors increase the risk of dying from CVD. Air pollution is not included in this risk calculation since the appreciation of air pollution as a modifiable risk factor is still limited. The purpose of this study was to analyze CVD mortality attributed to air pollution in all World Health Organization WHO member states and demonstrate the association of CVD mortality with air pollution depending on countries' income level.

Methods

The CVD death rate was calculated by dividing the number of deaths by the total population. The proportion of the population with primary reliance on clean fuels and technologies for cooking was calculated as an indicator of household air pollution. The annual mean concentration of fine particulate matter ≤2.5 µg/m3 and ≤10.0 µg/m3 to which the population is exposed was used as an indicator of ambient air pollution.

Results

There is a gradual increase in CVD mortality attributed to air pollution from high-income countries (HICs) to low-income countries (LICs). Household air pollution is the major cause of CVD mortality in LICs. Ischemic heart disease mortality attributed to ambient air pollution in all countries is higher than stroke mortality attributed to ambient air pollution. In LIC, mortality from stroke is attributed to household air pollution of 39.27 ± 14.47, which is more than twice the stroke mortality attributed to ambient air pollution at 18.60 ± 5.64, t = 7.17, p < 0.01.

Conclusion

Air pollution control should be an essential component of the CVD preventive strategy, along with lifestyle modifications and effective disease management.

Volatile organic compounds and mortality from ischemic heart disease: A case-cohort study

Background

Volatile organic compounds (VOCs) are major components of air pollution and tobacco smoke, two known risk factors for cardiovascular diseases. VOCs are ubiquitous in the environment and originate from a wide range of sources, including the burning of biomass, fossil fuels, and consumer products. Direct evidence for associations between specific VOCs and ischemic heart disease (IHD) mortality in the general population is scarce.

Methods

In a case-cohort study (stratified by age groups, sex, residence, and tobacco smoking), nested within the population-based Golestan cohort study (n = 50,045, 40-75 years, 58% women, enrollment: 2004-2008) in northeastern Iran, we measured urinary concentrations of 20 smoking-related VOC biomarkers using ultra high-performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry. We calculated hazard ratio (HR) and 95% confidence interval (CI) for their associations with IHD mortality during follow-up to 2018, using Cox regression models adjusted for age, ethnicity, education, marital status, body mass index, physical activity, wealth, and urinary cotinine.

Results

There were 575 non-cases from random subcohort and 601 participants who died from IHD, mean (standard deviation) age, 58.2 (9.3) years, with a median of 8.4 years follow-up. Significant associations [3rd vs. 1st tertile, HR (95% CI), P for trend] were observed between biomarkers of acrylamide [1.68(1.05,2.69), 0.025], acrylonitrile [2.06(1.14,3.72), 0.058], acrolein [1.98(1.30,3.01), 0.003 and 2.44(1.43,4.18), 0.002], styrene/ethylbenzene [1.83(1.19,2.84), 0.007 and 1.44(1.01,2.07), 0.046], dimethylformamide/methylisocyanate [2.15(1.33,3.50), 0.001], and 1,3butadiene [2.35(1.52,3.63),<0.001] and IHD mortality. These associations were independent of tobacco smoking, and they were only present in the non-smoking subgroup.

Conclusion

Our findings provide direct evidence for associations between exposure to several VOCs with widespread household and commercial use and IHD mortality many years after these exposures. These results highlight the importance of VOC exposure in the general population as a risk factor for cardiovascular diseases and underline the importance of bio-monitoring non-tobacco VOC exposure.

Regionalization of the Mortality Risk from Cardiomyopathy and Respiratory Diseases Based on the Maximum Entropy Model

This research presents a time-series study in one of the most polluted regions in Mexico, the southern part of the Mezquital Valley. Three mortality causes related to areas highly contaminated by industrial activities were considered to carry out this model, namely, ischemic cardiomyopathy, mesothelioma, and pneumoconiosis. The pollutant exposure factors used in the maximum entropy modeling were distance to rivers, distance to industries, particulate matter less than 2.5 microns (PM < 2.5 µm), and the digital elevation model (DEM). A model that expresses the presence of the disease by areas of exposure to pollutants was also obtained. In addition, the odds ratio was calculated to evaluate the level of association of ischemic cardiomyopathy (OR = 3.37 and 95% CI: 3.05-3.6) and mesothelioma (OR = 4.79 and 95% CI: 3.5-6.08) by areas of exposure. In the case of pneumoconiosis, only cases in the very high exposure category were recorded, so it was not comparable with the remaining areas. It is important to mention that particulate matter in the municipalities of the Mezquital Valley presented values above 20 μg/m3 and that in accordance with the provisions of the Norma Oficial Mexicana de Salud Ambiental or NOM (translated as Mexican Official Standard for Environmental Health) and the Agency for Toxic Substances and the Disease Registry (ATSDR), high concentrations of particulate matter can have a severe impact on the development of some diseases. In the studied area, ischemic cardiomyopathy and mesothelioma were attributed to pollution in 70.3% and 79.1%, respectively; therefore, pollution mitigation could prevent the occurrence of these two diseases.

Dietary Flavonoids: Mitigating Air Pollution's Cardiovascular Risks

Air pollution significantly impacts cardiovascular health, yet pollution reduction strategies in cardiovascular disease prevention remain limited. Dietary flavonoids show promise in protecting cardiovascular health, but their potential to mitigate air-pollution-induced risks is unexplored. This study investigates this research gap. Following PRISMA-ScR guidelines, literature from 2014-2024 was searched across MedLine/PubMed, ScienceDirect, and MDPI databases. Of 463 identified studies, 53 were eligible for analysis based on PICO criteria. Findings revealed significant impacts of air pollution on cardiovascular health, including increased disease risks and mortality. Flavonoid intake demonstrated protective effects against these risks. Flavonoid mechanisms include improved endothelial function, antioxidant and anti-inflammatory effects, blood pressure regulation, antiplatelet effects, cardioprotection, and enhanced lipid and glucose metabolism. Higher flavonoid intake was consistently associated with reduced cardiovascular risks. While reducing pollution remains crucial, promoting flavonoid-rich diets is a promising complementary strategy. Public health initiatives should raise awareness about these benefits. Further research on direct interactions between flavonoid intake and air pollution exposure is needed. Current evidence supports integrating dietary interventions into broader strategies to reduce air pollution's cardiovascular impacts.

Precision Medicine in Acute Coronary Syndromes

Nowadays, current guidelines on acute coronary syndrome (ACS) provide recommendations mainly based on the clinical presentation. However, greater attention is being directed to the specific pathophysiology underlying ACS, considering that plaque destabilization and rupture leading to luminal thrombotic obstruction is not the only pathway involved, albeit the most recognized. In this review, we discuss how intracoronary imaging and biomarkers allow the identification of specific ACS endotypes, leading to the recognition of different prognostic implications, tailored management strategies, and new potential therapeutic targets. Furthermore, different strategies can be applied on a personalized basis regarding antithrombotic therapy, non-culprit lesion revascularization, and microvascular obstruction (MVO). With respect to myocardial infarction with non-obstructive coronary arteries (MINOCA), we will present a precision medicine approach, suggested by current guidelines as the mainstay of the diagnostic process and with relevant therapeutic implications. Moreover, we aim at illustrating the clinical implications of targeted strategies for ACS secondary prevention, which may lower residual risk in selected patients.

Polystyrene nanoplastics induce cardiotoxicity by upregulating HIPK2 and activating the P53 and TGF-β1/Smad3 pathways

Nanoplastics (NPs) pollution has become a global environmental problem, raising numerous health concerns. However, the cardiotoxicity of NPs exposure and the underlying mechanisms have been understudied to date. To address this issue, we comprehensively evaluated the cardiotoxicity of polystyrene nanoplastics (PS-NPs) in both healthy and pathological states. Briefly, mice were orally exposed to four different concentrations (0 mg/day, 0.1 mg/day, 0.5 mg/day, and 2.5 mg/day) of 100-nm PS-NPs for 6 weeks to assess their cardiotoxicity in a healthy state. Considering that individuals with underlying health conditions are more vulnerable to the adverse effects of pollution, we further investigated the cardiotoxic effects of PS-NPs on pathological states induced by isoprenaline. Results showed that PS-NPs induced cardiomyocyte apoptosis, cardiac fibrosis, and myocardial dysfunction in healthy mice and exacerbated cardiac remodeling in pathological states. RNA sequencing revealed that PS-NPs significantly upregulated homeodomain interacting protein kinase 2 (HIPK2) in the heart and activated the P53 and TGF-beta signaling pathways. Pharmacological inhibition of HIPK2 reduced P53 phosphorylation and inhibited the activation of the TGF-β1/Smad3 pathway, which in turn decreased PS-NPs-induced cardiotoxicity. This study elucidated the potential mechanisms underlying PS-NPs-induced cardiotoxicity and underscored the importance of evaluating nanoplastics safety, particularly for individuals with pre-existing heart conditions.

Particulate Matter 2.5 Pollution Impact on Comorbid Cancer and Cardiovascular Disease Mortality in the U.S

Background

Evidence regarding the effect of long-term exposure to particulate matter (PM) 2.5 and comorbid cancer and cardiovascular disease (CVD) mortality is limited.

Objectives

In this study, the author report the association between long-term exposure to PM 2.5 and CVD mortality, cancer mortality and comorbid cancer and CVD mortality in the U.S. population.

Methods

The Centers for Disease Control and Prevention (CDC) WONDER (Wide-Ranging Online Data for Epidemiologic Research) multiple-cause-of-death database was used to obtain U.S. county-level mortality and population estimates from 2016 to 2020. Data on average daily density of PM 2.5 were abstracted from the 2018 CDC's National Environmental Public Health Tracking system. Counties were divided into quartiles with Q1 representing counties with least average daily density and Q4 representing counties with maximum average daily density of PM 2.5. Age-adjusted mortality rates were abstracted for each quartile, for the overall population and subgroups of population.

Results

The age-adjusted mortality rates for CVD, cancer, and comorbid cancer and CVD mortality were 505.3 (range: 505.0-505.7), 210.7 (range: 210.5-210.9), and 62.0 (range: 61.8-62.1) per 100,000 person-years, respectively. CVD mortality had the highest percentage excess mortality in Q4 compared with Q1, followed by comorbid cancer and CVD. Cancer had the least percentage excess mortality. A disproportionate effect of PM 2.5 exposure was noted on vulnerable and minority groups, based on Social Vulnerability Index and race stratification, respectively.

Conclusions

Higher levels of long-term PM 2.5 exposure reported increased CVD mortality, cancer mortality and comorbid cancer and CVD disease mortality, with a pronounced detrimental effect in vulnerable and minority population.