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Münzel T, Sørensen M, Lelieveld J, Hahad O, Al-Kindi S, Nieuwenhuijsen M, Giles-Corti B, Daiber A, Rajagopalan S. Heart healthy cities: genetics loads the gun but the environment pulls the trigger. Eur Heart J 2021; 42:2422-2438. [PMID: 34005032 PMCID: PMC8248996 DOI: 10.1093/eurheartj/ehab235] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/09/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.
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Affiliation(s)
- Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, Mainz 55131, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Universitetsvej 1, P.O. Box 260, DK-4000 Roskilde, Denmark
| | - Jos Lelieveld
- Atmospheric Chemistry Department, Max Planck Institute for Chemistry, Hahn-Meitner-Weg 1, 55128 Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, Mainz 55131, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Mark Nieuwenhuijsen
- Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader 88, 08003 Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), PRBB building (Mar Campus) Doctor Aiguader 88, 08003 Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain
| | - Billie Giles-Corti
- Center for Urban Research, RMIT University, 124 La Trobe Street, Melbourne VIC 3000, Australia
| | - Andreas Daiber
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, Mainz 55131, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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