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At the European Society of Cardiology (ESC) Congress 2024, experts raised alarm over the staggering disparity in cardiovascular disease (CVD)–related deaths due to air pollution between Europe and the United States. According to the data presented, Europe experiences nearly four times the number of CVD-related deaths from air pollution as North America.
“Europe is significantly behind, with almost four times the level of deaths due to cardiovascular disease compared to North America,” said Thomas Münzel, a recently retired cardiologist from the University Medical Center Mainz, Germany, during a session focused on environmental health concerns, including noise and air pollution.
Stark Global Disparities in CVD Deaths
Münzel and his colleagues from the Atmospheric Chemistry Department at the Max Planck Institute in Germany created a global heat map that visualizes excess mortality from cardiovascular causes attributable to air pollution. The map, published online in 2023, revealed that Asia leads in global deaths related to air pollution, with excess CVD-related deaths reaching 3.06 million annually. However, Europe emerged as a surprising and concerning second, with nearly half a million CVD deaths per year attributable to air pollution. In stark contrast, North America reports about 135,000 excess CVD deaths, nearly a quarter of the European total.
Andreas Daiber, a professor of molecular cardiology at the University Medical Center Mainz, highlighted that these differences largely stem from variations in legal limits for particulate matter with a diameter of 2.5 µm (PM2.5). “It’s a political issue,” Münzel noted, emphasizing the need for tighter regulations.
The Role of Air Pollution in CVD
The World Health Organization (WHO) recommends an annual average concentration of PM2.5 not exceeding 5 µg/m³. Current legal limits, however, vary widely: North America permits an annual limit of 12 µg/m³, Europe allows 25 µg/m³, while Australia and Canada enforce stricter limits of 8 µg/m³ and 10 µg/m³, respectively.
“Canada and Australia are doing much better than Europe,” Daiber commented, also noting that lower population densities in countries like the United States, Canada, and Australia play a role in mitigating air pollution impacts.
Adding to the complexity, Daiber mentioned growing concerns around ultrafine particles (UFPs), which are even smaller than PM2.5 and carry a higher potential to cause CVD and deaths. “These nano-sized UFPs are currently unregulated,” he warned.
Environmental Factors Driving CVD
Air pollution not only exacerbates existing cardiovascular conditions but can also initiate them. High concentrations of pollutants can accelerate atherosclerosis, contributing to the long-term buildup of arterial plaques. Additionally, exposure to air pollution is linked to increased risks of diabetes and hypertension—both significant CVD risk factors.
Daiber stressed that environmental factors are responsible for about two-thirds of all chronic diseases, particularly those of cardiometabolic origin, a finding supported by twin studies.
Noise Pollution: An Overlooked Hazard
Münzel also addressed the significant yet often overlooked impact of noise pollution on cardiovascular health. Epidemiologic studies have established strong connections between transportation noise and various cardiometabolic diseases, including ischemic heart disease, heart failure, arrhythmia, stroke, diabetes, and obesity. Noise exposure, especially at night, has been shown to cause high blood pressure, neurohormonal activation, and oxidative stress.
Münzel encouraged cardiologists to inquire about their patients’ exposure to noise and air pollution, particularly those presenting with chest pains. He also noted that lifestyle interventions, such as physical exercise and intermittent fasting, may help mitigate some of the adverse effects of noise pollution.
Call to Action
Franz Weidinger, a clinician scientist at Landstrasse Clinic in Vienna and session co-moderator, emphasized the urgency of addressing environmental health risks. He echoed the need for collaboration with global health organizations like the WHO and the World Heart Federation to raise awareness and drive policy changes.
“We need to spread this message globally,” Weidinger concluded. “It’s a message for the entire world.”
Both Münzel and Daiber, alongside Weidinger, called for immediate action to tighten regulations and protect public health, highlighting the critical need for interdisciplinary collaboration in combating the growing burden of air and noise pollution on cardiovascular health.
