Cardiovascular disease and air pollution: how doctors can help patients cope

Reducing fossil fuel emissions would not only slow global warming, but could also reduce worldwide deaths from cardiovascular diseases, according to a new study.

The study, which appears in the November 11 issue of The New England Journal of Medicine, examines the link between pollutants caused by fossil fuels such as coal, oil and gas—which are also major sources of global warming—and cardiovascular diseases, such as ischemic heart disease and stroke.

Authors Sanjay Rajagopalan, MD, chief of cardiovascular medicine and the Herman K. Hellerstein, MD, chair in cardiovascular research at University Hospitals Harrington Heart & Vascular Institute, and director of the Case Cardiovascular Institute at the Case Western Reserve University School of Medicine; and Philip J. Landrigan, MD, professor of biology at the Schiller Institute for Integrated Science and Society at Boston College, cite data showing that in 2019 about 5.5 million deaths worldwide resulted from cardiovascular diseases caused by air pollution. Cardiovascular diseases from all sources are the leading cause of death worldwide, killing an estimated 18.6 million people in 2019, including 957,000 in the U.S.

Until now, they say, measures to prevent cardiovascular diseases have focused almost entirely on individual behavioral and metabolic risk factors. And while few clinical trials have directly linked exposure to air pollution with decreased risk of cardiovascular disease, “data from multiple…investigations provide a consistent, actionable body of evidence supporting the cardiovascular health benefits of pollution control.”

Individual physicians can help patients prevent pollution-related cardiovascular disease by obtaining each patient’s history of pollution exposure, assessing the patient’s susceptibility to such diseases, and providing guidance on avoiding pollution. Guidance might include:

• recommending minimizing vigorous outdoor exercise on “bad air” days;
• reducing hazardous occupational exposures;
• avoiding the use of gas stoves, fireplaces, plug-in scents and other sources of household air pollution;
• using N95 masks, in-home air cleaners and air conditioning;
• using less-congested commuter routes; and
• avoiding travel to heavily polluted regions

In the long run, however, achieving such control will require “wide-scale control of pollution at its sources.” The best way to accomplish that, the authors say, is through government-supported transition away from fossil fuels to clean, renewable energy, using methods such as taxing pollutant emissions, instituting tax incentives for renewable energy, and ending federal subsidies for the fossil-fuel industry.