Unveiling the association between air pollution and cardiovascular diseases: the silent threat to heart health

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide, accounting for about 17.9 million deaths annually—making up roughly 31–32% of all global deaths (1, 2). Among various risk factors, air pollution has emerged as a major public health concern because of its strong link to CVDs. It is responsible for an estimated 20% of the global burden of CVD-related deaths, resulting in over 3 million deaths each year (3, 4). Air pollution is a complex mix of particulate matter, ozone, and nitrogen dioxide (NO), originating from both outdoor and indoor sources. Indoor air pollution is increasingly recognized as a main risk factor, especially in low- and middle-income countries (LMICs), where the use of solid fuels for cooking and heating is prevalent (5). As awareness about the health impacts of air quality grows, emerging research highlights the urgent need for comprehensive public health efforts to tackle this critical issue. Epidemiological studies consistently show a strong link between exposure to air pollution and higher risks of various cardiovascular problems, including heart attacks, strokes, and heart failure (HF) (6, 7). Notably, long-term exposure to fine PM2.5 has been linked to increased morbidity and mortality, highlighting that even concentrations below current safety standards can pose significant health risks (6, 8). The World Health Organization (WHO) has updated its air quality guidelines, urging countries to adopt more stringent standards to protect public health. However, substantial disparities still exist in the global implementation of effective air quality policies (9, 10). The biological mechanisms connecting air pollution to CVDs mainly involve oxidative stress and inflammation, which contribute to vascular dysfunction and speed up the development of atherosclerosis (11, 12). Vulnerable populations, including older adults and those with pre-existing health conditions, face a higher risk from the harmful effects of air pollution due to their increased physiological sensitivity (6). Ongoing research is essential to better understand these processes and to guide targeted interventions, especially in regions heavily affected by poor air quality. The growing body of evidence linking air pollution to negative cardiovascular outcomes has sparked renewed debate about regulatory frameworks and policy measures aimed at reducing health risks. Although some countries have made progress in adopting air quality standards aligned with WHO recommendations, many still lack sufficient laws to effectively protect public health (13). In light of these challenges, effective strategies—including personalized medicine, evidence-based interventions, and comprehensive public health policies—are crucial for reducing the health impacts of air pollution and improving cardiovascular outcomes (3, 14). Additionally, a review of various studies emphasizes that indoor air pollution, especially from solid fuel combustion, presents significant health risks that are often underestimated in traditional epidemiological models, which mainly focus on outdoor air quality (6). This gap highlights the need for further research focused on specific populations and environments to enable a more accurate assessment of exposure and its health effects (6). Addressing these challenges requires integrating personalized medical approaches, scientifically supported interventions, and coordinated public health policies. Implementing such strategies can significantly lessen the health burden of air pollution and promote better cardiovascular health outcomes worldwide scale.