Air Pollution, Built Environment, and Early Cardiovascular Disease

Abstract

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Keywords: air pollution; built environment; cardiovascular diseases; life change events; parks, recreational.

Figure 1.

A life-course perspective on exposure to air pollution and adverse built environment and cardiovascular disease (CVD). Note: Built environment and air pollution make up a key element of one’s social determinants of health. Early exposure to pollution and adverse environment beginning in-utero and in childhood can have a profound effect on cardiovascular health due to the cumulative nature of harm on cardiometabolic risk factors and disease. Early intervention is critical in reducing the lifetime burden of CVD.

Figure 2.

A general schema of the pathways and end organ responses to air pollution exposure. Note: PM_2.5 exposure from multiple sources lead to cardiovascular disease by several potential mechanisms, including lung inflammation and oxidative stress, PM spillover into circulation, oral intake leading to change in gut microbiome, and neurohormonal activation resulting in adrenal and autonomic imbalance.^{, , ,}

Figure 3.

Conceptual framework between built environment, green space and cardiovascular disease