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Review
. 2025 Jan;21(1):53-66.
doi: 10.1080/14796678.2025.2451545. Epub 2025 Jan 9.

Air pollution and coronary atherosclerosis

Andrea Caffè  1 , Vincenzo Scarica  1 , Francesco Maria Animati  1 , Matteo Manzato  1 , Alice Bonanni  1 , Rocco Antonio Montone  2
Affiliations
Review

Air pollution and coronary atherosclerosis

Andrea Caffè et al. Future Cardiol. 2025 Jan.

Abstract

The recently introduced concept of 'exposome' emphasizes the impact of non-traditional threats onto cardiovascular health. Among these, air pollutants - particularly fine particulate matter < 2.5 μm (PM2.5) - have emerged as significant environmental risk factors for cardiovascular disease and mortality. PM2.5 exposure has been shown to induce endothelial dysfunction, chronic low-grade inflammation, and cardiometabolic impairment, contributing to the development and destabilization of atherosclerotic plaques. Both short- and long-term exposure to air pollution considerably increase the incidence of ischemic heart disease (IHD)-related events, with clinical evidence linking pollution to higher mortality and adverse prognosis, especially in vulnerable populations. In this review, we explore the mechanistic pathways through which air pollutants exacerbate atherosclerotic cardiovascular disease (ASCVD) and discuss their clinical impact.Furthermore, special attention will be directed to the outcomes and prognosis of patients with pollution-aggravated coronary atherosclerosis, as well as the potential role of targeted public health interventions.

Keywords: ASCVD; Air pollution; PM2.5; atherosclerosis; prevention.

Plain language summary

In recent years, the concept of the ”exposome” has been introduced, focusing on how environmental factors, such as air pollution, can affect our health. Among these factors, fine particles in the air (PM2.5) are particularly harmful and have been linked to an increased risk of heart disease and related deaths. They can cause damage to blood vessels, and, over time, this can contribute to the buildup of fatty deposits in the arteries, which can become unstable and cause heart attacks. This review looks at the growing evidence that air pollution, especially PM2.5, is a major risk factor for heart disease, particularly a condition called coronary artery disease, where the heart’s arteries become narrow and blocked. It also discusses how pollution impacts heart health and the potential outcomes for patients, highlighting the importance of addressing air pollution to reduce the burden of heart disease.

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Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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