ABSTRACT Cardiovascular diseases continue to be the leading cause of mortality worldwide, traditionally attributed to well-established risk factors such as hypertension, diabetes, and smoking. However, emerging evidence now highlights air pollution as a significant, yet often overlooked, modifiable risk factor. Both acute and chronic exposure to ambient pollutants, especially fine particulate matter, nitrogen dioxide, and ozone, have been strongly associated with increased incidences of myocardial infarction, stroke, heart failure, and arrhythmias. These effects are mediated through multiple pathophysiological mechanisms, including systemic inflammation, oxidative stress, endothelial dysfunction, and autonomic dysregulation, all of which contribute to accelerated atherosclerosis and thrombosis. Epidemiological research and real-world evidence consistently demonstrate a dose-response relationship between pollutant exposure and cardiovascular morbidity and mortality. Notably, vulnerable populations such as the elderly, individuals with preexisting cardiometabolic disorders, and communities in low-resource settings experience a heightened risk. Despite mounting scientific consensus, clinical risk assessment and regulatory frameworks have yet to fully integrate air pollution as a routine determinant of cardiovascular risk. This review seeks to synthesize current evidence, highlight critical translational gaps, and advocate for urgent action at both clinical and policy levels.
Piyush Manoria (Mon,) studied this question.