There Is Still a Need for a Comprehensive Investigation of the Health Consequences of Exposure to Urban Air with Special Regard to Particulate Matter (PM) and Cardiovascular Effects

Air pollution is a foremost public health problem worldwide. The pulmonary effects of air pollution have been well established for decades, and substantial epidemiological evidence is consistently showing that both acute and chronic exposure to air pollution is linked to cardiovascular morbidity and mortality. The underlying cause for this link is, however, still unknown, and many questions remain open. Most of the epidemiological studies focusing on health consequences of exposure to urban air used data from air monitoring stations or—when applying personal sampling or monitoring—measured a limited number of components to assess the exposure. On the other hand, studies conducting a decent exposure characterization and measuring a relatively large number of components with personal sampling had little or no focus on the effects and investigated only a few biomarkers. The number of research studies on this topic is huge, but at the same time, it seems as if there was no need for a comprehensive examination of the effects of urban air pollution on health. Researchers and research supporting organizations, in their fascination with the search for “novelty” and “beyond state-of-the-art”, do not seem to be aware of that they will never be able to assemble the whole picture from the puzzle pieces of research activities focusing only on certain aspects. Without a comprehensive investigation, we might never be able to answer such questions as (i) which of the urban air pollutants are forerunners in causing health effects, especially cardiovascular effects? (ii) Which biomarkers have the best predictor performance in early effects? (iii) Are there biomarkers or combinations of biomarkers that can help determine the degree of individual susceptibility and sensitivity and the dependence of these by different factors (e.g., age, gender, and physical activity)? The authors of this article aim to go through the already investigated—at the same time, essential—elements of the topic and propose a more comprehensive study, which, of course, can be expanded, debated, and improved.