The Exposome and the Cardiovascular Health of a Rapidly Urbanizing Ethiopian City: A Review of Environmental Risk Factors and Public Health Imperatives in Dire Dawa

The 2026 European Society of Cardiology (ESC) clinical consensus statement identifies air pollution, noise, extreme heat, and chemical exposures as major cardiovascular risk factors. However, evidence from rapidly urbanizing African cities remains scarce. Purpose: This review applies the exposome framework to Dire Dawa, Ethiopia, synthesizing available data on environmental cardiovascular risk factors and outlining public health imperatives for clinical practice and policy. A narrative review of peer-reviewed literature, satellite-derived data, modeled forecasts, and gray literature was conducted, focusing on air quality, noise, thermal extremes, and chemical exposures. Dire Dawa exhibits moderate-to-high levels of multiple environmental hazards. PM2.5 often exceeds WHO guidelines, with episodic peaks reaching 154 μg/m³. Noise levels in commercial (81.97 dBA) and residential (68.08 dBA) zones surpass Ethiopian standards. Daytime temperatures regularly exceed 33 °C, with projected warming of 1.0–1.5 °C per 25 years under RCP8.5. Heavy metal exposure from e waste is suspected but unquantified. These exposures converge on oxidative stress, inflammation, endothelial dysfunction, autonomic imbalance, and circadian disruption—pathways that promote hypertension, myocardial infarction, and stroke. Dire Dawa’s environmental cardiovascular risk is substantial but poorly characterized. Critical gaps include the absence of continuous monitoring, prospective cohorts, and intervention trials. The Ethiopian Ministry of Health should embed environmental screening into hypertension programmes; the ESC should provide low resource implementation guidance; international funders should prioritize exposome CVD research in African secondary cities.