Cardiovascular risk factors of climate change: air pollution, COVID-19

The fine particles released due to air pollution are causally related to the existence and severity of cardiovascular diseases.

Authors: Annette Peters1,2,3,4 and Alexandra Schneider1

© Springer Nature Limited 2020

1.Helmholtz Center Munich - German Research Center for Environmental Health, Neuherberg, Germany

2.Ludwig-Maximillians-Universität, Munich, Germany

3.Munich Heart Alliance, German Center for Cardiovascular Research (DZHK e.V.), Munich, Germany

4.Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA USA

Unfortunately, climate change not only changes temperatures, but also negatively affects other environmental conditions, including air pollution, such as increased wildfires. Fine particles are causally related to the morbidity and mortality of cardiovascular diseases.1

Studies have impressively demonstrated the combined and severe effects of episodes of exposure to heat and particulate matter on cardiovascular disease mortality, such as a study made in Russia in 2010.2 A nationwide study in Italy showed that the effect of heat on mortality tripled at high fine particle concentrations compared to the low concentration of particles.3


Optimizing air pollution would be the solution

Taken together, these data highlight the need for action. Mitigation of climate change by implementing a zero-carbon economy is essential. For example, investments in low-carbon public transport systems and safe pedestrian and cycling networks will facilitate the transition from passive to active travel. These measures reduce greenhouse gas emissions and air pollution, while promoting physical activity and cardiovascular benefits.

These much-needed policy changes will reduce the burden of CVD for future generations, but we must also consider the direct consequences of CVD prevention and treatment. Many countries, regions or cities have implemented heat detection systems. However, concerns remain about whether the most vulnerable groups, such as the elderly or the homeless, are being adequately reached.

Individual risks of severe heat consequences are only partially manageable due to underlying cardiovascular disease and treatment regimens. Therefore, we need to raise awareness and enable patients with cardiovascular diseases to take preventive measures. Likewise, physicians are encouraged to increase awareness and potentially modify regimens. To support this effort, more research is needed on wearable health monitoring devices and ambulatory blood pressure measurements, cardiac arrhythmia or dysglycemia, and potential interactions with specific medications and comorbidities.

COVID-19 and other aggravating factors

In particular, type 2 diabetes and respiratory diseases are very important. During the ongoing coronavirus (COVID-19) pandemic that began in 2019, combined exposure to COVID-19 and heat may increase the disease burden of affected individuals. Similarly, co-exposure to COVID-19 and cold may increase the risk of death in the winter months beyond the apparent increased likelihood of SARS-CoV-2 infection.



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Factors contributing to the cardiovascular risks of climate change - summary

In summary, the combined effects of global warming, air pollution, and individual age, socioeconomic status, and health status are expected to result in an increase in heat-related deaths in the coming decades. Climate change is already increasing the risk of cardiovascular disease among the population, underscoring the urgency of implementing policy measures to achieve the Paris Agreement. Even at best, these environmental changes lead to quantifiable and avoidable acute CVD and should be considered as part of our efforts to prevent and treat CVD.

Global warming is leading to more frequent extreme heat. The health effects of exposure to heat are further increased by air pollution. Older individuals, individuals of low socioeconomic status, and those with underlying medical conditions associated with an increased risk of cardiovascular disease, such as type 2 diabetes mellitus and hypertension, are most at risk of heat-related acute cardiac - and vascular diseases, such as heart attack.


We thank M. Dallavalle (Helmholtz Center Munich, Germany) for help in designing the figure prior to submission and K. Chen (Yale University, New Haven, CT, USA) for discussions on the topic.

This work was supported by the HERA project (No. 825417) and the Exhaustion project (No. 820655) funded by the European Union's Horizon 2020 Program, and by the HI-CAM project funded by the Helmholtz Association.


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