This underscores a need to reinvent cities and address environmental risk factors that are associated with increased risk for cardiovascular diseases.
As the number of people living in urban areas continues to grow, it becomes all the more necessary to identify potential environmental risk factors for cardiovascular (CV) disease and find ways to mitigate them.
In a virtual presentation at the European Society of Cardiology (ESC 2020) Congress, Thomas Münzel, MD, Professor in the Department of Cardiology at the Univeristy Medical Center Mainz, specifically focused on the negative impact of air and noise pollution in urban cities on CV disease risk.
Beginning with air pollution, he referenced a 2015 study published in The Lancet that showed it to be the number 5 leading global risk factor for death. Quite interestingly, it fell just below high total cholesterol, a leading risk factor for CV disease.
Another study calculated that 790,000 deaths have occurred per year in Europe due to air pollution, with 49% of the total being attributed to ischemic heart disease.
Furthermore, the study determined that an overall 2.9 years of life expectancy are lost due to air pollution—compared with 2.2 years from tobacco smoking.
Thus, they emphasized that phasing out fossil fuel emissions and converting to clean, renewable energy would be a highly effective health prevention intervention. Doing so could reduce excess mortality rates by 434,000 per year in Europe as well as increase 1.2 years of life expectancy.
Although policies should be developed to encourage walking, cycling, and use of public transportation, there still remains a concern in increase of exposure to pollution due to outdoor activities, Münzel noted.
In the second half of his lecture, he addressed the prominence of noise pollution in urban areas and the CV burden it carries.
Certain noises, such as nearby aircrafts, jackhammers, and trucks, are considered nearing the threshold of pain on the decibel scale. As a result, they can lead to sleep and activity disturbances, which in turn impact cognitive and emotional responses that could trigger an elevation of stress hormone levels.
Therefore, Münzel indicated that the European Union transportation noise is estimated to result in 900,000 cases of hypertension, 43,000 hospital admissions, and >10,000 yearly premature deaths associated with heart disease and stroke.
Additionally, the World Health Organization has estimated that noise exposure in Western Europe leads to 1.7 million disability-adjusted life years.
This underscores the importance of applying measures to mitigate noise pollution, which includes, but is not limited to, investing in noise barriers, brake blocks for trains, low-noise tires, and electric cars. However, such efforts can be costly.
Münzel acknowledged that further research is needed to determine the combined effect of both noise and air pollution.
Of course, they are not the only environmental factors impacting CV health in urban areas. Additional factors include global rising temperature, concrete and asphalt—which exacerbates the elevated heat—and inadequate green spaces.
And finally, Münzel concluded with a reminder that despite this need to address these environmental risk factors, one cannot ignore the effects of physical inactivity, prolonged sitting, and an unhealthy diet on CV health.
“The city of the future needs to be a green city, a social city, an active city, and thus a heart healthy city,” he said. “And keep in mind: ‘Genetics loads the gun, but the environment pulls the trigger.’”