The science linking pollution to cardiovascular risk is clear, and it’s time for urgent action, according to a new joint statement from the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the World Heart Federation. Medscape Medical News spoke with first author Thomas Münzel, MD, about the importance of the statement and what clinicians should know.

Why have you and your colleagues decided to release this statement now? Was there suddenly a dramatic increase in environmental risk factors over the past year? What factored into the decision to publish this now?

The science is settled. The delay is political. Environmental stressors such as air pollution, noise, heat, and chemical exposures are now clearly established causes of cardiovascular disease, with a burden comparable to, or exceeding, many traditional risk factors. What is missing is not evidence but political integration into prevention strategies, regulation, and funding priorities. Continued inaction is no longer neutral; it is a policy choice with measurable cardiovascular consequences.

What are the most important changes you are hoping to see as a result of this statement?

We want environmental risk factors to move from the margins to the mainstream of cardiovascular medicine. This means recognizing air pollution, noise, heat, and chemical exposures as “true” cardiovascular risk factors, assessed alongside blood pressure, lipids, and smoking, not as background conditions.

We hope this statement accelerates their integration into guidelines, risk stratification, clinical training, and patient communication. Ultimately, environmental cardiovascular prevention should become routine clinical practice, not an optional add-on.

Can you give some examples of exactly how environmental risk factors are contributing to more deaths, particularly from ischemic heart disease, stroke, and hypertension?

Environmental risk factors contribute to cardiovascular deaths through well-defined and converging biological pathways.

Air pollution, particularly fine particulate matter, promotes oxidative stress, systemic inflammation, endothelial dysfunction, and thrombogenicity, accelerating atherosclerosis and triggering myocardial infarction and stroke.

Chronic transportation noise and nighttime noise exposure activate stress pathways, raise blood pressure, impair vascular function, and increase the risk for hypertension, ischemic heart disease, and stroke, especially during sleep. 

Heat extremes and climate-related events further exacerbate cardiovascular risk by increasing blood pressure variability, dehydration, arrhythmias, and acute coronary events, particularly in older and vulnerable populations.

What makes this especially dangerous is that these exposures often occur simultaneously, amplifying cardiovascular risk far beyond what would be expected from any single factor alone.

You and your co-authors state that healthcare provider training is essential to address environmental risk factors effectively. What kind of training and where should a healthcare provider start?

Training needs to be pragmatic, not theoretical. Healthcare providers should first learn to recognize environmental risk factors as modifiable cardiovascular risks and routinely ask about exposures such as air pollution, noise, heat, and occupational or residential environments. 

Core training should focus on basic exposure assessment, understanding vulnerable populations, and clear risk communication with patients. Clinicians should also be trained in simple, evidence-based mitigation strategies, such as advising on the timing of physical activity, indoor air quality, heat protection, and noise reduction. 

The natural starting point is integration into medical school curricula, cardiology training programs, and continuing medical education, aligned with future cardiovascular prevention guidelines.

You suggest that more studies be done to provide global, evidence-based environmental risk factors for cardiovascular health and noncommunicable diseases and prioritize funding for transdisciplinary research. Which environmental risk factors in particular do you think should be studied?

Priority should be given to environmental risk factors that combine high population exposure with clear cardiovascular plausibility but incomplete regulation.
This includes fine and ultrafine particulate air pollution, transportation noise —particularly nighttime exposure — extreme heat, temperature variability, and emerging chemical exposures such as per- and polyfluoroalkyl substances, pesticides, and plastic-related contaminants.

These stressors are ubiquitous, often disproportionately affect vulnerable populations, and act through shared pathways, including oxidative stress, endothelial dysfunction, inflammation, and autonomic dysregulation. Equally important is studying their combined and cumulative effects, rather than treating each exposure in isolation. Funding should explicitly support transdisciplinary research that links environmental science, cardiovascular biology, epidemiology, and health policy to deliver actionable evidence.

Air pollution and noise are ubiquitous environmental exposures, particularly in urban areas. What can a cardiologist offer right now for a patient in this regard in terms of preventive steps? 

Noise and air pollution should be addressed like other cardiovascular toxins, with exposure reduction as the primary preventive strategy.

For noise, cardiologists can identify high-risk patients, emphasize protection of nighttime sleep, and recommend bedroom sound insulation, quiet-side sleeping, or relocation of sleeping areas away from traffic when feasible.

For air pollution, practical steps include advising patients to avoid outdoor exercise during pollution peaks, use indoor air filtration, and preferentially choose low-traffic routes for walking or cycling.

Importantly, these individual measures should be combined with optimal control of traditional risk factors, because pollution and noise amplify their cardiovascular effects.

Finally, clinicians should empower patients by explaining that these exposures are not merely nuisances but measurable cardiovascular risks that justify both personal and societal prevention.

Münzel is the chairman of the Environmental Sustainability Task Force for the European Society of Cardiology.

Lois Anzelowitz Levine is a medical and lifestyle writer who lives in Dallas.