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J Am Coll Cardiol. 2018 Oct 23;72(17):2054-2070. doi: 10.1016/j.jacc.2018.07.099.

Air Pollution and Cardiovascular Disease: JACC State-of-the-Art Review.

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Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Case Cardiovascular Research Institute, Case Western Reserve University, Cleveland, Ohio. Electronic address:
Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.
Michigan Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.


Fine particulate matter <2.5 μm (PM2.5) air pollution is the most important environmental risk factor contributing to global cardiovascular (CV) mortality and disability. Short-term elevations in PM2.5 increase the relative risk of acute CV events by 1% to 3% within a few days. Longer-term exposures over several years increase this risk by a larger magnitude (∼10%), which is partially attributable to the development of cardiometabolic conditions (e.g., hypertension and diabetes mellitus). As such, ambient PM2.5 poses a major threat to global public health. In this review, the authors provide an overview of air pollution and health, including assessment of exposure, impact on CV outcomes, mechanistic underpinnings, and impact of air pollution reduction strategies to mitigate CV risk. The review concludes with future challenges, including the inextricable link between air pollution and climate change, and calls for large-scale trials to allow the promulgation of formal evidence-based recommendations to lower air pollution-induced health risks.


blood pressure; coronary artery disease; environment; insulin resistance; particulate matter; type 2 diabetes mellitus


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