Environmental determinants of cardiovascular disease: lessons learned from air pollution

Nat Rev Cardiol. 2020 Oct;17(10):656-672. doi: 10.1038/s41569-020-0371-2. Epub 2020 May 7.


Air pollution is well recognized as a major risk factor for chronic non-communicable diseases and has been estimated to contribute more to global morbidity and mortality than all other known environmental risk factors combined. Although air pollution contains a heterogeneous mixture of gases, the most robust evidence for detrimental effects on health is for fine particulate matter (particles ≤2.5 µm in diameter (PM2.5)) and ozone gas and, therefore, these species have been the main focus of environmental health research and regulatory standards. The evidence to date supports a strong link between the risk of cardiovascular events and all-cause mortality with PM2.5 across a range of exposure levels, including to levels below current regulatory standards, with no 'safe' lower exposure levels at the population level. In this comprehensive Review, the empirical evidence supporting the effects of air pollution on cardiovascular health are examined, potential mechanisms that lead to increased cardiovascular risk are described, and measures to reduce this risk and identify key gaps in our knowledge that could help address the increasing cardiovascular morbidity and mortality associated with air pollution are discussed.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Air Pollution / adverse effects*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / prevention & control
  • Environmental Exposure / adverse effects*
  • Humans
  • Particle Size
  • Particulate Matter / adverse effects
  • Risk Factors


  • Particulate Matter