A new review published in Atherosclerosis confirms that exposure to air pollution—particularly fine particulate matter (PM2.5)—accelerates artery damage and contributes significantly to the progression of heart disease.
The review compiles decades of research linking environmental pollutants to atherosclerosis, a condition marked by the buildup of fatty plaques in the arteries that can lead to strokes and heart attacks. The findings strengthen the case for treating air pollution as a major cardiovascular risk factor alongside smoking and poor diet.
Air Pollution: A Hidden Cardiovascular Threat
Cardiovascular disease (CVD) remains the leading cause of death worldwide, claiming over 20 million lives each year. While rates have declined in some areas, population growth and aging are fueling a steady rise in overall numbers.
Atherosclerosis—where fats and inflammatory cells accumulate in artery walls—underpins many of these deaths. When plaques rupture, they can block blood flow, triggering heart attacks or strokes.
Beyond traditional risks, the review emphasizes environmental factors. Air pollution, especially PM2.5, has emerged as a top contributor to cardiovascular disease. These microscopic particles, largely from combustion sources like vehicle exhaust, can infiltrate the bloodstream, triggering inflammation and oxidative stress.
Fine Particulate Matter Linked to Early Signs of Artery Disease
Numerous epidemiological studies highlight how long-term PM2.5 exposure increases measurable signs of atherosclerosis. These include:
Carotid intima-media thickness (CIMT): A marker of early artery thickening.
Coronary artery calcification (CAC): Calcium deposits linked to heart attack risk.
Arterial stiffness and aortic calcification: Indicators of vascular aging.
Meta-analyses show consistent associations between PM2.5 and these indicators, although effect sizes vary. The data is less consistent for larger particles (PM10), gaseous pollutants like nitrogen dioxide (NO2) or ozone (O3), and traffic proximity. However, black carbon—linked to burning fossil fuels—has shown particular harm.
Air Pollution’s Lifelong Impact
Evidence also points to early-life exposure risks. Prenatal and childhood contact with polluted air may cause long-term vascular changes, though more research is needed to confirm these effects. In adults, PM2.5 is linked to the development of unstable, rupture-prone plaques—raising the risk of acute cardiovascular events.
Despite some gaps—especially in data from lower-income regions and for short-term or gaseous pollutants—the review concludes there is overwhelming support for the link between air pollution and both the onset and worsening of atherosclerosis.
A Call for Action
Air pollution is now considered the second leading risk factor for global mortality and the top cause of disability-adjusted life years. The World Health Organization attributes 7–9 million premature deaths per year to pollution, around 70% of which are due to cardiovascular causes.
Experts urge global policy reforms to reduce air pollution exposure and mitigate its silent but deadly impact on heart health.
