Pollution can increase the risk of developing, in the short and long term, cardiovascular diseases such as heart attacks, arrhythmias, thrombosis or stroke. It is estimated that, worldwide, it is the cause of 8.8 million deaths each year, 30,000 of which in Spain. In this sense, the Revista Española de Cardiología, publication of the Spanish Society of Cardiology, presents a review on the influence of the environment on cardiovascular health in which several members of the Cardiovascular Diseases group of the Vall d'Hebron Research Institute (VHIR) and the Cardiology Service of the Vall d'Hebron University Hospital have participated.

The work, carried out by national and international experts, focuses on the analysis of the effects of particular air and heavy metals, contaminants that present the strongest scientific evidence on their influence on cardiovascular health. "Studying the contribution of environmental exposures is important to minimize the harmful influences of pollution and promote cardiovascular health through specific preventive or therapeutic strategies", says Dr. Jordi Bañeras, physician at the Cardiology Department of the Vall d'Hebron University Hospital, researcher of the Cardiovascular Diseases group at VHIR and first author of the paper.

Specifically, the review highlights the increase in hospitalizations due to heart failure caused by air pollution, as well as mortality due to these pathologies. Particularly relevant is the effect of inhaling particles with a diameter of less than 2.5 µm, as they can reach the bloodstream and activate inflammatory or oxidative stress pathways that promote heart ischemia, arrhythmias or thrombi.

In the case of heavy metals, the impact of cadmium and lead on the increase in mortality from cardiovascular causes has been studied. These metals can be found in food, air, tobacco smoke or water and have the capacity to accumulate in the body and are difficult to eliminate. Therefore, a clinical trial (TACT) was conducted to evaluate therapy with metal chelators, i.e. factors that have the ability to bind to and remove metals. The trial demonstrated the cardiovascular benefit of this strategy in patients with previous myocardial infarction, especially in diabetics. Now, the second phase of the TACT2 study is focused on analyzing the effect in patients with diabetes. In the future, it will be studied whether the measurement of heavy metals in blood or urine could help to calculate the risk of cardiovascular disease and, in these cases, to apply early interventions to avoid serious consequences.

In the field of prevention, the authors state that legislation and control of pollutants in the air, water, food and environmental policies for heart-healthy spaces are key measures to reduce the harmful effects of these substances and promote cardiovascular health. Moreover, they consider that awareness of the effects of environmental pollution is also essential, especially in patients at risk. "More research and actions in environmental cardiology contribute substantially to improving the prevention and treatment of cardiovascular diseases", concludes Dr. Bañeras.