It鈥檚 time for physicians to begin screening their patients for the health risks they face because of exposure to air pollution, says Professor of Biology Philip J. Landrigan, MD, director of the University鈥檚 Program for Global Public Health and the Common Good.
With numerous studies documenting air pollution鈥檚 link to heart-related illness and death, Landrigan and another preiminent American physician are calling on their peers to begin assessing and recommending steps to help patients reduce their exposure to indoor and outdoor air pollution in order to improve cardiovascular health, the researchers in the prestigious New England Journal of Medicine.
鈥淲hat has been missing from this whole conversation about cardiovascular disease is the impact of environmental factors outside of an individual鈥檚 control,鈥� said Landrigan, a pediatrician and epidemiologist whose pioneering work led to the removal of lead from gasoline. 鈥淚t is time to bring these issues into the conversation.鈥�
Professor of Biology Phil Landrigan
In addition, governments have a primary responsibility, as stewards of public health, to adopt technologies and regulations that reduce air pollution鈥攎easures that will also contribute to efforts to combat climate change, wrote Landrigan and Sanjay Rajagopalan, MD, chief of cardiovascular medicine at UH Harrington Heart & Vascular Institute, the Herman K. Hellerstein, MD, Chair in Cardiovascular Research, and director of the Case Cardiovascular Research Institute at the Case Western Reserve School of Medicine.
Cardiovascular diseases are the world鈥檚 leading cause of death and disability, responsible for 18.6 million deaths worldwide in 2019, including 957,000 deaths in the United States. That same year, an estimated 5.5 million cardiovascular deaths were linked to air pollution鈥攊ncluding 200,000 deaths in the United States, though the authors note that number could be up to ten times higher, based on a number of studies.
The grim statistics illustrate that it is now necessary for physicians, who have long addressed heart health from standpoints of nutrition, diet, smoking, and exercise, to play a greater role helping patients recognize their risk factors for exposure to pollutants and recommending evidence-based strategies in response, the co-authors argue.
鈥淭he first step in preventing pollution-related cardiovascular disease is to overcome neglect of pollution in disease prevention programs, medical education, and clinical practice and acknowledge that pollution is a major, potentially preventable risk factor for cardiovascular disease,鈥� Landrigan and Rajagopalan wrote in the journal.
In addition to obtaining patient histories of pollution exposure, doctors can provide guidance on pollution avoidance. They might recommend minimizing exercise on 鈥渂ad air鈥� days, avoiding exposure on the job, avoiding the use of pollution-emitting devices鈥攆rom fireplaces to incense sticks. Preventative recommendations could include the use of facemasks, in-home air cleaners, and air conditioning.
鈥淭he scientific knowledge is not brand new,鈥� said Landrigan, who also directs Boston College鈥檚 Global Observatory on Pollution and Health. 鈥淚t has been recognized for at least a decade that air pollution and lead are important causes for heart disease and stroke. However, that scientific knowledge hasn鈥檛 yet translated to clinical practice in the office, or in hospital at bedside. We think it is time for that to change. We are hoping this will change the practice of individual doctors and NPs, and that it will change the advice that prominent professional organizations give to their members and the public.鈥�
Pollution's deadly toll
18.6 million
Deaths worldwide in 2019
5.5 million
Worldwide deaths linked to air pollution
In addition to the call to action for their fellow physicians, Landrigan and Rajagopalan want to bring the issue of pollution to the attention of the world鈥檚 leading medical, health, and physician associations to enlist their members in the effort to control pollution. The American Heart Association has already issued guidance on steps individuals can take to protect themselves from air pollution, they note.
But the global scale of the problem is so great that physicians and health care providers cannot be expected to resolve it on their own, the physicians say. Governments, currently grappling with the global response to climate change at the COP26 meetings in Glasgow, Scotland, can use those same efforts to improve cardiovascular health.
鈥淎n enduring reduction in pollution-related cardiovascular disease will require more than changing individual behaviors,鈥� they wrote in the journal. 鈥淚t will necessitate widescale control of pollution at its sources. The most effective strategy for achieving this goal is a rapid, government-supported transition from all fossil fuels鈥攃oal, gas, and oil鈥攖o clean, renewable energy. Household air pollution in low-income countries is most effectively controlled by providing poor families with affordable access to cleaner fuels.鈥�
It will take government action to lead the way, they argue: 鈥淟asting prevention of pollution-related cardiovascular disease can be achieved only through government-supported interventions on a societal scale that control pollution at its source and encourage a rapid transition to clean energy.鈥�
Ed Hayward | University Communications | November 2021