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Air pollution and cardiovascular disease: the Paul Wood Lecture, British Cardiovascular Society 2021
  1. Shruti S Joshi,
  2. Mark R Miller,
  3. David E Newby
  1. BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Shruti S Joshi, BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK; sjoshi{at}


Air pollution is associated with up to 8.8 million excess deaths worldwide each year and is a major contributor to the global burden of disease. Cardiovascular conditions are the predominant cause for air pollution-related deaths and there is an urgent need to address the silent pandemic of air pollution on cardiovascular health. Air pollution exposure is associated with acute events like acute coronary syndrome and stroke, and with chronic conditions, such as atherosclerosis and heart failure. Several potential mechanisms have been proposed that link particle inhalation to cardiovascular disease including oxidative stress and inflammation, changes in autonomic balance and neuroendocrine regulation and the particle translocation into the circulation itself. This, in turn, can cause endothelial, vasomotor and fibrinolytic dysfunction and increased thrombogenicity and blood pressure which are implicated in the mediation of adverse cardiovascular events. Certain interventions can help mitigate these adverse effects. At an individual level, this includes the use of a facemask and indoor air purification systems. At an environmental level, interventions reducing the generation or release of combustion-derived pollutants are key and include public health policies to facilitate active transport, cleaner sources of energy and reductions in vehicular and fossil fuel emissions. In this review, we summarise the key pathways and mechanisms that draw together how air pollution can lead to adverse cardiovascular effects, as well as explore potential interventions to reduce the burden of air pollution-induced cardiovascular morbidity and mortality.

  • coronary artery disease
  • global health
  • heart failure
  • stroke

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  • Contributors SSJ drafted the manuscript. MRM and DEN provided expert input and revisions. Final manuscript was approved by all authors for submission.

  • Funding SSJ, MRM and DEN are supported by the British Heart Foundation (FS/CRTF/20/24087, CH/09/002, RG/05/003, RG/10/9/28286, PG/03/017/15071, RG/16/10/32375, RE/18/5/34216). DEN is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.