“We wrote this article to alert patients and medical providers that they need to start thinking about air pollution and how it affects health,” says Philip Landrigan, MD, a professor and the director of the Global Public Health Program at Boston College and a coauthor of the paper, published on November 11, 2021, in the New England Journal of Medicine. “It needs to be added to the list of risk factors for heart disease and stroke,” he says.
Pollution Causes Millions of Early Deaths Each Year
Pollution caused nine million deaths worldwide in 2019, according to the Global Burden of Disease (GBD) study, and an estimated three out of five of those deaths were due to cardiovascular disease, including heart attack and stroke. In September this year, the World Health Organization (WHO) issued new global air quality guidelines that lower the acceptable levels of many toxins, a measure they estimate could prevent almost 80 percent of air pollution related deaths.
Health Consequences of Pollution Haven’t Found Their Way Into Doctors’ Thinking
Large studies launched in the 1950s and ’60s helped identify big risk factors for heart disease and stroke, including cigarette smoking, hypertension, obesity, high cholesterol, and a sedentary lifestyle, says Dr. Landrigan. “Those findings have shaped guidelines and recommendations that we make for heart health and have helped knock down the death rate due to heart disease and stroke,” he says. The evidence that air pollution causes heart disease and stroke has now been accumulating for 20-some years, but it still is largely ignored as a risk factor, says Landrigan. The review references numerous studies and meta-analyses published over the past two decades linking particulate matter levels (a measure of the amount of tiny pieces of matter such as dust or smoke) to heart disease and risk of heart attack and stroke, as well as cardiovascular risk factors, including hypertension and diabetes. “Still, air pollution is missing from that list of risk factors, and we aren’t screening for air pollution exposure or offering interventions,” says Landrigan.
Doctors and Patients Need to Recognize the Risks of Air Pollution
Landrigan cites two possible reasons why air pollution’s connection to heart disease and death hasn’t translated into healthcare. There’s a fragmentation in how we address certain issues in the United States, and air pollution is an example of that, he says. “Air pollution has been considered an environmental issue, and it’s not something that health departments or the Department of Health and Human Services (HHS) take on. Instead, it’s an EPA (United States Environmental Protection Agency) issue, and so it’s not put on the medical metric,” Landrigan explains. Another obstacle is that individuals and doctors have tools in the form of medications and lifestyle modifications to control many risk factors for heart disease, he says. “These are factors that can be changed through individual choices and actions. By contrast, people don’t have much choice over the air they breathe. Control of air quality is a government responsibility.” Landrigan suggests that the first step is educating doctors and patients about the health risks of pollution exposure. Pollution exposure screening, as well as guidance on limiting exposure, could be part of an office visit, he says.
Screening or Providing Interventions for Air Pollution Is Easier Said Than Done
This paper highlights pollution’s impact on heart health, but air pollution also has health consequences for lungs and other organs and systems in our body, says Panagis Galiatsatos, MD, a pulmonary and critical care doctor at Johns Hopkins Medicine in Baltimore. Dr. Galiatsatos was not involved with the new paper. “The evidence is clear: What you breathe matters. I don’t think there are any physicians who would object to the premise that air pollution should be addressed and evaluated,” he says. How to best do that is still a big unanswered question, says Galiatsatos. “We don’t have the needed clarity or guidance on how to screen for air pollution exposure and what interventions are appropriate when it is identified, says Galiatsatos. “There’s no simple blood test for this that we can just send to a lab and get results,” he says.
Taking Steps to Address Climate Change Could Improve Air Quality and Health
Current global efforts to slow down climate change would also improve air quality, says Landrigan. “Any action we take to reduce fossil fuel combustion is going to help make the air we breathe cleaner. The best solution to cleaning up our air is a massive society-wide transition to move away from coal, oil, and gas to wind and solar energy,” he says. The increasing frequency of wildfires, violent storms, and coastal flooding have health impacts for all of us in the present. “Addressing climate change is often thought to be something that we should do for future generations, but it could actually help our health in the here and now by reducing pollution,” says Landrigan.
