COVID and Air Pollution: Cardio Societies Call for Urgent Action

Megan Brooks

January 29, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Four leading cardiovascular organizations — the World Heart Federation (WHF), American College of Cardiology (ACC), American Heart Association (AHA), and European Society of Cardiology (ESC) — have jointly called for the medical community and health authorities to take action to mitigate the harmful effects of air pollution on health.

The statement was published simultaneously January 28 in the Journal of the American College of Cardiology, Circulation, the European Heart Journal, and Global Heart.

Air pollution has been shown to increase the risk of cardiovascular disease (CVD), including myocardial infarction and stroke, as well as diabetes and respiratory diseases.

Recent evidence also suggests air pollution increases the risk of more severe COVID-19 and death from COVID-19, they note. Air pollution may also increase the risk of novel coronavirus transmission due to its impact on more frequent coughing.

This dangerous "triple threat" of air pollution, COVID-19, and CVD needs urgent action, the statement authors say.

"Even before the COVID-19 pandemic, air pollution was an issue of growing concern due to its impact on people's health, although it was frequently overlooked as a risk factor for cardiovascular disease," Michael Brauer, ScD, chair of the WHF air pollution expert group and co-author of the statement, said in a news release.

"COVID-19 has brought a new, deadly factor to the equation, and the time has come for the health community to speak up and take action," said Brauer.

The authors call for structural actions to reduce emissions of air pollutants and harmful exposure. They also call on healthcare providers to:

  • Advocate for air pollution mitigation as a health measure, further research on air quality and its impact on CVD, and interventions to reduce air pollution and its effect on noncommunicable disease.

  • Provide patients with personal measures to reduce exposure, such as room air filtration systems.

  • Integrate air pollution into disease management approaches, for example through the use of air quality indices.

  • Participate in the development of guidelines on air pollution and CVD.

  • Support ministries of environment, energy, and transportation in their mitigation efforts.

  • Work to educate and raise awareness on the cardiovascular benefits of clean air.

  • Collaborate with senior decision-makers in national, regional, and global governmental institutions to make air pollution-related heart disease a priority.

"Clinicians have a responsibility to educate their patients, their colleagues and their communities at large on the connection between air pollution and cardiovascular disease risk," Richard Kovacs, MD, senior author of the joint statement and immediate past-president of the ACC, said in the news release.

"By advocating for recognition of air pollution as a health factor, working individually with our patients to reduce exposure and associated risks, and integrating air pollution into broader disease management approaches, the healthcare community can provide support for larger pollution mitigation efforts," said Kovacs.

"Poor air quality can harm heart and brain health, with a disproportionate impact on low-income and poor communities located near sources of air pollution," added co-author Robert Harrington, MD, immediate past-president of the AHA.

"We must address this problem as a global community to equitably reduce exposure to air pollution and reverse the health harms of poor air quality for all," said Harrington.

ESC President Stephan Achenbach, MD, noted that air pollution is "one of the most underestimated causes of heart disease and stroke."

"Air pollution needs to be recognized as a major modifiable risk factor in the prevention and management of cardiovascular disease, and measures to reduce its detrimental short-term and long-term influence on cardiovascular health, potentially over generations, are urgently required," said Achenbach.

Kovacs reports other from Cook Research Inc, other from Clintrex, personal fees from Eli Lilly, grants and personal fees from Gen InCode, personal fees from Prilenia, other from Pfizer, outside the submitted work. Brauer, Harrington, and Achenbach have disclosed no relevant financial relationships.

J Am Coll Cardiol. Published online January 28, 2021. Full text

Circulation. Published online January 28, 2021. Abstract

Eur Heart J. 2021;ehaa1025. Abstract

Global Heart. 2021;16:8. Full text

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