Poor air quality accounts for more than 9 million deaths a year globally according to recent estimates. A large portion of these deaths are attributable to cardiovascular causes, with evidence indicating that air pollution may also play an important role in the genesis of key cardiometabolic risk factors. Air pollution is not experienced in isolation but is part of a complex system, influenced by a host of other external environmental exposures, and interacting with intrinsic biologic factors and susceptibility to ultimately determine cardiovascular and metabolic outcomes. Given that the same fossil fuel emission sources that cause climate change also result in air pollution, there is a need for robust approaches that can not only limit climate change but also eliminate air pollution health effects, with an emphasis of protecting the most susceptible but also targeting interventions at the most vulnerable populations. In this review, we summarize the current state of epidemiologic and mechanistic evidence underpinning the association of air pollution with cardiometabolic disease and how complex interactions with other exposures and individual characteristics may modify these associations. We identify gaps in the current literature and suggest emerging approaches for policy makers to holistically approach cardiometabolic health risk and impact assessment.

中文翻译：

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了解累积暴露影响背景下空气污染对心血管和代谢健康的影响

根据最近的估计，不良空气质量每年导致全球超过 900 万人死亡。其中很大一部分死亡可归因于心血管原因，有证据表明空气污染也可能在关键心脏代谢危险因素的发生中发挥重要作用。空气污染不是孤立存在的，而是一个复杂系统的一部分，受到许多其他外部环境暴露的影响，并与内在的生物因素和易感性相互作用，最终决定心血管和代谢结果。鉴于导致气候变化的化石燃料排放源也会造成空气污染，因此需要采取强有力的方法，不仅可以限制气候变化，还可以消除空气污染对健康的影响，重点是保护最易受影响的人群，同时也保护最脆弱的人群。针对最弱势群体的干预措施。在这篇综述中，我们总结了支持空气污染与心脏代谢疾病关联的流行病学和机制证据的现状，以及与其他暴露和个人特征的复杂相互作用如何改变这些关联。我们找出了当前文献中的差距，并为政策制定者建议了新的方法，以全面地进行心脏代谢健康风险和影响评估。