BACKGROUND As low- and middle-income countries urbanize and industrialize, they must also cope with pollution emitted from diverse sources. MAIN TEXT Strong and consistent evidence associates exposure to air pollution and lead with increased risk of cardiovascular disease occurrence and death. Further, increasing evidence, mostly from high-income countries, indicates that exposure to noise and to both high and low temperatures may also increase cardiovascular risk. There is considerably less research on the cardiovascular impacts of environmental conditions in low- and middle-income countries (LMICs), where the levels of pollution are often higher and the types and sources of pollution markedly different from those in higher-income settings. However, as such evidence gathers, actions to reduce exposures to pollution in low- and middle-income countries are warranted, not least because such exposures are very high. Cities, where pollution, populations, and other cardiovascular risk factors are most concentrated, may be best suited to reduce the cardiovascular burden in LMICs by applying environmental standards and policies to mitigate pollution and by implementing interventions that target the most vulnerable. The physical environment of cities can be improved though municipal processes, including infrastructure development, energy and transportation planning, and public health actions. Local regulations can incentivize or inhibit the polluting behaviors of industries and individuals. Environmental monitoring can be combined with public health warning systems and publicly available exposure maps to inform residents of environmental hazards and encourage the adoption of pollution-avoiding behaviors. Targeted individual or neighborhood interventions that identify and treat high-risk populations (e.g., lead mitigation, portable air cleaners, and preventative medications) can also be leveraged in the very near term. Research will play a key role in evaluating whether these approaches achieve their intended benefits, and whether these benefits reach the most vulnerable. CONCLUSION Cities in LMICs can play a defining role in global health and cardiovascular disease prevention in the next several decades, as they are well poised to develop innovative, multisectoral approaches to pollution mitigation, while also protecting the most vulnerable.

中文翻译：

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城市在减少低收入和中等收入国家环境污染对心血管影响方面的作用。

背景技术随着低收入和中等收入国家的城市化和工业化，它们还必须应对不同来源排放的污染。主要文本 强有力且一致的证据表明，接触空气污染和铅与心血管疾病发生和死亡的风险增加有关。此外，越来越多的证据（主要来自高收入国家）表明，暴露于噪音以及高温和低温也可能增加心血管风险。关于低收入和中等收入国家（LMIC）环境条件对心血管影响的研究要少得多，这些国家的污染水平往往较高，而且污染的类型和来源与高收入国家明显不同。然而，随着此类证据的收集，有必要采取行动减少低收入和中等收入国家的污染暴露，尤其是因为此类暴露非常高。污染、人口和其他心血管危险因素最集中的城市可能最适合通过应用环境标准和政策来减轻污染并实施针对最弱势群体的干预措施，从而减轻中低收入国家的心血管负担。城市的物质环境可以通过市政进程得到改善，包括基础设施发展、能源和交通规划以及公共卫生行动。地方法规可以激励或抑制企业和个人的污染行为。环境监测可以与公共卫生预警系统和公开的暴露地图相结合，向居民通报环境危害并鼓励采取避免污染的行为。短期内也可以利用有针对性的个人或社区干预措施来识别和治疗高危人群（例如，铅缓解、便携式空气净化器和预防性药物）。研究将在评估这些方法是否实现其预期效益以及这些效益是否惠及最弱势群体方面发挥关键作用。结论 未来几十年，中低收入国家的城市可以在全球健康和心血管疾病预防中发挥决定性作用，因为它们已做好准备，开发创新的多部门方法来减轻污染，同时保护最弱势群体。