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Air Pollution and CVD

A Window of Opportunity

Home > Global Advocacy > Air Pollution

Globally, more than 30% of cardiovascular disease deaths are attributable to air pollution — more than three million deaths every year — and air pollution is the 5th highest ranking risk factor for mortality, with more attributable deaths than high LDL cholesterol, high body-mass index, physical inactivity, or alcohol use.

Why Air Pollution?

In recent years, air pollution and its impact on people’s health has become a significant issue on the global health agenda. Nine out of ten people worldwide breathe polluted air, which disproportionately affects those living in low-resource settings. Air pollution is a major contributor to the global burden of disease, with an estimated 9% of all deaths in 2017* attributable to outdoor and household** air pollution. While the impacts of air pollution on respiratory diseases is widely recognized and immediately understood, 40% of the estimated 4.9 million deaths attributable to air pollution in 2017 are due to cardiovascular diseases.

Air pollution is a complex and dynamic mixture of numerous compounds in gaseous and particle form, originating from diverse sources, subject to atmospheric transformation and varying over space and time. Three common air pollutants, particulate matter (PM), ozone and nitrogen dioxide (NO2), are the focus of most monitoring programs, communication efforts, health impact assessments, and regulatory efforts.

Evidence for impacts on cardiovascular disease is most consistent for particulate matter, which is responsible for the vast majority of the disease burden via its impacts on ischemic heart disease, and stroke, as well as lung cancer, COPD, lower respiratory infections, Type 2 diabetes, pregnancy outcomes and related infant mortality. Ozone is mainly associated with exacerbation of respiratory disease, with COPD incidence and mortality and with metabolic effects. NO2 is often used as an indicator of traffic-related air pollution. Chronic exposure to NO2 is associated with incident childhood asthma while short-term variability is associated with exacerbation of asthma and increased daily mortality counts.

* While other estimates exist and each have their uncertainties, all estimates of attributable disease burden are large and high-ranking in comparison to traditional and more widely recognized CVD risk factors.
** Household air pollution is mainly a concern in low income countries where polluting fuels (coal, wood, agricultural residue, animal dung) are used for cooking and heating.

Air Pollution as a WHF Advocacy Priority

The WHF Advocacy Strategy covering the years 2019-2021 identifies the following as Specific Objective 2:

Support global and local actions to reduce the impact of air pollution on heart health by developing partnerships with organizations working at the intersection between health, air quality and physical activity.

Just as it affects all systems of the body, air pollution requires a multi-system and multi-sectoral response. The health sector as a whole, which bears the impact of air pollution, can provide much-needed support for ministries of environment, energy, and transportation, which are traditionally responsible for mitigation efforts. The World Heart Federation is advocating for senior decision-makers in national, regional and global governmental institutions to make air pollution related heart disease a priority and to identify interventions to reduce air pollution and its impact on NCDs.

Yet while structural actions to mitigate pollution emissions are ultimately necessary to reduce harmful exposures, health care providers can play several important roles before such mitigation is achieved. First, clinicians can advocate for air pollution mitigation as a health measure. Second, clinicians can provide patients with personal measures to reduce exposures and associated risk at the individual level. And finally, health care providers can integrate air pollution into disease management approaches. Through its Air Pollution Expert Group, WHF is working with the WHO to increase the development and use of clinical guidelines and toolkits on air pollution and cardiovascular disease to ensure its Members are equipped to counsel their patients on the risks of air pollution, while also supporting educational and policy initiatives to reduce air pollution exposure.

WHF Air Pollution Expert Group

Following a call for applications in the summer of 2019, ten distinguished air pollution and CVD experts from around the world were approved by the WHF Board to form the Air Pollution Expert Group (APEG).

The Group, which is proud to count WHF President of the Board Karen Sliwa as a distinguished Ex-Officio Member, is responsible for identifying priority issues and general objectives, outlining what WHF hopes to achieve in the field of air pollution, and advising the Board on important issues related to this topic. The APEG also leads on the production of documents related to clean air and air pollution.

The Air Pollution Expert Group is currently engaged in several technical projects, including a Position Paper, a capacity-building toolkit in partnership with the WHO, and a knowledge assessment survey of WHF Members.


Chair: Prof Michael Brauer, The University of British Columbia, Institute for Health Metrics and Evaluation (University of Washington) (Canada/United States)

Dr Narantuya Davaakhuu, National Center for Public Health Mongolia (Mongolia)

Dr Michael Hadley, Mount Sinai (United States)

Mr Daniel Kass, Vital Strategies (United States)

Prof Mark Miller, Centre for Cardiovascular Sciences, University of Edinburgh (United Kingdom)

Prof Maria Consuelo Escamilla Nuñez, Instituto Nacional de Salud Pública (Mexico)

Prof Dorairaj Prabhakaran, Public Health Foundation India (India)

Dr Ta-Chen Su, Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine (Taiwan)

Dr Ilonca C.H. Vaartjes, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (The Netherlands)

Dr Rajesh Vedanthan, Mount Sinai (United States)