The link between pollution and heart disease has always been known. The forms of pollution we expose ourselves to could be categorised into:
Things within our control such as tobacco use (including vaping and cigars), alcoholism, unhealthy eating and drinking habits. These could be extended to home cook stoves using biomass fuels — wood, coal, straw, dung, and charcoal. In richer households, inadequate ventilation, aerosol sprays, and volatile cleaning products could also be problematic.
Things outside our control such as air pollutants, toxic metal pollutants, plastic and chemical pollutants.
Merely recognising these as risk factors will increase the awareness level of cardiovascular diseases and enhance not just early detection, but also guided treatment and prevention of CVD risk in Indians. Besides this, as a thumb rule, you may be more vulnerable to pollution-led long-term hypertension, if you are:
of advanced age
have had prior cardiovascular disease
have had prior pulmonary disease
some form of immunosuppression; e.g. including COVID infection.
live in a very highly polluted city
live in proximity to highways and industrial facilities.
have an occupation that is connected to contact with pollutants.
have exposure to wildfire smoke and dust storms.
Air pollution is the world’s fourth leading cause of disease causing a 51 per cent increase in deaths since 1990. Without aggressive intervention, it is projected that these deaths could double by 2050, especially in South and East Asia.
The list of particulate and gaseous primary pollutants would include sulfur dioxide and carbon monoxide, which are released directly into the atmosphere, as well as secondary pollutants such as groundlevel ozone that are formed in the atmosphere. Organic aerosols such as benzene, toluene etc; are also pollutants. Most habits such as smoking, exposure to harmful gases while cooking and using cleaning products that are harmful also contribute to air pollution.
In recent times, scientific research has specifically linked ‘long-term exposure to particulate matter and nitrogen oxides’ to the premature ageing of blood vessels and rapid build-up of calcium in the coronary artery. This build-up of calcium can restrict blood flow to the heart and other major blood vessels –increasing the likelihood of cardiovascular events like heart attack and stroke.
Solution: Shift to green vehicles and green cooking technologies. Quit smoking and check the labels of the cleaning products used at home. Use N95 masks if you are in high risk category travelling in congested areas.
Metals such as lead, mercury, arsenic, and cadmium have long been implicated in the causation of cancer, neurobehavioral disorders, and renal disease. Toxic metal pollutants are now linked by an increasing body of evidence to the risk of cardiovascular disease. Lead is a known risk factor for hypertension. Mercury is known to potentially cause an increase in the risk of death from cardiovascular disease and nonfatal myocardial infarction. Mercury, contained in coal- becomes methylmercury in aquatic environments and is a potent developmental neuro-toxicant as well. Exposure to arsenic has also been connected to coronary heart disease and peripheral arterial disease. Specific experimental evidence is available to confirm that arsenic exposure accelerates atherogenesis and appears to cause tissue damage through oxidative and inflammatory pathways. This happens due to contamination of drinking water by naturally occurring arsenic. Cadmium is another confirmed atherogenic which human beings are exposed to.
Thanks to tobacco smoke and the consumption of green, leafy vegetables, cereals, and tubers grown in contaminated soils.
Solution: Become a more aware consumer. Stop polluting yourself and educate your family and society about the sources of these pollutants and steer clear of them.
This is also preventable by personal caution. Plastic-associated chemicals include bisphenol A (commonly called BPA) and phthalates. These materials are found in personal care products, food preservatives, pharmaceuticals, and paper products. They are associated with increased risks of diabetes and obesity.
The other side to this is the plastic trash that washes into the ocean and broken down into tiny fragments known as micro-plastics. These are consumed by marine creatures and are known to travel up the food chain. Micro plastics are known to alter the shape of and de-cluster human lung cells. Any damage to lungs contributes to compromising the heart. Extensive studies have shown phthalates to be well-known endocrine disruptors, with potential links to heart disease.
Solution: Minimise use of plastics in life. Avoid single use plastics entirely and become an ambassador for the environment.
Whatever the kind of pollution, if you are a victim of clinically significant exposure to pollution, visit a doctor. At the individual level, one can talk about minimising vigorous outdoor exercise on “bad air” days and reducing hazardous occupational exposures such as choosing less congested commutes and avoiding travel to heavily polluted regions. One should also ideally avoid the use of gas stoves, fireplaces, plug-in scents, incense, and other sources of household air pollution.
However, long-term reduction in pollution-related cardiovascular disease will require more than just changing individual behaviours. It will necessitate wide-scale control of pollution at its sources.
The author is world’s leading cardiac surgeon and head of Asian Heart Institute, Mumbai. Vews are personal.