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A comprehensive review/expert statement on environmental risk factors of cardiovascular disease
Thomas Münzel, Mette Sørensen, Jos Lelieveld, Philip J. Landrigan, Marin Kuntić, Mark J Nieuwenhuijsen, Mark R. Miller, Alexandra Elisabeth Schneider et al.. Cardiovascular Research, 2025-07-17
Topic: Risk, prevention and care in population studies
Cardiovascular disease (CVD) is the leading cause of mortality globally, with over 20 million deaths each year. While traditional risk factors-such as hypertension, diabetes, smoking, and poor diet-are well-established, emerging evidence underscores the profound impact of environmental exposures on cardiovascular health. Air pollution, particularly fine particulate matter (PM2.5), contributes to approximately 8.3 million deaths annually, with over half attributed to CVD. Similarly, noise pollution, heat extremes, toxic chemicals, and light pollution significantly increase the risk of CVD through mechanisms involving oxidative stress, inflammation, and circadian disruption. Recent translational and epidemiological studies show that chronic exposure to transport noise increases the risk of myocardial infarction, stroke, and heart failure. Air pollution, even below regulatory thresholds, promotes atherosclerosis, vascular dysfunction, and cardiac events. Novel threats such as micro- and nano-plastics are emerging as contributors to vascular injury and systemic inflammation. Climate change exacerbates these risks, with heatwaves and wildfires further compounding the cardiovascular burden, especially among vulnerable populations. The cumulative effects of these exposures-often interacting with behavioural and socioeconomic risk factors-are inadequately addressed in current prevention strategies. The exposome framework offers a comprehensive approach to integrating lifelong environmental exposures into cardiovascular risk assessment and prevention. Mitigation requires systemic interventions including stricter pollution standards, noise regulations, sustainable urban design, and green infrastructure. Addressing environmental determinants of CVD is essential for reducing the global disease burden. This review calls for urgent policy action and for integrating environmental health into clinical practice to safeguard cardiovascular health in the Anthropocene.
Key findings
- Similarly, noise pollution, heat extremes, toxic chemicals, and light pollution significantly increase the risk of CVD through mechanisms involving oxidative stress, inflammation, and circadian disruption.
Why it matters
This review is about environmental risk factors for cardiovascular disease, not Alzheimer's disease, so it provides no information on Alzheimer's treatment, cure or prevention. It describes how air pollution, noise, heat, chemicals and light pollution may raise cardiovascular risk.
New to this subject? Start with our plain-English guide: Prevention →
Study details
- Evidence strengthLow
How this study scored 52/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Cardiovascular Research) |
| Journal's citation record | 3 / 4 | Cardiovascular Research: journal h-index 299 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 83 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 27.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 5 / 6 | Cited 33.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 3 / 4 | Cited 83 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Andreas Daiber: h-index 99 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Edinburgh: institution h-index 1,378 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 12 institution(s) in 6 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40795898) |
| Free to read | 2 / 2 | Free to read |
| Total | 52 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1093/cvr/cvaf119
- PubMed: 40795898
- Original source →
- Free full text: Cardiovascular Research →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Münzel, T., Sørensen, M., Lelieveld, J., Landrigan, P. J., Kuntić, M., Nieuwenhuijsen, M. J., et al. (2025). A comprehensive review/expert statement on environmental risk factors of cardiovascular disease. Cardiovascular Research. https://doi.org/10.1093/cvr/cvaf119
Vancouver
Münzel T, Sørensen M, Lelieveld J, Landrigan PJ, Kuntić M, Nieuwenhuijsen MJ, et al. A comprehensive review/expert statement on environmental risk factors of cardiovascular disease. Cardiovascular Research. 2025. doi:10.1093/cvr/cvaf119. PMID: 40795898.
BibTeX
@article{munzel2025-40795898,
author = {Münzel, Thomas and Sørensen, Mette and Lelieveld, Jos and Landrigan, Philip J. and Kuntić, Marin and Nieuwenhuijsen, Mark J and Miller, Mark R. and Schneider, Alexandra Elisabeth and others},
title = {{A comprehensive review/expert statement on environmental risk factors of cardiovascular disease}},
journal = {Cardiovascular Research},
year = {2025},
doi = {10.1093/cvr/cvaf119},
pmid = {40795898},
url = {https://doi.org/10.1093/cvr/cvaf119}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.
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