Explaining the impact of environmental risk factors on cardiovascular health by the “exposome” concept

Abstract

There is growing evidence that environmental risk factors (pollution and non‐chemical stressors) contribute to the global burden of cardiovascular, metabolic and mental disease. Clinical and epidemiological studies support that traffic‐associated environmental risk factors, air pollution and noise exposure, are associated with a higher risk for cardiovascular disease and significantly contribute to overall mortality. According to the results of the Lancet Commission on pollution and health, up to 9 Mio global annual deaths can be attributed to environmental pollution [Landrigan et al., Lancet 2018]. The numbers will rather increase in the future, because of increasing urbanization and continuous refinement of global exposure‐mortality models, which is supported by the recently reported global all‐cause mortality rate attributable to ambient air pollution by PM2.5 and O3 of 8.79 Mio [Lelieveld et al. and Münzel, Eur Heart J 2019]. Air pollution is obviously the leading health risk factor in the physical environment, followed by water and soil pollution with heavy metals, pesticides, other chemicals and occupational exposures. However, non‐chemical environmental health risk factors such as mental stress, light exposure, climatic changes and traffic noise are so far ignored by global health action plans. Especially for traffic noise‐related health effects there are numerous clinical and epidemiological studies reporting significant impact on cardiovascular disease. In this respect, the “exposome” concept represents a comprehensive description of lifelong exposure history and a rather novel scientific field that is now investigated more systematically. We here provide an in‐depth overview on the health effects of the external exposome, with emphasis on air pollution and traffic noise, and briefly present the actual studies on this topic. In addition, we summarize our previously published experimental research investigating effects of aircraft noise exposure in mice and men providing mechanistic insights on how noise contributes to non‐communicable disease.Support or Funding InformationThe present work was supported by the Boehringer Ingelheim Foundation “Novel and neglected risk factors” (to A.D. and T.M.).The exposome concept. The external exposome represents the sum of all environmental exposures including behavioral/ lifestyle factors. The external exposome (e.g. mental stress and environmental pollution) confer changes of the internal exposome (e.g. altered circadian clock by forward/backward shift, stress hormones, inflammation and oxidative stress) leading to health risks and disease conditions (e.g. atherosclerosis, vascular stenosis and myocardial infarction). BJP, submitted.Figure 1