Chronic eutrophication and turbidity are critical detrimental factors impacting coral reef ecosystems, adversely affecting their ecological functions, services, benefits, and resilience across multiple spatial scales and over prolonged periods of time. Inadequate land use practices and lack of appropriate sewage treatment can adversely contribute to increase land-based source pollution (LBSP) impacts in coastal waters and to magnify impacts by sea surface warming trends associated to climate change. Fringing coral reefs off Vega Baja, Puerto Rico, support extensive remnant patches of Elkhorn coral Acropora palmata (Lamarck 1816), which was listed in 2006 as a threatened species under the US Endangered Species Act. Chronic impacts by LBSP have significantly affected local downstream fringing reefs. We characterized the spatial extent of a water quality stress gradient across 12 reefs along the Vega Baja coast through monthly measurements of multiple physico-chemical parameters. Most parameters, particularly PO4, , chlorophyll-a, and the concentration of optical brighteners (OABs), showed a statistically significant increase (PERMANOVA, p 4, , and chlorophyll-a, exceeded recommended concentrations for coral reef ecosystems by factors of 7 - 50 times, 600 - 1240 times, and 17 - 83 times, respectively, depending on the source of the effluents and the distance from sewage pollution sources. Also, water turbidity exceeded 4 - 10 times the recommended value for pristine coral reefs. Coral reefs showed significant decline in close proximity to the polluted zone, showing a significantly different benthic community structure (PERMANOVA, p i.e., macroalgae, algal turf) and bare substrate. Percent coral cover and abundance of A. palmata, showed a significant increase with distance. Coral species richness, species diversity index, and the variance in taxonomic distinctness were very low on reef patches adjacent to the polluted zone, increased at a moderate distance with increasing coral cover and co-existence of multiple species, and declined far from the pollution source due to dominance exerted by A. palmata. This study suggests that chronic LBSP resulted in a major decline of one of the largest and most dense remnant stands of A. palmata across the northeastern Caribbean and that nutrient and chlorophyll-a concentrations were unsustainable for coral reefs. This situation requires immediate solution to prevent further damage to these unprecedented resources. It further suggests that chronic LBSP may synergistically magnify sea-surface warming impacts driving corals to an increased state of risk in face of forecasted climate change impacts. Actions to mitigate and adapt to climate change impacts on coral reefs must require a priori controls of LBSP to be effective.