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This chapter discusses environmental threats to cardiovascular disease (see accompanying Hurst’s Central Illustration). Many cardiovascular conditions have been linked to environmental exposures. In air pollution, particulate matter has been associated with hypertension, atherosclerosis, acute myocardial infarction, arrhythmias, stroke, and cardiac mortality, and carbon monoxide has been linked to ischemic heart disease and heart failure. Exposure to metals, including lead, cadmium, mercury, arsenic, cobalt, and thallium, is associated with hypertension, atherosclerosis, stroke, coronary heart disease, myocardial infarction, cardiomyopathy, heart failure, arrhythmias, peripheral vascular disease, and cardiac death. Halogenated hydrocarbons, including halogenated alkanes and solvents, are associated with arrhythmias, coronary heart disease, ischemic heart disease, cardiomyopathy, hypertension, degenerative arteritis, and cardiac death. Exposure to organophosphate insecticides has been linked to arrhythmias and sudden cardiac death. Nitrate exposure has been strongly associated with angina, myocardial infarction, and cardiovascular death, and exposure to carbon disulphide is linked to hypertension and atherosclerosis. Additionally, chronic exposure to noise is associated with increased risk for hypertension, and subsequent risk for myocardial infarction and stroke. Finally, the increased surface temperatures related to global climate change are expected to increase death from heart disease and stroke. Given the widespread exposure of the general population to multiple potential environmental threats, every physician is advised to obtain a brief history of occupational and environmental exposure from every new patient and to follow up in more detail if suspicious of toxic exposure.

eFig 110-01

Cardiovascular disease linked to environmental exposures.


People in today’s ever more densely populated, tightly interconnected, highly urbanized and warming world are surrounded by a complex array of environmental threats to health that include air pollution, water pollution, toxic chemicals, changing dietary patterns, emerging infectious diseases, the urban built environment, noise, and global climate change. Numerous etiologic associations have been established between environmental exposures and disease, including cardiovascular disease.1

Pollution is the single most important environmental cause of disease and death.2,3 The World Health Organization estimates that household air pollution causes 4.3 million deaths annually in persons of all ages4,5; many of these deaths are due to heart disease and stroke.6 Ambient air pollution causes 3.7 million deaths,7 and many are due to heart disease and stroke. Polluted drinking water, poor sanitation, and inadequate hygiene cause 842,000 deaths.8 Polluted dust and soil at active and abandoned mines, smelters, industrial facilities, and hazardous waste sites kill tens of thousands more.9

Toxic chemicals in the environment are significant causes of disease, specifically cardiovascular disease.2 Substances known to be cardiotoxic and reviewed in this chapter include air pollution2,3; metals,9 including lead, mercury, arsenic, cobalt, and thallium; halogenated hydrocarbons, including chlorinated, brominated, and fluorinated compounds; organophosphate insecticides; nitrates; and carbon disulfide. Diseases of the heart and cardiovascular system that are linked to ...

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