The enemies of the heart and coronary arteries are many and go far beyond the traditional ones, the so-called modifiable risk factors or 'Smurfs' (cholesterol, diabetes, hypertension, smoking). While the 'great classics' are certainly not to be overlooked, it should be considered that at least 15% of heart attack victims do not present any known risk factor. It is therefore necessary to broaden the view and shed light on the new dangers from which to protect ourselves. This is what a review published in the 'European Heart Journal', coordinated by researchers from Fondazione Policlinico Universitario Gemelli Irccs-Catholic University of Rome, attempted to do, in collaboration with prestigious American experts (Deepak Bhatt of Mount Sinai in New York and Sanjay Rajagopalan of Case Western Reserve University in Cleveland).
The study summarizes the main 'new' risks for the heart under the umbrella name of 'exposome'. Among the 'new entries' we must consider pollution (of air, soil, water, exposure to chemical substances), socio-economic and psychological factors (stress, depression, social isolation), but also infectious diseases such as flu and Covid-19, which we deal with heavily every winter. “Although over the years the treatments against traditional risk factors have become increasingly effective and have contributed significantly to reducing the incidence and consequences of ischemic heart disease – underlines Rocco Montone, cardiologist at the Gemelli Intensive Cardiology Unit – this remains the main cause of death in the world. For this reason, attention is broadening from traditional risk factors to everything that surrounds us, to the world in which we are immersed, made up of pollution, viruses, economic and psychological problems which, in turn, can contribute in substantial way to determine and perpetuate the problem of 'ischemic heart disease'”.
“These risk factors – continues Montone – interact in an unpredictable way, often enhancing each other. This is why it is necessary to consider them in their entirety, including them in this new paradigm of the exposome. Our review therefore takes stock of how exposure to long-term exposure to the exposome may contribute to the onset of ischemic heart disease and suggests which potential risk mitigation strategies should be implemented”.
First factor analyzed by experts: environmental pollution. Air pollution (especially PM2.5 or fine particulate matter) alone can reduce life expectancy by 2.9 years (tobacco smoking reduces it by 2.2 years). The Global Burden of Disease (GBD) study estimated that in 2019, 7 million deaths in the world were directly attributable to pollution (4.1 from environmental pollution and 2.3 from domestic pollution). “These deaths from pollution – explains Montone – are caused above all by cardiovascular diseases (cardiac arrest, heart failure, arrhythmias, ischemic strokes and above all heart attacks) and act on various mechanisms. Exposure to polluted air, for example, 'oxidizes' bad cholesterol (LDL), making it more dangerous, and alters the functionality of 'good' cholesterol (HDL), thus making even statins less effective. Acute exposure to PM2.5 coming from diesel vehicle exhausts can cause a sudden rise in blood pressure Atmospheric pollutants can also alter insulin sensitivity and promote the onset of diabetes, through oxidative stress and chronic inflammation; according to the Gbd, up to 22% of cases of type 2 diabetes could be attributed to pollution”.
Other problems come from noise pollution, light pollution and social stress, which by altering stress hormones and circadian rhythms (with sleep deprivation or fragmentation) can worsen oxidative stress and the inflammatory response, leading to endothelial dysfunction, greater aggregability of platelets and thus promoting the appearance of ischemic heart disease. Finally, soil pollution, such as that from heavy metals (cadmium, lead and arsenic), pesticides or plastic particles, can contaminate the water and food we eat, also contributing to the onset of adverse cardiac events. Climate change, which is closely related to pollution, also has a major impact on heart health. “Heat waves – recalls Montone – are increasingly frequent; prolonged exposure to heat has recently been correlated with an increased risk of cardiovascular mortality”.
Mental health should not be underestimated, as it is closely linked to that of the heart. Chronic stress, depression, social isolation and loneliness can be major contributors to cardiovascular disease. Stress causes hyper-activation of the sympathetic nervous system which can lead to arterial hypertension, while the increased production of cortisol from the adrenals can promote insulin resistance and favor the onset of visceral obesity. Finally, stress is often associated with altered lifestyle habits (unhealthy diet, sedentary lifestyle, smoking) which enhance traditional cardiovascular risk factors. Then there is the chapter on infectious diseases. Many respiratory infections such as influenza and Covid-19, but also periodontitis and Helicobacter pylori and Chlamydia infections, are related to an increased cardiovascular risk; they increase systemic inflammation, oxidative stress, platelet activation and can directly damage heart cells (myocytes), the study highlights.
“Treating the exposome to protect the heart – the experts observe – is certainly not as easy as taking pills against cholesterol or blood pressure. And if individual responsibility still has an important place, environmental policy and mitigation actions are also necessary higher. However, it is important to be aware of the risks and contribute, each of us for our part, to the reduction of these risk factors which impact not only on the individual but on the entire community”.
“On the environmental pollution front – suggests Montone – it would be appropriate to speed up the transition from fossil fuels to renewable energy, implement policies to reduce traffic in city centers and promote transport with low or zero emission vehicles. It is also important to rethink cities, avoiding the mixing of industrial and residential areas. While outdoor physical exercise is always advisable, it is important that it is done in green areas, away from traffic. On days with a higher rate of pollution, it may be advisable to wear a mask when going out or staying at home with the windows closed, using air purifiers. Noise pollution is reduced by adopting technologies to reduce transport noise, regulating traffic, encouraging the use of electric vehicles, designing buildings with noise proof, creating green areas that act as a natural 'buffer' of noise.Light pollution can be fought at a public and personal level; in addition to reminding us to turn off the lights, to promote sleep hygiene, it is good to remember to close the shutters or wear an eye mask”. At an international level, the movement to raise awareness of the problem is growing and will celebrate the international 'DarkSky' week ', from 2 to 8 April.
Even at the table we must remember to adopt a diet from sustainable sources, such as the Mediterranean diet; reducing the consumption of red meat is good for personal health and that of the environment. While “on the front of protection from infectious diseases that put the heart at risk”, for Montone “it is important to insist on autumn vaccination campaigns against influenza and Covid-19, promote hand hygiene measures, the sanitisation of surfaces and environments, wear a face mask in closed and crowded places”.
“Although social awareness of the problem is increasing and major cardiovascular guidelines are now taking into consideration the importance of reducing exposure to these new cardiovascular risk factors – comments Filippo Crea, Editor-in-Chief of the European Heart Journal, director of the Center of Excellence for Cardiovascular Sciences at the Isola Tiberina-Gemelli Isola hospital, former full professor of Cardiology at the Catholic University – there is still a long way to go to implement preventive and management strategies. In this context, health workers and public organizations in general should be aware of the need to address this paradigm shift.”
“Finally – concludes Crea – it will be essential to promote further research to study the way in which these emerging risk factors, alone and in combination, influence the integrity of the cardiovascular system. It is important to begin to explore in depth the 'hidden side of moon' because, as demonstrated in a recent epidemiological work published in the 'New England Journal of Medicine', the known risk factors (hypertension
, diabetes, hypercholesterolemia and smoking) explain only half of cardiovascular diseases”.
#smog #mental #health #enemies #heart #defend
