Environmental Cardiology: Getting to the Heart of the Matter

Cardiovascular disease (CVD) is the leading killer in many developed countries, and is soon expected to be the leading killer in all countries. A number of factors have raised CVD to this unsavory stature, among them lack of exercise, poor diet, and smoking. But evidence has slowly been building to indicate that exposures to chemicals and other environmental substances also can have a profound impact on heart health.

 The link between environmental agents and CVD was once considered tenuous by much of the medical and scientific establishment. But after watching the evidence accumulate over the years, with a surge in the past five years, more and more scientists, doctors, and organizations are acknowledging the importance of a field that some are calling environmental cardiology.

One group that is beginning to embrace environmental cardiology is the American Heart Association (AHA), an 80-year-old organization that has traditionally focused on risk factors such as poor diet and lack of exercise as some of the most important contributors to CVD.

 In the 1 June 2004 issue of Circulation, an expert panel of 11 researchers and physicians published an AHA Scientific Statement that concluded that air pollutants, one of the major environmental exposure sources under investigation by environmental cardiologists, pose a “serious public health problem” for CVD. This is the first official AHA acknowledgment of such links.

The group’s decision was based on the breadth and depth of the accumulating information. “There was no single major study that prompted the writing of this paper,” says Sidney Smith, past president of the AHA and a professor of medicine at the University of North Carolina at Chapel Hill. “It was the gathering body of evidence that connected air pollution with cardiovascular diseases, extending well beyond cigarette smoke.”

The AHA paper was a very positive development in the eyes of some of the researchers who have been involved in the field for many years. “That’s pretty amazing,” says C. Arden Pope III, an environmental epidemiologist at Brigham Young University. “It’s taken the research out of the fringes and made it part of the mainstream.”

Less than two months after the release of the AHA statement, the U.S. Environmental Protection Agency (EPA) gave a clue to how seriously it takes this issue, awarding the largest scientific research grant in its history, $30 million, to study links between air pollution and CVD.

The research team will be headed by associate environmental and occupational health professor Joel Kaufman of the University of Washington, and includes scientists from nine other universities and medical centers.

A few other government agencies, such as the National Heart, Lung, and Blood Institute (NHLBI), have also begun to address the links between environmental agents and CVD, as have advocacy organizations such as the American Lung Association and the Natural Resources Defense Council. And the NIEHS, one of the original players in the environmental cardiology arena, has ramped up its efforts to explore this area of research.

There is still a ways to go before environmental cardiology is fully embraced as a medical paradigm. Many major public health organizations, such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), have yet to fold this concept into their prevention efforts in any significant way. And there is very little trickle-down into the typical doctor–patient relationship.

Nonetheless, environmental cardiology shows signs of increasingly becoming a factor in research, public policy discussion, and pollutant regulation, as its presence spreads into journals, conferences, textbooks, e-mail discussion groups, and continuing medical education courses. Even The Weather Channel is getting into the act with a new feature that advises viewers on daily levels of pollutants that can affect heart health.