Common sources of air pollution cut across many sectors and include residential energy for cooking and heating, vehicles, power generation, agriculture/waste incineration, and industry. Exposure to smoke from cooking fires causes 3.8 million premature deaths each year, mostly in low- and middle-income countries. Burning fuels such as dung, wood and coal in inefficient stoves or open hearths produces a variety of health-damaging pollutants, including particulate matter (PM), methane, carbon monoxide, polyaromatic hydrocarbons (PAH) and volatile organic compounds (VOC). Burning kerosene in simple wick lamps also produces significant emissions of fine particles and other pollutants.

Air pollution is a complex and dynamic mixture of numerous compounds in gaseous and particle form, originating from diverse sources, subject to atmospheric transformation and varying over space and time. Three common air pollutants, particulate

matter (PM), ozone and nitrogen dioxide (NO2), are the focus of most monitoring programs, communication efforts, health impact assessments, and regulatory efforts.

Evidence for impacts on cardiovascular disease is most consistent for particulate matter, which is responsible for the vast majority of the disease burden via its impacts on ischemic heart disease, and stroke, as well as lung cancer, COPD, lower respiratory infections, Type 2 diabetes, pregnancy outcomes and related infant mortality. Ozone is mainly associated with exacerbation of respiratory disease, with COPD incidence and mortality and with metabolic effects. NO2 is often used as an indicator of traffic-related air pollution. Chronic exposure to NO2 is associated with incident childhood asthma while short-term variability is associated with exacerbation of asthma and increased daily mortality counts.

The World Heart Federation is committed to reducing the impact of air pollution on people’s health and we have made it a priority area in our global advocacy efforts. We are taking action in three key areas to address the issue of air pollution and CVD: research, advocacy, and education.

Just as it affects all systems of the body, air pollution requires a multi-system and multi-sectoral response. The health sector as a whole, which bears the impact of air pollution, can provide much-needed support for ministries of environment, energy, and transportation, which are traditionally responsible for mitigation efforts. The World Heart Federation is advocating for senior decision-makers in national, regional and global governmental institutions to make air pollution related heart disease a priority and to identify interventions to reduce air pollution and its impact on NCDs.

Yet while structural actions to mitigate pollution emissions are ultimately necessary to reduce harmful exposures, health care providers can play several important roles before such mitigation is achieved. First, clinicians can advocate for air pollution mitigation as a health measure. Second, clinicians can provide patients with personal measures to reduce exposures and associated risk at the individual level. And finally, health care providers can integrate air pollution into disease management approaches. Through its Air Pollution Expert Group, WHF is working with the WHO to increase the development and use of clinical guidelines and toolkits on air pollution and cardiovascular disease to ensure its Members are equipped to counsel their patients on the risks of air pollution, while also supporting educational and policy initiatives to reduce air pollution exposure.