Researchers Link Pollution to Cardiovascular Disease, Develop Strategies to Reduce Exposure and Encourage Government Intervention

CLEVELAND–In a new review article, published today in The New England Journal of Medicine, researchers from University Hospitals (UH), Case Western Reserve University and Boston College discuss evidence linking pollution and cardiovascular disease. The research team highlights strategies for reducing individual exposure to pollution, and the importance of government-supported interventions encouraging clean energy.

The researchers note that pollution was estimated to be responsible for nine million deaths worldwide in 2019, 5.1 million of which were due to cardiovascular disease. They explain that while these numbers are high, they likely undercut the full contribution of pollution to the global burden of cardiovascular disease, as they are based on a subset of known environmental risk factors. Attribution of health effects to pollutants can be complex, given their ubiquitous presence in the environment and the expanding list of chemicals associated with human health effects.

“Until now, prevention of cardiovascular diseases has focused almost exclusively on individual behavioral and metabolic risk factors,” said Sanjay Rajagopalan, MD, chief of cardiovascular medicine and the Herman K. Hellerstein, MD, Chair in Cardiovascular Research at UH Harrington Heart & Vascular Institute, and director of the Case Cardiovascular Research Institute at the Case Western Reserve School of Medicine. “Pollution reduction has received scant attention in programs for cardiovascular disease control and has been largely absent from guidelines.”

Philip J. Landrigan, MD, MSc, FAAP, Director of the Program for Global Public Health and the Common Good, Director of the Global Observatory on Pollution and Health, and Professor of Biology at the Schiller Institute for Integrated Science and Society at Boston College collaborated with Dr. Rajagopalan on the review. The researchers emphasize that their overarching goal is to persuade all physicians of the importance of considering pollution as a risk factor when working with their patients to prevent and control cardiovascular disease.

The article provides an overview of the cardiometabolic health effects of pollutants for physicians, and outlines strategies for reducing pollution exposure. The researchers explain that the first step in preventing pollution-related cardiovascular disease is to emphasize the role of pollution in disease prevention programs, medical education and clinical practice, and acknowledge that pollution is a major, potentially preventable risk factor for cardiovascular disease.

The article also addresses the direct link between environmental pollutants like air pollution and contribution to climate change. This is especially important given that this paper comes at the heels of the 26th UN Climate Change Conference (COP 26) in Glasgow, Scotland.

“One of the important takeaways from COP26 is that the efforts to cut emissions, adapt to climate threats and deal with health problems are often carried out independently,” emphasized Dr. Rajagopalan. “By keeping the focus on health effects of pollutants, many of which are exacerbated by and contribute to climate change, there is a much higher chance of engagement by stakeholders.”

The researchers note many ways in which individual physicians can bring the environmental lens to their patients.

“Physicians can qualitatively assess exposure risk in patients when relevant, assess individual susceptibility, and provide guidance on pollution avoidance,” said Dr. Rajagopalan. “Patients at very high risk, for instance, include individuals with pre-existing atherosclerotic cardiovascular disease, diabetes or chronic kidney disease, or individuals in special demographic categories including the elderly and transplant recipients.”

The team explains that physicians can take collective action through professional societies to persuade elected officials to reduce pollution levels for all patients across the United States. They emphasize that the most effective of these actions will be a massive, rapid shift away from fossil fuels to clean, renewable energy, with the added benefit of slowing the rate of climate change.

Prevention of pollution-related cardiovascular disease through a large-scale transition from fossil fuels to clean, renewable energy will not only reduce cardiovascular disease and associated deaths, but also benefit humanity by slowing the rate of climate change. The research team concludes that the global epidemic of cardiovascular disease can only be contained through a multipronged strategy that combines pollution prevention with control of individual risk factors.


Rajagopalan, S. and Landrigan, P. “Pollution and the Heart.” The New England Journal of Medicine. DOI: 10.1056/NEJMra2030281.

About University Hospitals / Cleveland, Ohio Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 23 hospitals (including 5 joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Oxford University and the Technion Israel Institute of Technology. The main campus also includes the UH Rainbow Babies & Children’s Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women’s Hospital, Ohio’s only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit

Case Western Reserve University is one of the country’s leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 5,800 undergraduate and 6,300 graduate students comprise our student body. Visit to see how Case Western Reserve thinks beyond the possible.