Air pollution and cardiovascular diseases. Opinion and recommendations of experts from the Prevention and Epidemiology Section of the Polish Cardiac Society.

Air pollution is currently a global health problem. A key component of polluted air includes particulate matter (PM2.5 and PM10), carbon monoxide, nitrogen oxides, sulfur oxides, and volatile organic compounds. According to World Health Organization data, air pollution accounts for one in eight deaths annually (6.7 million deaths worldwide). Poland ranks first, with a rate of 732.82 deaths per one million inhabitants. Air pollution significantly contributes to the development and progression of cardiovascular diseases, including hypertension, acute coronary syndromes, cardiac arrhythmias, heart failure, chronic kidney disease, and stroke. The impact of air pollution on hypertension is associated with endothelial dysfunction, vascular inflammation, and activation of the autonomic nervous system. The populations most at risk are older adults and individuals with diabetes. Air pollution also significantly affects the incidence of acute coronary syndromes through both short- and long-term exposure. A strong correlation has been demonstrated between increased air pollution levels and the risk of ventricular arrhythmias as well as out-of-hospital cardiac arrest. The impact of polluted air on heart failure is bidirectional: it contributes to the progression of risk factors leading to heart failure, while also increasing the likelihood of acute decompensation. In the case of chronic kidney disease, the primary harmful factor is exposure to PM2.5 particles, which cause vascular damage and glomerulosclerosis. There is strong evidence linking smog exposure with an increased risk of ischemic stroke, whereas data regarding hemorrhagic stroke remain limited. There is a clear need to develop recommendations for healthcare systems, both to improve monitoring and to implementpreventive strategies. Such recommendations should include medical documentation standards, guidance on minimizing exposure to polluted air, individualized counseling for patients, as well as group and telephonic counseling. Implementing such measures may help reduce patient exposure and its associated health risks.