Although most of the risk factors for cardiovascular diseases (CVD) are avoidable and known, this group of pathologies continues to be the main cause of mortality in Spain, above cancer and circulatory diseases, and affects around 10% of the population. Specifically, the latest data from the National Institute of Statistics determine that in 2021 around 120,000 people lost their lives due to cardiovascular disease, compared to 113,000 deaths attributable to cancer or around 36,000 related to chronic respiratory diseases, which In the case of diseases of the circulatory system, it represents 26.4% of the total, and a rate of 251.8 deaths per 100,000 inhabitants.
The data across the European Union are just as disheartening, with cardiovascular disease once again the leading cause of mortality, responsible for nearly two million deaths a year. And the same thing happens on a global level. The latest report from the World Heart Federation (WHF) indicates that more than 500 million people around the world continue to be affected by cardiovascular diseases, which accounted for 20.5 million deaths in 2021, about a third of the total, with ischemic heart disease and strokes as the main associated causes.
The report also highlights the fact that, although mortality has increased in recent decades, rates by age have decreased – especially in high-income countries compared to middle- and low-income countries, and with disparate results. depending on sex or socioeconomic level–, which indicates that progress is being made in the prevention and treatment of these pathologies, but not in an equitable way.
In the progression of cardiovascular disease, risk factors play a primary role. Among them, in recent years, environmental issues have gained visibility, such as “air, water and soil pollution, exposure to chemical products, climate change and ultraviolet radiation,” point out the World Health Organization. Health (WHO). Specifically, WHO estimates in 2019 attributed 4.2 million premature deaths worldwide due to exposure to fine particulate matter to air pollution, with cardiovascular disease as the most common cause.
37% of these deaths were due to ischemic heart disease and stroke, 18% to chronic obstructive pulmonary diseases, 23% to acute respiratory infections, and 11% to airway cancer. Already in 2019, the study “Taking a Stand Against Air Pollution – The Impact on Cardiovascular Disease”, carried out by the WHF, the American College of Cardiology, the American Heart Association and the European Society of Cardiology, showed similar data. With an estimate of 3.3 million deaths attributable to air pollution, of the 6.7 total caused by cardiovascular diseases, the document placed poor air quality as the fourth highest mortality risk factor, only by behind hypertension, smoking and poor diet.
The latest WHF report considers similar figures: 4.8 million deaths in the world are associated with poor air quality. In Europe, notes the European Environment Agency (EEA), “emissions of many air pollutants have been significantly reduced over recent decades, with a consequent improvement in air quality throughout the region.
However, concentrations of air pollutants remain very high and air quality problems persist.” In fact, they warn, around 90% of the urban population of the European Union is exposed to concentrations of atmospheric pollutants at high levels considered harmful to health, such as fine particles (PM2.5) present in the atmosphere. , which are estimated to reduce life expectancy in the EU by more than eight months. And they also recognize that air pollution is the greatest environmental risk to health in Europe.
Faced with this reality, the Spanish Society of Cardiology and the Spanish Heart Foundation created the SEC-FEC Verde project in 2022, a working group specialized in environmental cardiology that aims to “reduce the morbidity and mortality of cardiovascular diseases related to pollution through study and development of specific preventive and therapeutic strategies to minimize the harmful influences of environmental pollution, including supporting sustainable urban environments.”
When we talk about air pollution, they clarify from the website of the Ministry for the Ecological Transition and the Demographic Challenge, suspended matter (PM) is the most dangerous for health. Specifically, those with a diameter equal to or less than 10 microns, known as PM10, since they can penetrate the body through inhalation; and those of smaller size (2.5 microns in diameter, or less -PM2.5-) that can even reach the lung alveoli, which allows them to carry harmful substances to very sensitive areas and aggravate pathologies that can even lead to a early death.
Likewise, they add, the effect is potentially more dangerous if we refer to the particles known as ultrafine, with a diameter less than 0.1 microns, which can reach the blood flow and affect various organs, the central nervous system and the reproductive system. among others. According to the National Inventory of Polluting Emissions into the Atmosphere, the most influential source of atmospheric pollution due to this type of particles comes from combustion in non-industrial sectors, both for PM10 and PM2.5, followed by road traffic (in the case of PM10) or agriculture (PM2.5). In Spain, they detail, “high levels of PM10 are recorded in areas of very diverse typology, in cities, in some industrial areas and even rural areas, because the distribution of sources of particle emission is very complex, since they can come from from road traffic (both engine emissions, brake wear and road surface erosion), mining, industry, domestic and residential emissions, mineral dust of African origin, or marine spray, among others.”
In fact, the analyzes carried out by the SEC-FEC Verde determined in 2022 that all Spanish autonomous communities exceeded the average annual concentration of PM2.5 recommended by the WHO during the last decade. Although these levels had decreased between 2010 and 2020 (except in the Canary Islands, Murcia and La Rioja), the downward revision (to 5 micrograms/m3) of the annual concentration limit value recommended by the WHO in its latest guidelines It made all the communities overcome it. Regarding PM10, only in the Canary Islands and Galicia did the average annual concentration of these particles increase, although only Extremadura, Navarra and Aragon were below the limit recommended by the WHO, which, in the case of PM10, is 15 micrograms. /m3.
Beyond the relationship between air quality and cardiovascular health, the SEC-FEC Verde group warned in June, on the occasion of World Environment Day, of the influence that noise can have on the health of the population, which, According to the WHO, it can be considered the second environmental cause of health problems, only behind air pollution and suspended particles. The European Environment Agency (EEA) also recognizes this risk, and estimates that there are “12,000 premature deaths caused each year in Europe due to noise pollution and 48,000 new cases of ischemic heart disease”, 1,300 in Spain.
The relationship between noise and cardiovascular health is explained by the ability of this type of sound to increase heart rate, blood pressure and levels of cortisol, the main stress hormone, which in turn favors a low-intensity inflammatory state that, maintained over time, can increase the development of cardiovascular disease. “Noise has a significant impact on cardiovascular health. Numerous studies have shown that chronic exposure to noise, especially traffic noise, is associated with an increased risk of cardiovascular disease. A study conducted in the United Kingdom was recently published in which long-term exposure to road traffic noise was related to a higher incidence of primary hypertension over an average follow-up of eight years. This effect was also more important in the presence of greater air pollution,” explained Dr. Violeta Sánchez, coordinator of the SEC-FEC Verde Group.
The main sources of noise pollution include roads, railways, airports and industrial activity, with road traffic being the most important of all. In Spain, this type of pollution affects five million people who are exposed to noise levels greater than or equal to 55db, a figure that marks the limit established by the EU Environmental Noise Directive. In this regard, the WHO sets the limits at 53 db during the day and 45 at night, considering that the harmful effects associated with noise occur even below these thresholds.
