Environmental stressors and cardio-metabolic disease: Part II-mechanistic insights

Thomas Münzel, Mette Sørensen, Tommaso Gori, Frank P. Schmidt, Xiaoquan Rao, Frank R. Brook, Lung Chi Chen, Robert D. Brook, Sanjay Rajagopalan

Research output: Contribution to journalReview articlepeer-review

224 Scopus citations


Environmental factors can act as facilitators of chronic non-communicable diseases. Ambient noise and air pollution collectively outrank all other environmental risk factors in importance, contributing to over 75% of the disease and disability burden associated with known environmental risk factors. In the first part of this review, we discussed the global burden and epidemiologic evidence supporting the importance of these novel risk factors as facilitators of cardiometabolic disease. In this part, we will discuss pathophysiological mechanisms responsible for noise and air pollution-mediated effects. Akin to traditional cardiovascular risk factors, a considerable body of evidence suggests that these environmental agents induce low-grade inflammation, oxidative stress, vascular dysfunction, and autonomic nervous system imbalance, thereby facilitating the development of diseases such as hypertension and diabetes. Through their impact on traditional risk factors and via additional novel mechanisms, environmental risk factors may have much larger impact on cardiovascular events than currently appreciated. In the second part of this review, we discuss deficiencies and gaps in knowledge and opportunities for new research.

Original languageEnglish (US)
Pages (from-to)557-564
Number of pages8
JournalEuropean heart journal
Issue number8
StatePublished - Feb 1 2017


  • Air pollution
  • Atherosclerosis
  • Cardiometabolic disease
  • Cardiovascular risk factor
  • Environment
  • Inflammation
  • Noise
  • Oxidative stress

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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