Selected Environmental Drivers of Cardiovascular Disease: A Narrative Review of Mechanisms and Implications for Population and Public Health
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Abstract
Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. Environmental exposures may contribute to cardiovascular risk beyond established clinical and behavioural risk factors. This review aimed to synthesise evidence on environmental exposures associated with cardiovascular risk, including shared biological pathways, interactions between exposures, population vulnerability, and implications for prevention, public-health policy, and environmental justice.A narrative review informed by a structured literature search was conducted using PubMed, Scopus, and Web of Science for publications from January 2000 to December 2024. Reference lists and selected institutional and technical sources were also examined. Of 642 records identified, 231 duplicates were removed, leaving 411 records for screening; 92 full-text publications were assessed for eligibility. 22 sources met the eligibility criteria and were included in the principal narrative synthesis. Evidence was interpreted according to methodological limitations, consistency across studies, exposure–response relationships, biological plausibility, and convergence between epidemiological and mechanistic evidence. PM2.5 had the strongest and most consistent evidence of cardiovascular harm. Extreme heat and transportation noise showed substantial but context-dependent associations, whereas evidence concerning artificial light at night, persistent chemical pollutants, and microplastics and nano plastics remained heterogeneous or emerging. Shared biological pathways included oxidative stress, systemic inflammation, endothelial dysfunction, autonomic and circadian dysregulation, metabolic dysregulation, and thrombosis. Co-exposures may have additive or interactive effects, although evidence for synergistic effects remains exposure-specific. In Thailand, a modelling study using 2009 exposure data estimated a population-attributable fraction of approximately 14.6% for cardiovascular mortality associated with ambient PM2.5 exposure. Supplementary contextual evidence indicated increasing attention to PM2.5; however, evidence concerning cardiovascular risk awareness, policy effectiveness, health outcomes, and equity remains limited. Cardiovascular prevention in Thailand should consider environmental exposure assessment, protection of vulnerable populations, source-specific exposure reduction, and evaluation of policy effects using cardiovascular and equity outcomes.
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ผู้แต่งที่ตีพิมพ์กับวารสารโรคและภัยสุขภาพ ภาคตะวันออก ประเทศไทย จะต้องยอมรับเงื่อนไขต่อไปนี้ :
ผู้แต่งจะต้องสงวนลิขสิทธิ์และให้สิทธิ์กับวารสารในการตีพิมพ์เผยแพร่บทความ โดยบทความจะถือเป็นลิขสิทธ์ของ สำนักงานป้องกันควบคุมโรคที่ 6 จังหวัดชลบุรี
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