Impact of air pollution and noise exposure on cardiovascular disease incidence and mortality: A systematic review

Background: The relationship between environmental pollutants, specifically air pollution and noise, and cardiovascular disease is well-recognized. However, their combined effects on cardiovascular health are not fully explored. Objectives: To review evidence on the correlation between air pollution and noise exposure and cardiovascular disease incidence and mortality. Methods: Following the PRISMA 2020 guidelines, we identified relevant studies through multiple databases and snowballing. We focused on studies published between 2003 and 2024. Studies were selected based on a PEOS framework, with a focus on exposure to air pollution or noise and clinical cardiovascular outcomes and evaluated for bias using the ROBINS-E tool. Results: A total of 140 studies met our inclusion criteria. Most studies suggested a consistent association between long-term exposure to air pollutants and an increased risk of cardiovascular diseases, notably ischemic heart disease and stroke. While air pollution was often studied in isolation, the interaction effects between air pollution and noise exposure were less commonly investigated, showing mixed results. The majority of these studies were conducted in Western countries, which may limit the generalizability of the findings to global populations. No studies were found to use time-updated confounders, despite the long durations over which participants were followed, which could influence the accuracy of the results. Moreover, none of the studies incorporated both residential and occupational addresses in exposure assessments, suggesting a need for future studies to include these multiple exposure points to improve measurement precision and accuracy. Conclusion: Air pollution exposure is increasingly linked to cardiovascular disease risks. Although individual air pollution and noise exposures are recognized as significant risk factors, the combined interaction between these exposures needs further exploration. Registration: PROSPERO (CRD42023460443).