title: Environmental stressors and cardio-metabolic disease: part II-mechanistic insights.
abstract: 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.
authors.affiliation: Center for Cardiology, Cardiology I, Angiology and Intensive Care Medicine, University Medical Center Mainz and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Sørensen
authors.affiliation: Center for Cardiology, Cardiology I, Angiology and Intensive Care Medicine, University Medical Center Mainz and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gori
authors.affiliation: Center for Cardiology, Cardiology I, Angiology and Intensive Care Medicine, University Medical Center Mainz and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Schmidt
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland Medical Center, 110 South Paca Street, Suite 7-100, Baltimore, MD 21201, USA.
authors.forename: Xiaoquan
authors.initials: X
authors.lastname: Rao
authors.affiliation: Air Quality Research Division, Environment and Climate Change Canada, Toronto, Canada.|Processes Research Section Environment and Climate Change Canada, Canada.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Brook
authors.affiliation: Department of Environmental Medicine, New York University, New York, USA.
authors.forename: Lung Chi
authors.initials: LC
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland Medical Center, 110 South Paca Street, Suite 7-100, Baltimore, MD 21201, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rajagopalan
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D000818:Animals; D002318:Cardiovascular Diseases / Q000209:etiology*; D004195:Disease Models, Animal; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D008659:Metabolic Diseases / Q000209:etiology*; D009624:Noise, Transportation / Q000009:adverse effects*; D052638:Particulate Matter / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D052638:Particulate Matter
keywords: Air pollution; Atherosclerosis; Cardiometabolic disease; Cardiovascular risk factor; Environment; Inflammation; Noise; Oxidative stress