A systematic review of the impact of Air pollution on heart failure

Abstract

Background: Heart failure (HF) is a major global health issue, characterized by high rates of morbidity and mortality. Environmental factors, particularly air pollution, have been implicated in exacerbating HF risk. However, the extent and consistency of these associations across various pollutants and exposure durations remain unclear. This systematic review and meta-analysis aim to synthesize the evidence on the relationship between air pollution exposure and HF outcomes, focusing on short- and long-term effects.
Methods: A systematic search of major databases was conducted to identify studies examining the impact of air pollutants, including particulate matter (PM2.5, PM10) and gaseous pollutants (NO₂, SO₂, CO, O₃), on HF incidence, hospitalization, or mortality. Eligible studies were analyzed using a random-effects model, and subgroup analyses were performed to explore variations by geographic region, study design, and exposure metrics. Sensitivity analyses assessed the robustness of the results, and risk of bias was evaluated using standardized criteria.
Results: The review included 100 studies spanning diverse geographic and demographic contexts. Both short- and long-term exposures to particulate matter and nitrogen dioxide were consistently associated with increased HF risk, with stronger effects observed for chronic exposures. The findings highlighted notable geographic disparities, with populations in low- and middle-income countries exhibiting higher susceptibility to air pollution-related HF compared to those in high-income regions. No significant association was found for ozone exposure.
Conclusions: Air pollution, particularly exposure to particulate matter and nitrogen dioxide, is a significant risk factor for HF. The results emphasize the urgent need for interventions aimed at improving air quality, especially in regions with severe pollution. Policymakers and public health initiatives must prioritize strategies to mitigate environmental contributors to HF while addressing regional and socioeconomic disparities. Further research is needed to clarify the long-term impacts of certain pollutants and identify vulnerable subgroups.