Special Publications in ESC, AHA, ACC and WHF
MARKOPOLO researcher Prof. Dr. Thomas Münzel coordinated a position paper on environmental exposures and cardiovascular health that was published in the journals of four leading cardiovascular societies in parallel: European Society of Cardiology, American Heart Association, American College of Cardiology and World Heart Federation.
- Environmental stressors and cardiovascular health: acting locally for global impact in a changing world. Münzel T, Lüscher T, Kramer CM, Churchwell K, Mbakwem A, Rajagopalan S.
Eur Heart J. 2026 Jan 20:ehaf915. doi: 10.1093/eurheartj/ehaf915. - Environmental Stressors and Cardiovascular Health: Acting Locally for Global Impact in a Changing World: A statement of the European Society of Cardiology, the American College of Cardiology, the American Heart Association, the World Heart Federation. Münzel T, Lüscher T, Kramer CM, Churchwell K, Mbakwem A, Rajagopalan S.
Glob Heart. 2026 Jan 20;21(1):3. doi: 10.5334/gh.1514. - Environmental Stressors and Cardiovascular Health: Acting Locally for Global Impact in a Changing World: A statement of the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the World Heart Federation. Münzel T, Lüscher T, Kramer CM, Churchwell K, Mbakwem A, Rajagopalan S.
J Am Coll Cardiol. 2026 Jan 20:S0735-1097(26)00078-1. doi: 10.1016/j.jacc.2026.01.015. - Environmental Stressors and Cardiovascular Health: Acting Locally for Global Impact in a Changing World: A Statement of the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the World Heart Federation. Münzel T, Lüscher T, Kramer CM, Churchwell K, Mbakwem A, Rajagopalan S.
Circulation. 2026 Feb 24;153(8):597-604. doi: 10.1161/CIRCULATIONAHA.125.079034.
Short description:
Non-communicable diseases (NCDs) are responsible for nearly 70% of global deaths, claiming over 38 million lives annually, with cardiovascular disease (CVD) as the leading cause. While traditional risk factors remain important, it is no longer scientifically or politically defensible to ignore the decisive role of environmental risk factors (ERFs) in driving this global health crisis.
ERFs, largely man-made and preventable, include air pollution, transportation noise, artificial light at night, plastic and chemical contamination, and the escalating impacts of climate change such as heatwaves, wildfires, floods, and desert dust events. These exposures do not act in isolation but as a cumulative, synergistic exposome, amplifying cardiovascular risk across the life course. Urbanization has transformed large parts of the world into high-risk exposure zones, disproportionately affecting vulnerable populations who contribute least to environmental degradation yet bear the greatest health burden. This is not merely a public health issue, it is a matter of environmental injustice and policy failure. Crucially, the majority of these exposures are modifiable through political action. Evidence from clean air policies and urban redesign demonstrates that regulatory interventions can rapidly reduce cardiovascular morbidity and mortality at the population level. Yet, current policy responses remain fragmented, insufficient, and too slow.
Addressing ERFs requires decisive, upstream policy measures targeting the sources of exposure, transport, energy, industry, agriculture, and urban planning—rather than downstream treatment of disease. This includes enforceable standards for air quality, noise reduction, chemical regulation, and climate mitigation, alongside health-centered urban design and resilient infrastructure.
In an era of increasing climate instability and cascading environmental crises, inaction is no longer a neutral option, it is a driver of preventable disease and death. Integrating environmental and planetary health into cardiovascular prevention strategies must become a core mandate for health systems, governments, and international institutions. Reducing the global burden of CVD will not be achieved by medical care alone. It requires political courage, cross-sector collaboration, and binding international commitments to tackle the root environmental determinants of health.
The science is clear — the remaining question is whether policy will follow.
