Cardiovascular and Planetary Health: Two Sides of the Same Planet.
Cardiovascular and Planetary Health: Two Sides of the Same Planet.
复制标题
心血管和行星健康：同一个星球的两侧。
DOI：
10.1161/circulationaha.123.065486
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发表时间：
2024
期刊：
影响因子：
37.8
通讯作者：
Brook,RobertD
中科院分区：
文献类型：
--
作者：
Rajagopalan,Sanjay;Brook,RobertD
人类福祉与地球福祉相互依存的确凿证据要求我们从根本上转变观念，不再相信个人健康与地球健康是截然不同和可分离的。相反，我们现在面临的现实是，个人和地球的福祉是相互依存的，环境和社会制度发挥着关键作用。全球疾病负担研究人员估计，每年有920万人死于已知的环境污染物，其中一半以上仅由心血管原因引起，包括心肌梗死，中风和心力衰竭。1-3因此，暴露于环境污染本身就是全球心血管疾病的一个非常重要的风险因素。重要的是要注意，污染对健康（如代谢，精神，癌症和其他系统）的全部公共健康影响很难完全描述，而且可能比估计的要大得多。个人健康和地球健康之间的关系最好通过“拉沃斯甜甜圈”的比喻来形象化，它结合了两个同心圆，描绘了保护人类健康的社会和生态边界。基于资源开采和消费的日益陈旧的社会环境基础设施系统已经导致了对多个地球边界的超越，并具有讽刺意味地影响了心血管结局的进一步改善。从这个角度来看，回到拉沃斯甜甜圈内行星健康的安全空间应该被认为是一个生存的必要条件，可能是改善人类健康的最大机会之一。这篇简短的评论旨在强调地球和人类健康之间不可分割的联系以及改善两者的潜在机会。主要来自化石燃料燃烧的空气污染是“人类世时代”的主要人为因素之一，“人类世时代”被定义为人类活动开始改变地球生态系统的时代。空气污染每年造成的死亡人数超过所有战争、疟疾、结核病、艾滋病毒和其他传染病的总和，其中一半以上是心血管疾病。2来自动物和人类研究的有力证据已经阐明了空气污染诱导的心血管效应的机制，这些效应通过涉及血液动力学、炎症和血栓形成因子的多种途径介导。4大量证据也表明，空气污染与传统风险因素本身的发病机制有关，最明显的是高血压和糖尿病。这种令人印象深刻的证据基础将空气污染与心血管疾病联系起来，无疑是由于一种简单、可量化和可扩展的空气污染指标的可用性，即≤ 2.5微米的颗粒物质量表示为每立方米环境空气中的微克数。尽管其化学性质和来源具有内在的复杂性，但使用区域监测器对≤ 2.5微米的颗粒物进行测量，并最终使用来自卫星数据的增强信息以1× 1公里网格覆盖全球大部分表面，从而可以推导出综合响应暴露函数和全球负担估计数。尽管存在一些局限性，但这种替代品在2024年美国心脏协会庆祝其成立100周年时取得了巨大成功。本文是由国际思想领袖撰写的整个AHA期刊系列的一部分，涉及心脑血管研究和护理的过去，现在和未来。要了解完整的百年收藏，请访问https：//www. ahajournals。组织/百年纪念
Unassailable evidence for the interdependence of human and planetary well-being necessitates a fundamental shift away from believing that one’s personal health is distinct and separable from that of the planet. Rather, we are now confronted with the reality that personal and planetary welfare are interdependent, with the environment and social systems playing critical roles. The Global Burden of Disease investigators estimates that 9.2 million deaths per year are attributable to known environmental pollutants, with more than half resulting from cardiovascular causes alone, including myocardial infarctions, strokes, and heart failure. 1–3 Exposure to environmental pollution alone is thus a singularly important risk factor for cardiovascular disease worldwide. It is important to note that the full public health effect of pollution on health (eg, metabolic, mental, cancers, and other systems) is difficult to fully characterize and is likely much larger than estimated. The relationship between personal and planetary health is best visualized through the analogy of the “Raworth Donut” which combines 2 concentric circles to depict the social and ecological boundaries that ensconce human health. 1 An increasingly archaic social-environmental-infrastructural system based on resource extraction and consumption has already resulted in the transgression of multiple planetary boundaries and ironically impinges on further improvements in cardiovascular outcomes. Seen in this light, returning to the safe space of planetary health within the Raworth Donut should be considered an existential imperative and may be one of the greatest opportunities to improve human health. This brief review aims to highlight the inextricable connection between planetary and human health and the potential opportunities to improve both. Air pollution, derived principally from fossil fuel combustion, is one of the key man-made factors that characterizes the “Anthropocene epoch,” defined as when human activity has begun to alter the Earth’s ecosystem. Air pollution contributes to more deaths per year than all wars, malaria, tuberculosis, HIV and other infectious disease combined, more than half of which are of cardiovascular origin. 2 Robust evidence from animal and human studies has elucidated the mechanisms of air pollution–induced cardiovascular effects, which are mediated through diverse pathways involving hemodynamic, inflammatory, and thrombotic factors. 4 An abundant body of evidence also implicates air pollution in the pathogenesis of traditional risk factors per se, most notably hypertension and diabetes. This impressive evidence base linking air pollution with cardiovascular disease was undoubtedly facilitated by the availability of a simple, standardizable, and scalable metric of air pollution, the mass of particulate matter≤ 2.5 microns expressed as the micrograms per cubic meter of volume of ambient air. Despite the intrinsic complexity of its chemistry and sources, the measurement of particulate matter≤ 2.5 microns using regional monitors, and eventually covering most of the global surface in 1× 1 km grids using augmented information from satellite data, has allowed the derivation of integrated response exposure function and global burden estimates. Despite some limitations, this surrogate has been highly successful inThe American Heart Association celebrates its 100th anniversary in 2024. This article is part of a series across the entire AHA Journal portfolio written by international thought leaders on the past, present, and future of cardiovascular and cerebrovascular research and care. To explore the full Centennial Collection, visit https://www. ahajournals. org/centennial