TY - JOUR T1 - Air pollution and cardiovascular risk: is it time to change guidelines? JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2022-001961 VL - 9 IS - 1 SP - e001961 AU - Marco Bernardi AU - Giuseppe Biondi-Zoccai AU - Francesco Versaci Y1 - 2022/06/01 UR - http://openheart.bmj.com/content/9/1/e001961.abstract N2 - “One must be a sea, to receive a polluted stream without becoming impure.” Friedrich Nietzsche, Thus Spoke ZarathustraEnvironmental pollution is a great challenge of our times that has been neglected for too long, despite its ongoing worsening and established adverse impact on health. The Global Burden Disease (GBD) study estimated that 9 million people died worldwide due to pollution in 2019, in most cases because of cardiovascular disease.1 Realistically, health implications of the totality of all forms of pollution—the so-called pollutome—are even more remarkable.2Among heterogeneous air pollutants, particulate matter (PM) plays a major and well-established detrimental role in human health and disease, in general, especially cardiovascular disease, mainly when its diameter is equal or less than 2.5 µm (PM2.5).3 4 Particles of this size may reach the alveolocapillary barrier, enter the systemic circulation and activate pathogenetic patterns such as inflammation, oxidative stress and dysregulation of the autonomic nervous system.5 All of these effects can, for instance, increase plaque progression and favour its rupture and coronary instability.6 Even short-term changes in levels of PM2.5 can impact on cardiovascular events, as poignantly epitomised by recent studies performed in the COVID-19 pandemic: during the lockdown, critical cardiovascular events decreased, in line with the reduction of polluting emissions.7–9The endless war against individual cardiovascular risk factors significantly reduced the burden of cardiovascular diseases, thanks to the identification of patient-level risk factors such as hypercholesterolaemia, diabetes, hypertension, … ER -