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Airborne pollution and cardiovascular disease: burden and causes of an epidemic

P.M. Mannucci
DOI: http://dx.doi.org/10.1093/eurheartj/eht045 First published online: 20 February 2013

This editorial refers to ‘Long-term exposure to air pollution is associated with survival following acute coronary syndrome’, by C. Tonne and P. Wilkinson, doi:10.1093/eurheartj/ehs480

The first well-known episode of air pollution causing a marked mortality peak developed in London during the great smog between 5 and 9 December 1952. In those days, air pollution—owing to a combination of high atmospheric pressure, absence of wind and rain, and intensive domestic heating with low-quality coal as fuel—caused as many as 12 000 deaths. To give an idea of the dramatic dimension of that episode, the number of London victims of German bombs was 30 000 during the Second World War.1 More recently, in 2008, the World Health Organization (WHO) estimated that urban outdoor air pollution caused 1.34 million premature deaths worldwide, an annual number that can be contrasted with the 4.8 million premature deaths attributable to smoking.2 According to WHO, the impressive number of deaths attributed to bad air had increased by 16% from 2004 to 2008, with little reason to imagine that the situation has improved in subsequent recent years.2

Air pollution affects the whole planet, particularly densely populated metropolitan areas of Eastern and Southern China, Northern India, and the emerging countries of South-East Asia. Europe is not spared, particularly Benelux and the South and East of the continent. The main pollutants are distinguished as primary—such as NOx and SO2 produced directly from car traffic, industrial emissions, and domestic heating—and secondary (typically ozone), that stem from primary pollutants as a consequence of chemical reactions taking place in the atmosphere. Particulate matter (PM) in the inhaled air, …