Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Centre ÉPIC and Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.
Rev Esp Cardiol (Engl Ed). 2022 Dec;75(12):1050-1058. doi: 10.1016/j.rec.2022.05.030. Epub 2022 Aug 2.
The environment is a strong determinant of cardiovascular health. Environmental cardiology studies the contribution of environmental exposures with the aim of minimizing the harmful influences of pollution and promoting cardiovascular health through specific preventive or therapeutic strategies. The present review focuses on particulate matter and metals, which are the pollutants with the strongest level of scientific evidence, and includes possible interventions. Legislation, mitigation and control of pollutants in air, water and food, as well as environmental policies for heart-healthy spaces, are key measures for cardiovascular health. Individual strategies include the chelation of divalent metals such as lead and cadmium, metals that can only be removed from the body via chelation. The TACT (Trial to Assess Chelation Therapy, NCT00044213) clinical trial demonstrated cardiovascular benefit in patients with a previous myocardial infarction, especially in those with diabetes. Currently, the TACT2 trial (NCT02733185) is replicating the TACT results in people with diabetes. Data from the United States and Argentina have also shown the potential usefulness of chelation in severe peripheral arterial disease. More research and action in environmental cardiology could substantially help to improve the prevention and treatment of cardiovascular disease.
环境是心血管健康的重要决定因素。环境心脏病学研究环境暴露的影响，旨在通过特定的预防或治疗策略，尽量减少污染的有害影响，促进心血管健康。本综述重点介绍了颗粒物和金属，这是具有最强科学证据的污染物，并包括可能的干预措施。立法、减少和控制空气、水和食物中的污染物，以及有利于心脏健康的环境政策，是心血管健康的关键措施。个体策略包括螯合重金属，如铅和镉，这些金属只能通过螯合作用从体内排出。TACT（评估螯合疗法的试验，NCT00044213）临床试验表明，在有既往心肌梗死的患者中，尤其是在有糖尿病的患者中，具有心血管获益。目前，TACT2 试验（NCT02733185）正在复制 TACT 试验在糖尿病患者中的结果。来自美国和阿根廷的数据也表明了螯合疗法在严重外周动脉疾病中的潜在有效性。环境心脏病学领域的更多研究和行动可能会极大地有助于改善心血管疾病的预防和治疗。
