In a recent review published in the Canadian Journal of Cardiology, researchers discussed the relationship between cardiovascular health and the exposome, which includes the cumulative effects of environmental exposures on human well-being and health.
Study: The exposome and cardiovascular health. Image credit: SUWITNGAOKAEW/Shutterstock.com
In a nature-versus-nurture approach to understanding disease, the exposome emerged as an additional concept to the genome. It refers to the cumulative effect of environmental influences on a person’s health throughout his life.
Addressing exposome effects on human health involves characterization of environmental exposures over the human lifespan.
Substantial evidence from a variety of studies indicates that specific components of the exposome are closely related to cardiovascular health, including the built and natural environment.
Adverse environmental exposures account for approximately 40% of the burden of cardiovascular disease in African and South Asian countries and contribute significantly to the burden of cardiovascular disease worldwide.
Identifying different exposome components can help us understand the downstream pathways and how environmental exposures affect human health. In addition, this knowledge is useful during various life activities, for example, traveling, working, etc. helps to assess the impact of environmental exposure on the development and progression of cardiovascular diseases.
In this study, researchers discussed some of the common technologies used to assess lifetime environmental exposures, provided mechanistic and epidemiologic perspectives on the association between exposome and cardiovascular disease, while highlighting interactions between environmental factors and mechanistic pathways and addressing gaps. in current research and potential directions for future research.
Exposome quantification and characterization
Understanding exposure characteristics and their effects on cardiovascular health requires a multidisciplinary approach, and various technologies have been used to understand different facets of environmental exposure.
Exposures including temperature, air quality and green cover parameters have been extensively studied using remote sensing tools. Ground-level particles were also estimated using chemical transport models and satellite imagery, which were then further calibrated using ground observations. The effect of particulate matter exposure and its association with cardiovascular disease can be assessed using metabolic, biomarker-based markers determined from blood samples.
The normalized difference vegetation index can be used to estimate green cover, an important parameter of the exposome, with values between zero and one indicating green cover and values below 0 indicating water cover.
This parameter can then be used to estimate open areas for walking and exercise, which are negatively associated with the prevalence of heart disease. Rapid computer vision techniques have also been used to quantify environmental exposure parameters and their impact on health outcomes.
A social vulnerability index that combines demographic and socioeconomic information with census data can also be used to understand the impact of psychosocial stressors that are part of the exposome.
Recently, machine learning has also been used to identify community-level phenotypes that include environmental, behavioral, and socioeconomic risk factors and to understand the relationship between these phenotypes and cardiovascular mortality.
Environmental exposure and cardiovascular disease
The review comprehensively covered various environmental influences and their association with CVD risk, providing detailed explanations of epidemiology and community-based mechanisms.
The researchers discussed the effects of short-term and long-term exposure to particles below 2.5 microns and the mechanisms by which air pollution increases cardiovascular disease risk through initiator and transmission pathways and effector mechanisms.
Other components of the exposome include water and land pollution, extreme temperatures, food, the built environment, social determinants, age and climate change.
Among water and land pollutants, researchers have extensively discussed toxic metal pollution and the effects of toxic metal exposure on cardiovascular health. Chemical pollutants such as perfluoroalkyl substances and bisphenol A were also discussed.
Additionally, in the built environment, researchers have discussed factors such as walking in the area and access to green spaces that have positive effects on cardiovascular health. The review also looked at food insecurity and the impact of ultra-processed food consumption on cardiovascular health.
Major gaps in knowledge were the combined effects of multiple exposures on cardiovascular disease risk and interactions between expososomes and genomes affecting general and cardiovascular health.
Overall, the review provided an overview of the various tools and methods used to characterize and quantify environmental exposures and their impact on human health and cardiovascular disease risk.
The researchers also comprehensively discussed the various components of the exposome, their effects on cardiovascular health, and possible mechanisms by which they increase the risk of cardiovascular disease.
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