Global Trends in Cardiovascular Mortality: Impact of Air Pollution and Urbanization

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide, with a growing body of evidence linking environmental exposures—particularly air pollution and urbanization—to increasing CVD morbidity and mortality. Fine particulate matter (PM₂.₅), nitrogen dioxide (NO₂), and other urban air pollutants contribute to endothelial dysfunction, systemic inflammation, oxidative stress, and autonomic imbalance, exacerbating atherosclerosis, hypertension, and arrhythmias. Rapid urban expansion, especially in low- and middle-income countries, has intensified population exposure to environmental cardiotoxicants while straining healthcare infrastructure. Methods and Results: This review synthesizes epidemiological, clinical, and environmental health data from global cohorts and burden-of-disease studies spanning the last two decades. Meta-analyses show a robust association between chronic PM₂.₅ exposure and increased cardiovascular mortality, with hazard ratios ranging from 1.10 to 1.30 per 10 µg/m³ increment. Time-series studies reveal acute spikes in myocardial infarction and stroke during high pollution episodes. Urbanization has contributed to both positive and negative cardiovascular trends—facilitating access to care and technology while increasing sedentary behavior, processed food consumption, and environmental risk. Satellite-derived pollution estimates and spatial mapping tools identify regions with the highest CVD burden attributable to air quality, including South Asia, sub-Saharan Africa, and parts of Eastern Europe. Policy interventions such as clean air legislation, urban green space expansion, and active transit infrastructure are associated with improved cardiovascular outcomes. Conclusion: Air pollution and urbanization are critical, modifiable drivers of global cardiovascular mortality.