Impact of outdoor air pollution on cardiovascular health in Mainland China

Although China has achieved great progress in ambient pollution reduction in the past two decades, it is still one of the few countries with the worst air pollution levels in the world. In addition to lifestyle choices such as smoking, diet and exercise, exposure to outdoor air pollution is being considered a major determinant of cardiovascular disease in the Chinese population. Numerous epidemiological studies on air pollution and cardiovascular mortality have been conducted in China, using time-series, case-crossover, or cross-sectional designs. The increased cardiovascular mortality risks observed in the Chinese population are similar in magnitude, per amount of pollution, to the risks found in other parts of the world. However, the importance of these increased cardiovascular risks is greater than in North America or Europe, because the air pollution in China is at much higher levels in general and the Chinese population accounts for more than one fourth of the world's total. There has been no air pollution cohort study in China examining the long-term effects of air pollution, nor any published Chinese data assessing the relation between air pollution and cardiovascular morbidity and sub-clinical indicators. Future research in China should focus on a prospective analysis of association between air pollution and cardiovascular disease and the likely underlying pathophysiologic links.