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The Impact of Particulate Matter Air Pollution on Coronary Heart Disease: A Systematic Review

Gabriela Valencia Putri Husodho orcid  -  Faculty of Medicine, Universitas Diponegoro, Jl. Prof. Sudarto, Tembalang, Tembalang, Semarang, Indonesia 50275, Indonesia
*Muhammad Abi Ghoffari Siregar orcid  -  Biomedical Science Masters Program, Faculty of Medicine, Universitas Andalas, Padang, Indonesia, Indonesia
Agyta Hanifa Faiza orcid  -  Faculty of Medicine, Universitas Diponegoro, Jl. Prof. Sudarto, Tembalang, Tembalang, Semarang, Indonesia 50275, Indonesia
Open Access Copyright (c) 2025 Diponegoro International Medical Journal
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Abstract

Background: Coronary heart disease remains a significant global public health threat, with around 315 million patients in 2022, having risen due to global population growth, with regional disparities persisting. Air pollution, specifically fine particulate matter (PM) categorized according to size into PM2.5 and PM10, has been identified as a critical and modifiable determinant of coronary heart disease, associated with 4.2 million deaths globally in 2019, most of cardiovascular origin. Hence, a systematic review was conducted to assess the impact that PM2.5 and PM10 have on coronary heart disease. Coronary heart disease remains a significant global public health threat, with around 315 million patients in 2022, having risen due to global population growth, with regional disparities persisting. Air pollution, specifically fine particulate matter (PM) categorized according to size into PM2.5 and PM10, has been identified as a critical and modifiable determinant of coronary heart disease, associated with 4.2 million deaths globally in 2019, most of cardiovascular origin.

Objective: To assess the impact that PM2.5 and PM10 have on coronary heart disease.

Methods: A literature search was done to identify relevant articles using three databases (PubMed, ScienceDirect, EBSCO) between 2020-2025. Studies written in English and observational studies were included. Articles without complete data and case reports were excluded. The systematic review followed PRISMA guidelines.

Results: 46 studies were included in the final synthesis. 24 studies discussed only PM2.5, 22 studies discussed both PM2.5 and PM10, while none of the studies discussed only PM10. The majority of the studies were conducted in China (21 studies). Overall, PM2.5 had higher OR, RR, and HR for coronary heart disease compared to PM10, due to its smaller size. Lower quality of life, which includes higher mortality and hospitalization rates, was also seen with higher PM exposure.

Conclusion: PM exposure increases the risk of coronary heart disease occurrence and decreases quality of life in patients, with PM2.5 having a higher effect than PM10.

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Keywords: Air pollution; Coronary heart disease; Particulate matter; Quality of life

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  1. Stark B, Johnson C, Roth GA. Global Prevalence of Coronary Artery Disease: an Update From the Global Burden of Disease Study. J Am Coll Cardiol [Internet]. 2024;83(13):2320. Available from: http://dx.doi.org/10.1016/S0735-1097(24)04310-9
  2. Chong B, Jayabaskaran J, Jauhari SM, Chan SP, Goh R, Kueh MTW, et al. Global burden of cardiovascular diseases: projections from 2025 to 2050. Eur J Prev Cardiol [Internet]. 2024 Sep 13;zwae281. Available from: https://doi.org/10.1093/eurjpc/zwae281
  3. Miller MR, Di Cesare M, Rahimzadeh S, Adeoye M, Perel P, Taylor S, et al. Clearing the Air to Address Pollution’s Cardiovascular Health Crisis. Glob Heart. 2024;19(1):82
  4. Zhong X, Chen Y, Sun L, Chen H, Qu X, Hao L. The burden of ambient air pollution on years of life lost from ischaemic heart disease in Pudong new area, Shanghai. Sci Rep. 2025;15(1):1–9
  5. Cujic MR, Cirovic ŽM, Djolic MB, Mandic LJJ, Radenkovic MB, Onjiac AE. Assessment of the Burden of Disease Due To Pm2.5 Air Pollution for the Belgrade District. Therm Sci. 2023;27(3):2265–73
  6. Dąbrowiecki P, Konduracka E, Kołtowski Ł, Chciałowski A, Dąbrowiecka A, Kępa P, et al. Ambient air pollution and risk of hospital admission due to acute and chronic coronary syndromes: a time-stratified case-crossover study in the 3 largest urban agglomerations in Poland. Polish Arch Intern Med [Internet]. 2025 Jan 15;135(3):16925. Available from: https://www.mp.pl/paim/issue/article/16925
  7. Luengo-Fernandez R, Walli-Attaei M, Gray A, Torbica A, Maggioni AP, Huculeci R, et al. Economic burden of cardiovascular diseases in the European Union: a population-based cost study. Eur Heart J [Internet]. 2023;44(45):4752–67. Available from: https://doi.org/10.1093/eurheartj/ehad583
  8. Padda I, Fabian D, Farid M, Mahtani A, Sethi Y, Ralhan T, et al. Social determinants of health and its impact on cardiovascular disease in underserved populations: A critical review. Curr Probl Cardiol [Internet]. 2024;49(3):102373. Available from: https://www.sciencedirect.com/science/article/pii/S0146280624000124
  9. Uli RE, Satyana RPU, Zomer E, Magliano D, Liew D, Ademi Z. Health and productivity burden of coronary heart disease in the working Indonesian population using life-table modelling. BMJ Open. 2020;10(9):1–9
  10. Guerreiro RA. Refining the classification of cardiovascular prevention. Rev Port Cardiol [Internet]. 2024 Mar;43(3):159–62. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0870255123004547
  11. Kaufman JD, Elkind MSV, Bhatnagar A, Koehler K, Balmes JR, Sidney S, et al. Guidance to Reduce the Cardiovascular Burden of Ambient Air Pollutants A Policy Statement From the American Heart Association. Circulation. 2020;142(23):E432–47
  12. Tewma C, Mifsud JL, Mifsud JL. The impact of air pollution on atherosclerotic cardiovascular disease development. Br J Cardiol. 2024;(April):3–4
  13. Wurie HR, Cappuccio FP. Europe PMC Funders Group Cardiovascular disease in low- and middle-income countries : an urgent priority Europe PMC Funders Author Manuscripts. Ethn Health. 2022;17(6):1–8
  14. Kanayson P, Dain K, Renshaw N. Ensuring health lives for all [Internet]. 2018. Available from: https://ncdalliance.org/sites/default/files/resource_files/UHC and NCDs_EN.pdf
  15. Vervoort D, Verstappen A, Nair SM, Chin Eu C, Zheleva B. Health Systems Strengthening to Tackle the Global Burden of Pediatric and Congenital Heart Disease: A Diagonal Approach. Congenit Heart Dis. 2024;19(2):131–8
  16. Hosseini MS, Jahanshahlou F, Akbarzadeh MA, Zarei M, Vaez-Gharamaleki Y. Formulating research questions for evidence-based studies. J Med Surgery, Public Heal [Internet]. 2024;2(December 2023):100046. Available from: https://doi.org/10.1016/j.glmedi.2023.100046
  17. Higgins JPT, Morgan RL, Rooney AA, Taylor KW, Thayer KA, Silva RA, et al. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). Environ Int. 2024;186(June 2023)
  18. Wei Y, Feng Y, Danesh Yazdi M, Yin K, Castro E, Shtein A, et al. Exposure-response associations between chronic exposure to fine particulate matter and risks of hospital admission for major cardiovascular diseases: population based cohort study. BMJ. 2024;
  19. Gao H, Li J, Ma Q, Zhang Q, Li M, Hu X. Causal Associations of Environmental Pollution and Cardiovascular Disease: A Two-Sample Mendelian Randomization Study. Glob Heart. 2024;19(1):52
  20. Kim HJ, Oh YH, Park SJ, Song J, Kim K, Choi D, et al. Combined Effects of Air Pollution and Changes in Physical Activity With Cardiovascular Disease in Patients With Dyslipidemia. J Am Hear Assoc . 2024 Dec 3;13(23)
  21. Kriit HK, Andersson EM, Carlsen HK, Andersson N, Ljungman PLS, Pershagen G, et al. Using Distributed Lag Non-Linear Models to Estimate Exposure Lag-Response Associations between Long-Term Air Pollution Exposure and Incidence of Cardiovascular Disease. Int J Environ Res Public Health. 2022 Mar 1;19(5)
  22. Rhee TM, Ji Y, Yang S, Lee H, Park JB, Kim HK, et al. Combined Effect of Air Pollution and Genetic Risk on Incident Cardiovascular Diseases. J Am Heart Assoc. 2024;13(22):e033497
  23. Raza W, Krachler B, Forsberg B, Sommar JN. Does physical activity modify the association between air pollution and recurrence of cardiovascular disease? Int J Environ Res Public Health. 2021 Mar 1;18(5):1–11
  24. Kim OJ, Lee SH, Kang SH, Kim SY. Incident cardiovascular disease and particulate matter air pollution in South Korea using a population-based and nationwide cohort of 0.2 million adults. Environ Heal A Glob Access Sci Source. 2020 Dec 1;19(1)
  25. Muszyński P, Pawluczuk E, Januszko T, Kruszyńska J, Duzinkiewicz M, Kurasz A, et al. Exploring the Relationship between Acute Coronary Syndrome, Lower Respiratory Tract Infections, and Atmospheric Pollution. J Clin Med. 2024;13(17):5037
  26. Zhang J, Shen P, Wang Y, Li Z, Xu L, Qiu J, et al. Interaction between walkability and fine particulate matter on ischemic heart disease: A prospective cohort study in China. Ecotoxicol Environ Saf. 2025 Jan 15;290
  27. Yang X, Ben B, Wang W, Long B, Xie Y, Wu K, et al. Fine particulate matter pollution in the Sichuan Basin of China from 2013 to 2020: Sources, emissions, and mortality burden. Environ Int. 2025 Mar 1;197
  28. Zhang Y, Wang Y, Du Z, Chen S, Qu Y, Hao C, et al. Potential causal links between long-term ambient particulate matter exposure and cardiovascular mortality: New evidence from a large community-based cohort in South China. Ecotoxicol Environ Saf. 2023 Apr 1;254
  29. Tapia V, Steenland K, Sarnat SE, Vu B, Liu Y, Sánchez-Ccoyllo O, et al. Time-series analysis of ambient PM2.5 and cardiorespiratory emergency room visits in Lima, Peru during 2010–2016. J Expo Sci Environ Epidemiol. 2020 Jul 1;30(4):680–8
  30. Wang W, Zhou N, Yu H, Yang H, Zhou J, Hong X. Time Trends in Ischemic Heart Disease Mortality Attributable to PM2.5 Exposure in Southeastern China from 1990 to 2019: An Age-Period-Cohort Analysis. Int J Environ Res Public Health. 2023;20(2)
  31. Liang R, Chen R, Yin P, van Donkelaar A, Martin R V., Burnett R, et al. Associations of long-term exposure to fine particulate matter and its constituents with cardiovascular mortality: A prospective cohort study in China. Environ Int. 2022 Apr 1;162
  32. Liu M, Yu J, Zhu A, Ling J, Chen R, Zhang Y, et al. Association Between Air Pollution and Coronary Heart Disease Hospitalizations in Lanzhou City, 2013–2020: a Time Series Analysis. J Urban Heal [Internet]. 2023;100(6):1246–57. Available from: https://doi.org/10.1007/s11524-023-00797-w
  33. Chaulin AM, Sergeev AK. Modern Concepts of the Role of Fine Particles (PM 2.5) in the Genesis of Atherosclerosis and Myocardial Damage: Clinical and Epidemiological Data, the Main Pathophysiological Mechanisms. Curr Cardiol Rev. 2022;19(2)
  34. Chaulin AM, Sergeev AK. The Role of Fine Particles (PM 2.5) in the Genesis of Atherosclerosis and Myocardial Damage: Emphasis on Clinical and Epidemiological Data, and Pathophysiological Mechanisms. Cardiol Res [Internet]. 2022;13(5):268–82. Available from: https://www.doi.org/10.14740/cr1366
  35. Miller MR. Oxidative stress and the cardiovascular effects of air pollution. Free Radic Biol Med. 2020;151(November 2019):69–87
  36. Pope CA, Bhatnagar A, McCracken JP, Abplanalp W, Conklin DJ, O’Toole T. Exposure to Fine Particulate Air Pollution Is Associated With Endothelial Injury and Systemic Inflammation. Circ Res [Internet]. 2016 Nov 11;119(11):1204–14. Available from: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.116.309279
  37. Geng J, Liu H, Ge P, Hu T, Zhang Y, Zhang X, et al. PM2.5 promotes plaque vulnerability at different stages of atherosclerosis and the formation of foam cells via TLR4/MyD88/NFκB pathway. Ecotoxicol Environ Saf [Internet]. 2019;176(September 2018):76–84. Available from: https://doi.org/10.1016/j.ecoenv.2019.03.068
  38. Kaufman JD, Adar SD, Barr RG, Budoff M, Burke GL, Curl CL, et al. Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): a longitudinal cohort study. Lancet [Internet]. 2016 Aug;388(10045):696–704. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673616003780
  39. Liang S, Zhang J, Ning R, Du Z, Liu J, Batibawa JW, et al. The critical role of endothelial function in fine particulate matter-induced atherosclerosis. Part Fibre Toxicol. 2020;17(1)
  40. Wyatt L, Kamat G, Moyer J, Weaver AM, Diaz-Sanchez D, Devlin RB, et al. Associations between short-term exposure to PM2.5and cardiomyocyte injury in myocardial infarction survivors in North Carolina. Open Hear. 2022;9(1):1–8
  41. Liu T, Huang H, Hu G. A Time Series Study for Effects of PM10 on Coronary Heart Disease in Ganzhou, China. Int J Environ Res Public Health. 2023;20(1)
  42. Radan M, Dianat M, Badavi M, Mard SA, Bayati V, Goudarzi G. Gallic acid protects particulate matter (PM10) triggers cardiac oxidative stress and inflammation causing heart adverse events in rats. Environ Sci Pollut Res [Internet]. 2019;26(18):18200–7. Available from: https://doi.org/10.1007/s11356-019-05223-w
  43. Urbanowicz T, Skotak K, Olasińska-Wiśniewska A, Filipiak KJ, Bratkowski J, Wyrwa M, et al. Long-Term Exposure to PM10 Air Pollution Exaggerates Progression of Coronary Artery Disease. Atmosphere (Basel). 2024;15(2):1–13
  44. Li N, Chen G, Liu F, Mao S, Liu Y, Liu S, et al. Associations between long-term exposure to air pollution and blood pressure and effect modifications by behavioral factors. Environ Res. 2020 Mar;182:109109
  45. Du Y, Xu X, Chu M, Guo Y, Wang J. Air particulate matter and cardiovascular disease: The epidemiological, biomedical and clinical evidence. J Thorac Dis. 2016;8(1):E8–19
  46. Vahedian M, Garkaz O, Khanjani N, Mirzaee M, Koolivand A. The effect of exposure to ambient air pollutants on cardiovascular mortality in Arak, Iran. Int Cardiovasc Res J. 2020;14(4):132–6
  47. Hajat A, Allison M, Diez-Roux A V., Jenny NS, Jorgensen NW, Szpiro AA, et al. Long-term Exposure to Air Pollution and Markers of Inflammation, Coagulation, and Endothelial Activation. Epidemiology [Internet]. 2016 May;26(3):310–20. Available from: http://journals.lww.com/00001648-201505000-00004

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