The intersection of planetary and cardiovascular health is no longer a distant concern — it is reshaping the clinical management of the most prevalent chronic diseases affecting adults today. As ambient temperatures rise and extreme weather intensifies, cardiometabolic risk factors are being disrupted through mechanisms that standard clinical frameworks were never designed to address.
This review in the European Journal of Preventive Cardiology synthesizes evidence showing that heat exposure and air pollution independently drive vascular endothelial dysfunction, systemic inflammation, and oxidative stress — producing measurable deterioration in blood pressure regulation, glycemic control, and lipid metabolism. Extreme weather events — floods, heatwaves, and wildfires — are associated with acute spikes in cardiovascular events through pathways including dehydration-induced hemoconcentration, myocardial ischemia, and arrhythmia triggers. Beyond direct physiological insults, climate disruption also degrades food system quality and interrupts medication adherence — compounding cardiometabolic risk through behavioral and logistical channels. Vulnerable populations including older adults, racial and ethnic minorities, and those with lower socioeconomic status bear a disproportionately amplified burden across all of these pathways.
This review is editorially significant because it reframes climate as an upstream cardiovascular risk modifier — equivalent in conceptual importance to smoking or sedentary behavior — rather than a downstream policy concern. The mechanistic specificity here matters: particulate matter and ozone exposure have well-documented dose-response relationships with blood pressure elevation, and heat stress is now linked to impaired insulin signaling in recent experimental work. However, several important limitations apply. Much underlying evidence remains observational and geographically uneven, with limited causal data on the magnitude of climate-attributable cardiovascular risk at individual versus population levels. The proposed clinical adaptations — climate-sensitive risk stratification and anticipatory guidance — are largely conceptual frameworks lacking validated implementation protocols. For now, this work is best understood as a well-constructed call to integrate environmental exposure histories into routine cardiovascular risk assessment — an incremental but directionally important shift in preventive medicine thinking.
