Environmental cardiology [1] and climate cardiology [2] are emerging terms emphasizing the importance of changes in the environment and climate on cardiovascular health and disease. The consequences of unhealthy environments are outlined in recent reports from the World Health Organization (WHO; [3]) and the Global Burden of Disease (GBD) study [4]. The WHO estimates that unhealthy environments accounted for up to 12.6 million global deaths in 2012, with a vast number of these deaths related to cardiovascular causes [3]. Likewise, the GBD study indicates that diseases caused by all forms of pollution account for 268 million disability-adjusted life years [5]. Specifically, climate change-related events such as extreme heat are associated with increased cardiovascular risks [6].

As acknowledged by the Lancet Commission on pollution and health, chemical pollution is considered the most important environmental cause of disease and premature death globally [7]. Chemical pollution-induced diseases were responsible for an estimated 9 million premature deaths (or 16% of all deaths worldwide) in 2015 [7]. A leading risk factor is ambient air pollution, which reduces global average life expectancy by 2.9 years and outcompetes even the reduction caused by tobacco smoking (2.2 years; [8]). In total, 9 million premature global deaths per year were attributed to air pollution in the form of particulate matter with a diameter of ≤ 2.5 μm (PM2.5; [9]); in fact, noise pollution is recognized as the second leading environmental health risk factor in the European region [10, 11]. Traffic noise is ubiquitous with > 20% of the European population being exposed to levels exceeding the EU guideline value of 55 dB [12]. A report from the European Environmental Agency suggests that traffic noise accounts for 12,000 premature deaths and 48,000 cases of ischemic heart disease per year in Europe [12]. Importantly, these exposures add to the harms of other coexisting cardiovascular risk factors [13].

The emerging appreciation of the cardiovascular effects of environmental and climate changes on cardiovascular health was discussed at the annual meetings of the German Society for Cardiology (DGK) from 2007 to 2023 (https://dgk.org/dgk-kongresse/). We searched this database using the following terms: “environment (Umwelt)”; “climate (Klima)”; “pollution (Verschmutzung)”; “air pollution (Luftervschmutzung)”; “noise (Lärm)”; or “heat (Hitze)”; focusing on the section “Kardiovaskuläre Risikofaktoren & Prävention—Umweltfaktoren/Umweltverschmutzung” (“Cardiovascular Risk Factors & Prevention—Environmental Factors/Environmental Pollution”). The findings of the search results are summarized in Table 1. The search identified 34 (average of two per year) contributions that were clearly linked to the topics during the 17 years of the meeting proceedings, indicating that there is room for improvement, although trends in recent years show promise. However, it is possible that contributions related to environmental/climate changes were missed because they were not directly evident based on the title of the presentation, and because the search terms might be insufficient. It is also possible that there may be inconsistencies between the printed program and the online program.

Table 1 Environment- and climate change-related findings presented at the annual meetings of the German Society for Cardiology (DGK) from 2007 to 2023
Full size table

An important question is: What can be done to increase contributions related to environmental and climate cardiology? Some important steps include (a) increasing the awareness of researchers and clinicians on the impact of environmental/climate changes on cardiovascular health, (b) forming task forces and expert groups to increase funding for preclinical and clinical studies, (c) promoting educational programs (high school to university level, including medical curricula) that integrate these topics with other social determinants of health, and (d) improving epidemiological studies in developed and developing countries on the impact of environmental and climate changes on cardiovascular outcomes. Important is the existence of non-academic platforms that promote focused multidisciplinary studies on the association between environment and/or climate changes on health and disease, such as the Helmholtz Munich—German Research Center for Health and the Environment or the Leibniz Research Institute for Environmental Medicine located in Düsseldorf (both in Germany).

There are important unanswered questions on the cardiovascular effects of climate/environmental changes, including: What are the best methods to identify patients at risk? Which instruments and diagnostic tools should be used in primary prevention to determine individual exposures and risks? Is it beneficial to introduce environmental exposures into established cardiovascular risk scores? What specific therapeutic and preventive measures are effective on an individual level? Are the risks greater in patients with other comorbidities? A new health discipline that combines evidence from environmental and climate cardiology to lower the burden of cardiovascular disease could produce benefits at a patient and population level.