Changes in cardiovascular burden attributable to air pollution in south asia over the past 30 years: evidence from the global burden of disease:

Therapeutic Area: ASCVD/CVD Risk Factors Background: Particulate matter (PM2.5) air pollution is a global health problem associated with adverse cardiovascular outcomes. With the use of fossil fuels and ambient air pollution levels many-fold over the air quality standards, air pollution is a significant concern in the South Asia region (SAR). We, therefore, sought to examine the effect of particulate matter on cardiovascular disease (CVD) burden in the SAR from 1990 to 2019. Methods: We used the 1990–2019 global burden of disease methodology to calculate the total PM2.5, ambient PM2.5, and household PM2.5-related CVD deaths and years of life lost (YLL) in SAR (India, Pakistan, Bangladesh, Bhutan and Nepal). We additionally tracked population-weighted ambient PM2.5 and household air pollution (HAP) use (proportion of population) over the study period using the State of the Global Air repository. Results: The average annual population-weighted ambient PM2.5 exposure in SAR increased from 68 μg/m3 [95% confidence interval (CI): 34.5-120] in 1990 to 78.2 μg/m3 [95% CI: 71.9–85] in 2019. This is contrasted with a reduction in the proportion of HAP exposure proportion from 86% (95% CI: 85-87) in 1990 to 61% (95% CI: 58-63) in 2019. In 2019, particulate matter pollution contributed to 27.6% (95% CI: 25.7-29.5%) of deaths and 31.4% (95% CI: 29.3–33.4%) of YLL due to CVD in the SAR. From 1990 to 2019, the age-standardized rate of PM2.5-attributable CVD death decreased by 52 per 100,000 due to HAP and increased by 23 per 100,000 due to ambient PM2.5. Similarly, the age standardized rate of YLL attributed to HAP decreased by 63.4% while that attributed to ambient PM2.5 increased by 107.2% from 1990 to 2019. Conclusions: Despite the decrease in HAP exposure, ambient PM2.5 increased in SAR over the past 3 decades. Overall PM2.5 air pollution continues to have significant contribution to overall CVD mortality, accounting for one quarter of CVD deaths. Societal and personal interventions are urgently needed to curb the CVD pandemic in SAR.