In a recent review published in the Canadian Journal of Cardiology, researchers discussed the association between cardiovascular health and the exposome, which comprises the cumulative impact of environmental exposures on the well-being and health of an individual.
Study: The Exposome and Cardiovascular Health. Image Credit: SUWITNGAOKAEW/Shutterstock.com
In the nature versus nurture approach to understanding diseases, the exposome has emerged as a complementary concept to the genome. It refers to the cumulative impact of environmental exposures over an individual's lifetime on their health.
Deciphering the impact of the exposome on human health involves the characterization of environmental exposures across an individual's lifespan.
Substantial evidence from various studies indicates that specific components of the exposome are closely linked to cardiovascular health, including built and natural surroundings.
Adverse environmental exposures account for about 40% of the cardiovascular disease burden in African and South Asian countries and contribute significantly to the cardiovascular disease burden globally.
Identifying the various exposome components can help understand the downstream pathways and how environmental exposures affect human health. Furthermore, this knowledge will also help evaluate the effect of environmental exposures during various life activities, such as commute, work, etc., on cardiovascular disease development and progression.
About the study
In the present study, the researchers discussed some of the common technologies used to assess environmental exposures over a lifespan, provided mechanistic and epidemiological perspectives on the link between exposome and cardiovascular disease while highlighting the interactions between environmental factors and mechanistic pathways, and addressed the gaps in current research and potential directions for future studies.
Exposome quantification and characterization
A multidisciplinary approach is required to understand exposome characteristics and their impact on cardiovascular health, and various technologies have been used to understand the diverse facets of environmental exposures.
Exposures involving temperature, air quality, and greenery parameters have been extensively studied using remote sensing tools. Ground-level particulate matter has also been assessed using chemical transport models and satellite imagery, which are then calibrated further using ground-based observations. The impact of particulate matter exposure and its link to cardiovascular disease can be assessed using distinct metabolic, biomarker-based signatures detected from blood samples.
The Normalized Difference Vegetation Index can be used to evaluate green cover, an important parameter of the exposome, with values between zero and one indicating green cover and values below 0 indicating water cover.
This parameter can then be used to assess the open areas available for walking and exercise, which is negatively associated with the prevalence of heart disease. Emergent computer vision techniques have also been used to quantify environmental exposure parameters and their effect on health outcomes.
The social vulnerability index, which incorporates demographic and socioeconomic information with census data, can also be employed to understand the impact of psychosocial stressors, which are also a part of the exposome.
Machine learning has also been used recently to identify community-level phenotypes, which encompass environmental, behavioral, and socioeconomic risk factors, and understand the association between these phenotypes and cardiovascular mortality.
Environmental exposures and cardiovascular disease
The review comprehensively covered various environmental exposures and their association with cardiovascular disease risk, with detailed insights into the epidemiology and mechanisms involved in the association.
The researchers discussed the impact of short- and long-term exposure to particulate matter below 2.5 microns and the mechanisms through which air pollution, via initiator and transmission pathways and effector mechanisms, increases the risk of cardiovascular disease.
The other components of the exposome include water and land pollution, extreme temperatures, food, built environment, social determinants, age, and climate change.
Among water and land pollutants, the researchers extensively discussed toxic metal pollution and the impact of poisonous metal exposure on cardiovascular health. Chemical pollutants such as perfluoroalkyl substances and bisphenol A were also discussed.
Additionally, in the built environment, the researchers discussed factors such as walkability and access to green spaces in an area, which positively impact cardiovascular health. The effects of food security and consumption of ultra-processed foods on cardiovascular health were also covered in the review.
Major gaps in knowledge comprised the combined impact of multiple exposures on cardiovascular disease risk and the interactions between exposomes and genomes that impact overall and cardiovascular health.
Overall, the review presented an overview of the various tools and techniques used to characterize and quantify environmental exposures and their impact on human health and the risk of cardiovascular disease.
The researchers also comprehensively discussed the various components of the exposome, their impacts on cardiovascular health, and possible mechanisms through which they increase the risk of cardiovascular disease.