Ambient air pollution has emerged as a major public health threat, contributing significantly to the global burden of non-communicable diseases, particularly cardiovascular disease (CVD). Despite growing epidemiological evidence, establishing a causal relationship remains complex due to the multifactorial nature of CVD. This paper applies Bradford Hill’s criteria of causation to critically examine whether long-term exposure to ambient air pollutants—particularly fine particulate matter (PM₂.₅), nitrogen dioxide (NO₂), and ozone (O₃)—can be considered a causal factor in the development and progression of cardiovascular conditions such as coronary artery disease, stroke, and hypertension.
Findings from cohort studies, time-series analyses, and experimental models indicate strong and consistent associations between air pollution and cardiovascular outcomes. The biological plausibility is supported by mechanisms involving oxidative stress, systemic inflammation, endothelial dysfunction, and atherosclerosis. Evidence of temporality, dose-response relationships, and experimental reversibility further strengthens the case. While challenges such as exposure misclassification and socioeconomic confounding remain, the application of Hill’s framework suggests that ambient air pollution is not merely associated with but likely contributes causally to cardiovascular disease.
Given the substantial and preventable health burden, this analysis underscores the urgent need for stricter air quality regulations and cross-sectoral policy interventions to reduce exposure and mitigate cardiovascular risk.
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- Kingsley Adimabua (Autor), 2025, Can Dirty Air Break Your Heart? Applying Hill’s Criteria to the Link Between Ambient Air Pollution and Cardiovascular Disease, Múnich, GRIN Verlag, https://www.grin.com/document/1597570
