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  • Review Article
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Soil and water pollution and cardiovascular disease

Nature Reviews Cardiology (2024)Cite this article

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Abstract

Healthy, uncontaminated soils and clean water support all life on Earth and are essential for human health. Chemical pollution of soil, water, air and food is a major environmental threat, leading to an estimated 9 million premature deaths worldwide. The Global Burden of Disease study estimated that pollution was responsible for 5.5 million deaths related to cardiovascular disease (CVD) in 2019. Robust evidence has linked multiple pollutants, including heavy metals, pesticides, dioxins and toxic synthetic chemicals, with increased risk of CVD, and some reports suggest an association between microplastic and nanoplastic particles and CVD. Pollutants in soil diminish its capacity to produce food, leading to crop impurities, malnutrition and disease, and they can seep into rivers, worsening water pollution. Deforestation, wildfires and climate change exacerbate pollution by triggering soil erosion and releasing sequestered pollutants into the air and water. Despite their varied chemical makeup, pollutants induce CVD through common pathophysiological mechanisms involving oxidative stress and inflammation. In this Review, we provide an overview of the relationship between soil and water pollution and human health and pathology, and discuss the prevalence of soil and water pollutants and how they contribute to adverse health effects, focusing on CVD.

Key points

  • Illnesses related to chemical pollution of the soil, water and air are responsible for an estimated 9 million premature deaths annually, which equates to 16% of all global deaths; half of these deaths are of cardiovascular origin.

  • Degradation of the soil threatens the health of at least 3.2 billion people (40% of the global population), whereas >2 billion people live in water-stressed countries (25% of the global population).

  • Eco-disruptive causes of soil and water pollution include deforestation, climate change, airborne dust, over-fertilization and unhealthy city designs.

  • Pollution by heavy metals, pesticides, and microplastics and nanoplastics causes cardiovascular damage by interacting with protein-bound thiols, inducing oxidative stress and inflammation, and impairing circadian rhythms.

  • Exposure to chemicals (such as heavy metals, solvents, dioxins and pesticides) at workplaces, through consumer products or indirectly via environmental contamination contributes to endothelial dysfunction and cardiovascular disease.

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Fig. 1: Deaths associated with chemical pollution and distribution and sources of soil pollution.
Fig. 2: Regional distribution of chemical soil and water pollution.
Fig. 3: Cellular mechanisms of cardiovascular damage mediated by exposure to metals or metalloids and pesticides23.
Fig. 4: Main effects of soil contaminants on organ systems.
Fig. 5: Association between metals, pesticides and cardiovascular and cardiometabolic outcomes.
Fig. 6: The routes of entry and cardiotoxic effects of MNPs.
Fig. 7: Annual mortality related to stroke and ischaemic heart disease from dust exposure.

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Acknowledgements

T.M. is the principal investigator of the German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany. O.H. and A.D. received funding from the DZHK. O.H. and A.D. have received vascular biology research grants from the Foundation Heart of Mainz. M.A. was supported by grants from the National Institute of Environmental Health Sciences (R01ES07331 and R01ES10563). All the authors were supported by the environmental network EXPOHEALTH, funded by the state of Rhineland-Palatinate, Germany.

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Authors and Affiliations

  1. University Medical Center Mainz, Department of Cardiology, Johannes Gutenberg University Mainz, Mainz, Germany

    Thomas Münzel, Omar Hahad & Andreas Daiber

  2. German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany

    Thomas Münzel, Omar Hahad & Andreas Daiber

  3. Atmospheric Chemistry Department, Max Planck Institute for Chemistry, Mainz, Germany

    Jos Lelieveld

  4. Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA

    Michael Aschner

  5. Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain

    Mark J. Nieuwenhuijsen

  6. Global Observatory on Planetary Health, Boston College, Boston, MA, USA

    Philip J. Landrigan

  7. Centre Scientifique de Monaco, Monaco, Monaco

    Philip J. Landrigan

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  1. Thomas Münzel
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Münzel, T., Hahad, O., Lelieveld, J. et al. Soil and water pollution and cardiovascular disease. Nat Rev Cardiol (2024). https://doi.org/10.1038/s41569-024-01068-0

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