Whether heart failure develops and how it progresses depends not only on physical factors, but also on external influences and the duration of exposure, according to scientists at University Medical Center Mainz in collaboration with an international research group. Their systematic review, published in Nature Reviews Cardiology, revealed that both individual risk factors, such as high blood pressure and lack of exercise, and stressful environmental factors, such as poor air quality, noise, and heat, are important starting points for preventing the disease and more effectively reducing the number of people affected.
More than 64 million people worldwide are affected by heart failure, and more than 4 million are in Germany. Despite modern drug therapies and interventional procedures, the chances of recovery are low and the long-term survival prognosis is poor: About half of those affected die within six years of diagnosis. This makes prevention all the more important. Until now, prevention and therapy have focused primarily on individual risk factors such as high blood pressure, diabetes, and genetic predisposition.
Dr. Omar Hahad, a scientist at the Department of Cardiology at the University Medical Center Mainz, is first author of the review, “The environmental exposome in heart failure risk and progression.” The team focused on the so-called exposome, the totality of all environmental and living conditions to which a person may be exposed in the course of their life. They concluded that these factors can have a significant influence on whether heart failure develops and how it progresses.
Environmental factors have a long-term and simultaneous effect
The international research group, with participants from the U.S., including Harvard Medical School, Yale School of Medicine, and Columbia University, evaluated numerous studies on the influence of individual environmental pollutants on heart failure. These include particulate matter, traffic and aircraft noise, extreme temperatures, artificial light at night, and toxic metals such as lead and cadmium.
According to the study’s findings, a decisive factor in the development of the disease is that these influences do not occur in isolation, but simultaneously, over many years and often already in early stages of life. “The continuous interaction of humans with the influencing factors of their environment leads to a considerable cumulative burden at the population level,” explains Dr. Hahad.
Environmental pollution exacerbates social inequalities
The risk of exposure to these factors is not the same for everyone. People with lower socioeconomic status are particularly affected. They are more likely to live in areas with poor air quality, higher noise pollution, and limited access to green spaces. At the same time, they often have limited access to preventive and therapeutic measures—and, as a result, higher mortality rates.
Based on their findings, the authors of the study recommend taking a more holistic approach to the prevention and treatment of heart failure. In addition to medical measures, they advocate measures to protect air quality and protect against noise and heat.
More information
Omar Hahad et al, The environmental exposome in heart failure risk and progression, Nature Reviews Cardiology (2026). DOI: 10.1038/s41569-026-01247-1
The content is provided for information purposes only.