Air pollutionis similar to the death rate from tobscco smoking.
It is much higher than deaths from auto accidents, said Fernando Zanetti MD Ph D at the meeting at the AHA meeting 
Air pollution is a world wide enviromental threat recently implicated for several adverse cardiovascular effects including arterial hypertension.
It is a big contribution to global mortality, particularly cardiovascular mortality.
About 4.2 million deaths occur every year worldwide as a result of exposure to ambient pollution, according to the World Health Organization WHO.
One of three deaths, 34 per cent, from air pollution are due to ischemic heart disease and 20 per cent from stroke
Particular matter of 2.5, PM2.5, are important because they can carry toxic substances that can penetrate through the capillaries to the circulation
These particles are 32 smaller in diameter than a human hair. They are the size of a rat cell.
Air pollutions and exposure to these particles can trigger oxidative stress and systematic inflammation that leads to endothelial dysfunction, autonomic nervous system imbalance and vasoconstriction. A short-term increase in air pollution can raise blood pressure rapidly.
An increase in ambient PM2.5 by 10 micro per cubic  meter is associated with 3 mm Hg increase in systolic and diastolic blood pressure in just a few days.
Long-term exposure to the particles may cause hypertension by impairing renal sodium excretion.
According to WHO 92 percent of pollution related deaths occur in low and middle income countries, India and China have some of the world’s highest concentration of particulate matter.
In some countries as the USA lower level air pollution can still lead to increased blood pressure, insulin resistance, typ 2 diabetes, atherosclerosis, systematic oxidative stress and thrombosis.
Clinicians should be aware that cold temperature can increase blood pressure and hypertension is more difficult during cold and winter, besides the air pollution effects.
A link violence and CVD
Established literature demonstrates that children who undergo adverse cultural experiences are at risk for both violent behavior and early onset of cardiovascular risk factors.
Being the victim of violence, witnessing violence and even such as divorce or abuse are all considered adverse cultural events ACE
Evidente also suggest that people with post-traumatic stress disorder are at high risk for the premature onset of CVD risk factors as hypertension, typ 2 diabetes and high cholesterol
Stressful life experiences may elicit proliferative responsens in the endothelium that become nidus for atherosclerosis and could lead to potential consequences such as high blood pressure, said selvyn rogers, Md, founding director of the new univ of Chicago medicine trauma center. He shared perspectives on managing the burden in Communities where it is ongoing concern
From AHA sa
Environmental Noise Linked to Increased Cardiovascular Risk
Further evidence that people living in areas with high levels of environmental noise have a higher risk for cardiovascular events has come from a new study.
The study also suggests that this link is mediated by increased activity in the amygdala, an area of the brain involved in stress response and thought to trigger arterial inflammation.
"We found that people living in areas with a higher level of noise had increased activity in the amygdala, showing a higher level of stress perception," lead author Azar Radfar, MD, Massachusetts General Hospital, Boston, told | Medscape Cardiology. "They also had higher levels of arterial inflammation and cardiovascular events. The results were the same after adjustment for many confounders, including air pollution.
She added that they can't yet say that noise is a causal risk factor for cardiovascular disease; larger, longitudinal studies and research assessing interventions will be required for that.
"But our results strengthen the link between environmental noise and cardiovascular risk," she said. "While we all currently focus on the known cardiovascular risk factors, such as diabetes, blood pressure, and cholesterol, we believe that, going forward, environmental factors, including noise levels, also need to be considered when thinking about the risks for cardiovascular disease."
Patients and their physicians should consider chronic noise exposure when assessing cardiovascular risk and might want to take steps to minimize or mitigate such chronic exposure, Radfar said.
The study is to be presented at the upcoming American Heart Association Scientific Sessions 2018.
Important Results
In a Skype "perspective" on the study, American Heart Association volunteer expert, Richard C. Becker, MD, University of Cincinnati Heart, Lung & Vascular Institute, described the results as "important and intriguing."
For the study, the researchers analyzed the association between noise exposure and major cardiovascular events in 499 individuals who were free of cardiovascular disease and cancer.
A subset of 281 subjects also underwent validated PET/CT imaging to assess arterial inflammation, and amygdalar activity, which was measured by uptake of the radiotracer fluorodeoxyglucose (FDG).
To gauge noise exposure, the researchers used the home addresses of the participants and derived noise-level estimates from the Department of Transportation's Aviation and Highway Noise Map.
The medical records of the participants were analyzed over a median follow-up of 3.7 years for the occurrence of cardiovascular events.
Results showed that individuals who lived in the areas with the highest levels of noise exposure had higher levels of amygdalar activity and more arterial inflammation.
Patients living in areas in the highest quartile of noise exposure had an amygdala/background brain FDG uptake ratio of 0.85, compared with 0.78 for those in the other three quartiles (P < .001).
During follow-up, 40 individuals experienced a major adverse cardiovascular event, with those in the highest quartile for noise exposure having more than a threefold higher risk for an event (hazard ratio, 3.35; P < .001).
This remained significant after adjustment for other cardiovascular risk factors and air pollution (P = .003).
American Heart Association (AHA) Scientific Sessions 2018: Abstract Su1287. To be presented November 11, 2018.
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