The recent update of the  Global Burden of Disease study in the Lancet of December 17, 2014 explores the mechanisms and relationships between ambient air pollution and cardiovascular disease to highlight and raise awareness of the importance and wide-ranging impact of air pollution on cardiovascular disease. The study also provides guidance to society, patients, and healthcare professionals on the potential health impacts of air pollution, and make recommendations for future public health and research priorities to manage and mitigate this avoidable cause of death and increasingly worrying link of air pollution to diseases of normally healthy human beings. It also indicates the global  impact of air pollution with as many as 3.1 million of 52.8 million all-cause and all-age deaths being attributable to ambient air pollution in the year 2010.1  The publication comes in the same week that the EC announced that the EU clean air directive, designed to reduce the health impacts from air pollution and a waste directive that would set states the target of recycling 70% of waste by 2030, were at risk as part of their current regulation review. The EHA signed a joint letter last year to urge the EU Commission to ensure that separate clean transport regulations would be implemented by the new EU Commission and not only as part of the EU Emission Trading System.

The EU clean air package would have set more stringent pollution emission limits than ever before, including regulation of harmful substances such as fine particulate matter (PM2.5) for the first time. EU analysts believe that the measures would save 58,000 premature deaths a year, with annual health benefits of between €40bn and €140bn. But the proposal will now be adapted and repackaged as an adjunct to the EU’s 2030 climate and energy targets, in a more appetizing way for industry and EU states, Vice president of the EU Commission Timmermans said.

“We will bring forward a modified [air quality] programme that will better reflect synergies with the 2030 energy and climate package and reduce unnecessary burdens,” he told the European Parliament in Strasbourg. “We are not compromising on the goals we want to attain, but looking critically at the methods we can bring to bear so that we have a measure we can implement soon.”

Timmermans said the proposal had to be put on ice because of an emerging gap between what Parliament and EU states might see as an “acceptable outcome” to negotiations. EU emissions regulations now require real-world testing for vehicles, with plans to bring in further real world testing in future, including for nitrogen oxide emissions from light-duty diesel vehicles. At a hearing on December 4 in the EU Parliament on Air Quality Daimler AG’s Klaus Land said that such regulation would need a  legal basis to ensure the same stringency for RDE (Real Driving Emissions) tests across the board, HE emphasised that the industry  is not blocking or delaying RDE but that it was proposing a RDE package that “will lead to a simultaneous air quality benefit” and it is of “comparable” stringency to the Euro VI RDE programme. He explained that due to necessary “massive” hardware changes at car manufacturing plants to bring in new RDE tests, the industry’s stance is that the only way an RDE regulation can be brought in is via a gradual ‘2-step’ approach, including an intermediate and a final step. This, Mr Land said, would lead to the ACEA’s proposed RDE regulation being introduced from perhaps shortly after 2020, but he added that meeting EU NO2 limits would depend on the rate of introduction of RDE compliant vehicles on roads, which “is not in the control of the industry”.

Ambient air pollution ranked ninth among the modifiable disease risk factors, being listed above other commonly recognized factors, such as low physical activity, a high-sodium diet, high cholesterol, and drug use. Finally, air pollution accounts for 3.1% of global disability-adjusted life years, an index that measures the time spent in states of reduced health.1

Historically, the 1952 Great Smog of London led to an increase in cardiovascular death as well as deaths due to respiratory disease. Subsequent studies in the 1990s, such as the Harvard Six Cities2 and American Cancer Society cohort studies,2,3 established an enduring positive association between long-term exposure to air pollution and total and cardiovascular mortality, mainly due to coronary artery disease.4 In Europe, the first study that supported this association between long-term exposure and mortality was the Netherlands Cohort Study on Diet and Cancer.5 Associations with cardiovascular morbidity and mortality are also seen with short-term (e.g. day-to-day fluctuations) pollutant exposures of residents in large urban areas worldwide, including the United States of America6 and Europe.7,8 Among multiple pathways linking air pollution to cardiovascular morbidity and mortality, the most relevant are the induction of oxidative stress, systemic inflammation, endothelial dysfunction, atherothrombosis, and arrhythmogenesis.9 (Photo: EV traffic jam in Rotterdam)