A Road Forward to Improve Public Health

Air quality has improved in many countries, including the United States, during the past few decades.1,2 Importantly, these gains have translated into observable health benefits. Reductions in fine particulate matter (PM) have significantly contributed to the increase in life expectancy in the United States since the 1980s.2 However, the burden of adverse health effects caused by high levels of air pollution continues to grow throughout many regions of the world. Outdoor air pollution ranks as the 8th-leading risk factor for death among high-income countries.3 Estimates are that anthropogenic fine PM contributes to ≈3.5 million cardiopulmonary deaths globally per year.4 Perhaps not well appreciated is the reality that cardiovascular (CV) deaths likely constitute the largest portion of this mortality.1Article see p 1721Despite improvements in vehicular emissions, many factors related to urbanization (eg, increased commuting, traffic congestion, denser road networks) conspire to make traffic-related sources a major cause of air pollution exposures worldwide.5 Compounding this problem in modern-day societies, mounting evidence implicates traffic as a specific pollution source associated with CV morbidity and mortality.5 Therefore, a better understanding of the CV effects posed by vehicular emissions, as well as feasible means to mitigate them, is of growing public health importance. In many regions, diesel engines are a major contributor to this pollution (eg, ≈50% of cars in Europe, areas of commercial goods movement, and ports).5 Most of the standard diesel vehicles and equipment in use today produce particle emissions that are many times greater than those produced by gasoline engines, and thus they warrant ongoing attention.5In the present issue of Circulation , Lucking et al report the results of a study investigating a host of CV responses after short-term diesel exhaust exposure.6 Their protocol used well validated …