Heatwaves and cold spells are linked to an increase in major cardiovascular events, which are further exacerbated by air pollution. Findings regarding the adverse effects of climate change and environmental pollution on cardiovascular risk were presented at ESC Preventive Cardiology 2026, the annual congress of the European Association of Preventive Cardiology (EAPC).

“Poland is now experiencing unprecedented periods of heatwaves alongside extreme cold snaps. We assessed the acute health impacts of these temperature extremes,” explains Professor Łukasz Kuźma from the Medical University of Białystok, Poland.

A geospatial analysis of data covering eight million residents of Eastern Poland was conducted. Data on acute hospitalizations and all-cause mortality from 2011 to 2020 were obtained from the National Health Fund. The primary endpoint—major adverse cardiovascular and cerebrovascular events (MACCE)—included cardiovascular death, ST-segment elevation myocardial infarction (STEMI), and ischemic stroke.

During this period, 573,538 cases of acute cerebrovascular accidents, 377,373 cardiovascular deaths, and 831,246 all-cause deaths were recorded. Both heatwaves and cold spells were associated with a significant increase in incidents, though with different temporal patterns. Heatwaves had an immediate impact: during such periods, cases of acute cerebrovascular accidents increased by 7.5%, and cardiovascular mortality rose by 9.5%. Cold waves had a delayed and more sustained effect, with the risk of MACCE rising between 4.0% and 5.9% in the days following exposure, while cardiovascular death risk increased between 4.7% and 6.9%.

Air pollution worsened the effects of extreme temperatures: $O_3$ and benzo[a]pyrene intensified the consequences of heatwaves, while $O_3$, fine particulate matter (PM2.5), and $NO_2$ amplified the effects of extreme cold. “The results demonstrate a significant cumulative risk associated with temperature extremes and air pollution in driving cardiovascular disease,” says Professor Kuźma.

In a separate analysis, the short-term and long-term impacts of air pollution on major adverse cardiovascular events (MACE; myocardial infarction and cardiovascular death) were evaluated.

Of the 377,344 cardiovascular deaths recorded, approximately 13% were linked to air pollution, accounting for 71,440 years of life lost over a decade. PM2.5 and benzo[a]pyrene were found to be significant contributors to the risk of MACE, with women and younger individuals showing the highest vulnerability. A monthly increase in exposure to air pollution was associated with a 10% increase in MACE; these effects were ~5% higher in women than in men, and ~9% higher in individuals under 65 compared to those over 65.

“While air pollution is recognized as a major cardiovascular risk factor, its impact is still underestimated,” stated Dr. Kuras. “These results challenge the traditional paradigm of risk factors, which suggests only specific populations are vulnerable. Our findings clearly indicate the need for coordinated public health policies to reduce air pollution levels, as well as further research to determine exactly who is at greatest risk and what mechanisms are responsible.”

Professor Kuźma concluded: “We will continue to study cardiovascular risk factors in a broader sense, including light and noise pollution, considering the interconnectedness of adverse environmental changes—their acute and chronic consequences, as well as their direct and indirect impacts on individuals and the healthcare system. We also aim to develop a method to integrate environmental factors into cardiovascular risk prediction algorithms to more effectively direct preventive measures.”