"There is now ample evidence that air pollution is associated with cardiovascular morbidity and mortality," said corresponding author Robert Storey from the University of Sheffield, Britain.

"It not only makes existing heart conditions worse but also contributes to development of the disease," Storey added.There is a two-way interaction between air pollution and cardiovascular risk factors.

Obese people and those with diabetes may be at higher risk of the cardiovascular effects of pollution, while air pollutants may exacerbate and instigate the development of risk factors such as high blood pressure and impaired insulin sensitivity.

Avoiding air pollution, where possible, may help to reduce cardiovascular risk and cardiologists should incorporate this information into lifestyle advice for their patients, Storey pointed out.

"Avoid walking and cycling in streets with high traffic intensity, particularly during rush hour traffic," the authors from European Society of Cardiology recommended, adding that major traffic roads should be avoided while exercising.

Limiting time spent outdoors during highly polluted periods, especially infants, elderly, and those with cardiores piratory disorders could help cope with increasing air pollution.  

However, the role of indoor air pollution should not be downplayed."Indoor air quality in homes, schools, working places and community sites is not a trivial problem," the authors concluded.

The recommendations appeared in the European Heart Journal.

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