Environmental pollution: a cardiovascular, life-threatening risk factor. Is there a different impact between sexes? A narrative review

. Some studies have shown that there are differences in cardiovascular outcomes related to long-term exposure to air pollution, particularly fine particulate matter, between men and women. Moreover, climate change could play an important role as a risk-amplifier in the relationship between pollution and cardiovascular diseases, especially in more vulnerable individuals. While both sexes are affected by air pollution, some researchers suggest that women may be more susceptible to its cardiovascular effects than men, although the results are not entirely consistent. Several studies have indicated that women, especially postmenopausal women, may experience a greater increase in cardiovascular risks, including hypertension, myocardial infarction, and stroke, compared to men when exposed to high levels of particulate matter (PM2.5). This heightened susceptibility could be due to differences in biological factors like hormonal status (e.g., estrogen may offer some protective effects that diminish after menopause), smaller airways, and differences in inflammatory responses. Some authors also reported that women tend to have more nonfatal cardiovascular events compared to men, though fatal events are also increased. On the other hand, men may have a higher incidence of certain other cardiovascular outcomes, such as heart failure, in response to pollution exposure, but overall, the sex differences indicate slightly worse outcomes for women. Pre-menopausal women, who still have higher levels of estrogen, might experience some protection against cardiovascular damage caused by air pollution, whereas post-menopausal women lose that hormonal protection. Women may experience greater oxidative stress and inflammatory responses in response to air pollution compared to men. This can accelerate atherosclerosis (hardening of the arteries) and other cardiovascular conditions. Moreover, some gender differences highlighted in recent studies have suggested that women, due to lifestyle factors or occupational differences, may be exposed to more indoor pollution (from cooking, household activities, etc.) in addition to outdoor air pollution, potentially increasing their overall exposure. While the consensus points to women being more vulnerable to the cardiovascular effects of PM2.5 exposure, more research is needed to fully understand these differences, as some studies have shown more mixed results. Nonetheless, acknowledging these sex-specific differences can help in tailoring prevention and treatment strategies to reduce cardiovascular risk.