Heatwaves and coldwaves are associated with increases in major cardiovascular events that are exacerbated by air pollution.1 Concerning results on the adverse impact of climate change and pollution on cardiovascular risk were presented today1,2 at ESC Preventive Cardiology 2026 , the annual congress of the European Association of Preventive Cardiology (EAPC), a branch of the European Society of Cardiology (ESC).
"Climate change is driving extreme weather events, yet temperate climates remain understudied," explained Professor Lukasz Kuzma from the Medical University of Bialystok, Poland. "Poland is now seeing unprecedented heatwaves alongside existing coldwaves. We assessed the acute health impacts of these temperature extremes as part of the Polish Smog EP-PARTICLES cohort study."
A geospatial analysis was performed of more than eight million residents of Eastern Poland. Data on acute hospitalisations and all-cause deaths from 2011–2020 were obtained from the National Health Fund.1 Heatwave and coldwave events were indexed using the Excess Heat/Cold Factor. The primary endpoint of major adverse cardiovascular and cerebrovascular events (MACCE) included cardiovascular death, ST-segment elevation myocardial infarction and ischaemic stroke.
Over the time period, 573,538 MACCE events, 377,373 cardiovascular deaths and 831,246 all-cause deaths were recorded. Both heatwaves and coldwaves were associated with significant increases in events, but with distinct temporal patterns. Heatwaves had an immediate impact. On the day of exposure to heatwaves, MACCE increased by 7.5% and cardiovascular deaths increased by 9.5%. Coldwaves produced a delayed and more sustained effect, with the risk of MACCE rising from 4.0% to 5.9% over several days after exposure and the risk of cardiovascular death rising from 4.7% to 6.9%.
Exposure to air pollution further amplified the effects of extreme temperatures, with O3 and benzo[a]pyrene intensifying the effects of heatwaves, while O3, particulate matter (PM2.5) and NO2 exacerbated the impact of coldwaves. "Our results highlight that the problems of climate change now extend to Northern Europe and demonstrate the considerable combined hazards of temperature extremes and air pollution on increasing cardiovascular events," said Professor Kuzma.
A separate analysis from the EP-PARTICLES cohort, presented by Doctor Anna Kurasz from the Medical University of Bialystok, Poland, evaluated the short- and long-term effects of air pollution on major cardiovascular events (MACE; myocardial infarction and cardiovascular death).2
A total of 377,344 deaths due to cardiovascular disease were recorded. Around 13% of cardiovascular deaths were associated with air pollution, corresponding to 71,440 years of life lost over the decade. PM2.5 and benzo[a]pyrene were found to be important contributors to MACE risk, with the greatest vulnerability observed in women and younger people. Monthly air pollution exposure increases were associated with up to a 10% rise in MACE and these effects were ~5% higher in women than men and ~9% higher in individuals aged younger than 65 years compared with older than 65 years.
"Even though air pollution is recognised as a major cardiovascular risk factor, it is still underappreciated," stated Doctor Kurasz. "These results challenge the traditional risk factor paradigm about which groups of individuals are most susceptible. Our findings clearly support the need for coordinated public health policies aimed at reducing air pollution and also for further investigations into who is most affected and the mechanisms responsible."
Professor Kuzma concluded: "With our collaborators, we will continue to study the wider exposome, including light and noise pollution, considering the interconnectedness of adverse environmental changes, their acute and chronic impact, and the direct and indirect effects on individuals and the healthcare system. We also aim to develop a method to incorporate environmental factors into a cardiovascular risk prediction algorithm to enable more effective targeting of preventive efforts."
