Heart healthy cities: Genetics loads the gun but the environment pulls the trigger

Thomas Münzel, Mette Sørensen, Jos Lelieveld, Omar Hahad, Sadeer Al-Kindi, Mark Nieuwenhuijsen, Billie Giles-Corti, Andreas Daiber, Sanjay Rajagopalan

Research output: Contribution to journalReview articlepeer-review

64 Scopus citations


The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.

Original languageEnglish (US)
Pages (from-to)2422-2438
Number of pages17
JournalEuropean heart journal
Issue number25
StatePublished - Jul 1 2021


  • Air pollution
  • Environmental stressors
  • Heart healthy city
  • Heat islands effects
  • Light pollution
  • Noise pollution
  • Urban and transport planning and design interventions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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