[The cardiovascular exposome: areas of action for prevention and practical cardiology]

Environmental risk factors are recognized as essential determinants of the cardiovascular disease burden but are still poorly represented in clinical guidelines. External environmental exposures such as air pollution, traffic noise, heat, light pollution, chemical contamination of soil and water as well as urban planning, our social environment and lifestyle contribute significantly to the global disease burden and premature deaths. In particular, cardiovascular morbidity and mortality are significantly influenced by these environmental stressors. The exposome concept provides an overarching framework for this by associating lifelong external exposures with changes in biological processes such as oxidative stress, inflammatory responses, vascular damage, metabolic dysregulation, disturbances of circadian regulation, our circadian clock, and the resulting chronic diseases and deaths. Environmental exposures not only increase the risk of chronic diseases in healthy individuals but also amplify classic risk factors, worsen the prognosis for vulnerable groups, and thus open concrete prevention and intervention opportunities in outpatient and inpatient care. Practicing cardiologists can systematically integrate environmental exposures into medical history taking, identify particularly at-risk individuals, recommend behavior-related protective measures, work interdisciplinarily with general practitioners and occupational physicians, and at the same time advocate for heart-healthier living environments in health policy. This review summarizes the current evidence on the impact of the exposome on cardiovascular health and derives recommendations for cardiologists from it. The goal is to view the exposome from the perspective of daily care: from risk stratification to patient-centered interventions to structural measures at the level of practice, clinic, and society.