[Green paper ANMCO: Environmental sustainability in cardiology: a shared commitment of healthcare professionals]

Environmental sustainability represents an emerging priority for cardiology, owing to the close interconnection between planetary health and human health, with cardiovascular diseases constituting the main clinical outcome. The global healthcare sector accounts for approximately 4-5% of total greenhouse gas emissions, and cardiology contributes substantially to this burden because of its high resource intensity in diagnostic testing, interventional procedures, and energy consumption. At the same time, environmental factors such as air pollution, extreme temperatures, defined as values significantly above or below the regional average caused by climate change, and exposure to emerging contaminants, including heavy metals (lead, cadmium, arsenic) and micro- and nanoplastics are increasingly recognized as major determinants of cardiovascular risk. Chronic exposure to these pollutants is associated with oxidative stress, systemic inflammation, and accelerated progression of atherosclerosis. Strategies for sustainable cardiology primarily aim to reduce emissions related to energy use and supply chains. Priority actions include adopting circular economy principles (reduce, reuse, recycle), improving the appropriateness and optimization of diagnostic testing favoring lower environmental impact modalities, such as echocardiography, over carbon-intensive techniques and implementing telemedicine to reduce patient and provider travel. Furthermore, primary cardiovascular prevention can be considered an effective "double-benefit strategy", capable of simultaneously reducing disease burden and the demand for emission-intensive healthcare. In this context, healthcare professionals and scientific societies, including ANMCO, are called upon to lead a cultural shift by integrating environmental sustainability as a core ethical principle of contemporary cardiology practice.