Editing IPCC:AR6/WGII/Chapter-7 (section)

==== 7.2.3.1 Cardiovascular Diseases ====

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CVDs are a group of disorders of the heart and blood vessels that include coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism. CVDs are the leading cause of death globally and over three quarters of the world’s CVD deaths now occur in low- and middle-income countries ( [[#Roth--2020|Roth et al., 2020]] ).

''Climate change affects the risk of CVD through high temperatures and extreme heat (assessed in [[#7.2.4.1|Section 7.2.4.1]] ) and through other mechanisms (medium confidence), though the degree to which non-temperature risks may increase remains unclear.'' For example, exposure to air pollutants including PM, ozone (via its precursors), black carbon, oxides of nitrogen, oxides of sulphur, hydrocarbons and metals can invoke pro-inflammatory and prothrombotic states, endothelial dysfunction and hypertensive responses ( [[#Giorgini--2017|Giorgini et al., 2017]] ; [[#Stewart--2017|Stewart et al., 2017]] ). Winter peaks in CVD events, associated with greater concentrations of air pollutants, have been reported in a range of countries and climates ( [[#Claeys--2017|Claeys et al., 2017]] ; [[#Stewart--2017|Stewart et al., 2017]] ); however, the association between air pollution, weather and CVD events is complex and seems to differ between cold and warm months, particularly for gaseous pollutants such as ozone ( [[#Shi--2020|Shi et al., 2020]] ).

Climate change is projected to increase the number and severity of wildfires ( [[#Liu--2015b|Liu et al., 2015b]] ; [[#Youssouf--2014|Youssouf et al., 2014]] ) and the evidence for wildfire smoke-related CVD morbidity and mortality is suggestive of increased CVD morbidity and mortality risk ( [[#Chen--2021a|Chen et al., 2021a]] ) including significant increases in certain cardiovascular outcomes (e.g., cardiac arrests) ( [[#Dennekamp--2015|Dennekamp et al., 2015]] ). CVD risks to highly exposed populations, such as firefighters, are clearer ( [[#Navarro--2019|Navarro et al., 2019]] ) and could increase with additional exposure driven by climate change.

Other climate-related mechanisms that may increase CVD risk include reductions in physical activity related to hot weather ( [[#Obradovich--2017|Obradovich et al., 2017]] ), sleep disturbance ( [[#Obradovich--2017|Obradovich et al., 2017]] ) and dehydration ( [[#Lim--2015|Lim et al., 2015]] ; [[#Frumkin--2019|Frumkin and Haines, 2019]] ). There is little literature on how changes in winter weather may affect these risks. Saline intrusion of groundwater related to sea level rise ( [[#Taylor--2012|Taylor et al., 2012]] ) may increase the salt intake of affected populations, a risk factor for hypertension that has been observed to increase blood pressure in exposed populations ( [[#Talukder--2017|Talukder et al., 2017]] ; Al [[#Nahian--2018|Nahian et al., 2018]] ).

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