HeatRisk and air quality risk recommendations: A narrative review and action algorithm for the care of people at risk for and living with cardiovascular disease.

Authors

Elizabeth Beveridge, Jose Ramon Medina Inojosa, Riya Goel, Rebecca Philipsborn, Zachary T Martin, Kristen Harris, Noah Newman, Sanjay Rajagopalan, Laurence Sperling

Published in

American journal of preventive cardiology. Volume 31. Pages 101704. Epub Jun 15, 2026.

Abstract

Cardiovascular disease remains the leading cause of mortality worldwide and is influenced by climate change-related exposures. Non-optimal temperature and poor air quality exposure worsens cardiovascular outcomes, particularly for individuals with preexisting cardiovascular disease. While the Centers for Disease Control and Prevention and Environmental Protection Agency recommend tools like HeatRisk and Air Quality Index, there is limited guidance for implementation in those with preexisting cardiovascular disease. This narrative review addresses this gap.
A literature review was conducted using PubMed, supplemented by snowballing to identify studies published between 2000 and 2025 related to the cardiovascular effects of temperature extremes and poor air quality. Systematic reviews and meta-analyses were prioritized, particularly those that addressed risk factors such as pregnancy, obesity, geography, and socioeconomic status. Additional context was obtained from public health agencies including the Centers for Disease Control and Prevention, Environmental Protection Agency, and National Weather Service. The pathophysiology and risk factors were then applied to the existing guidance, recommendations, and algorithms of these agencies.
Non-optimal temperature and poor air quality are associated with an increased mortality and morbidity in patients with heart failure, ischemic heart disease, stroke, and myocardial infarction. These exposures also worsen cardiometabolic risk factors such as hypertension, insulin resistance, and atherosclerosis. High-risk subgroups included women, older adults, residents of temperate climates, individuals taking certain medications, pregnant individuals, and those with socioeconomic or occupational exposure risk.
Patients with cardiovascular disease should be counseled on the risks associated with non-optimal temperature and poor air quality. It is recommended that high risk individuals (risk score greater than or equal to three) should take precautions at HeatRisk Level 1 (Yellow) and/or the AQI ≥ 50, while moderate risk individuals (score less than two) should consider precautions at HeatRisk Level 2 (Orange) and/or AQI ≥ 100 (Central Illustration).

PMID:
42892957
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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