Associations between exposure to fine particulate matter and impacts in the cardiorespiratory system are well-established, but associations are expected to vary based on exposure duration and concentration. Domestic and international agencies set standards and guidelines for PM2.5 in part to protect public health. This systematic review explores if associations exist between adverse cardiovascular endpoints and PM2.5 exposure when the concentrations are below regulatory standards. In total, 1349 documents were screened, with 95 articles meeting criteria (i.e. peer-reviewed, PM2.5 concentrations reported, cardiovascular endpoints measured). Of the included articles, 67% (64 articles) observed significant associations with adverse cardiovascular endpoints with variable findings based on specific cardiovascular endpoints (e.g. direct measurements – 69% of articles, cardiovascular endpoints – 44% of articles, events and mortality – 76% of articles, and biomarkers – 67% of articles). While not universally consistent, significant associations were observed between PM2.5 exposure and adverse cardiovascular effects, even at levels deemed compliant with current regulations. This review highlights the necessity for further research across diverse geographical settings and populations to clarify the implications of low-level PM2.5 exposure on cardiovascular health. The findings advocate for a review of regulatory standards for PM2.5 exposure in the context of cardiovascular health.
Published May 15, 2026
Roper, C., Aminone, V. T., Abedin, M., Fletcher, L. M., Harden, L., Stewart, J. A., & Faruque, F. S. (2026). A systematic review of low-level ambient fine particulate matter (PM2.5) exposures and adverse cardiovascular health outcomes. Environmental Pollution, 397, 127978. https://doi.org/10.1016/J.ENVPOL.2026.127978