Comorbidities related to cardiovascular disease (CVD) and environmental pollution have emerged as serious concerns. The exposome concept underscores the cumulative impact of environmental factors, including climate change, air pollution, chemicals like PFAS, and heavy metals, on cardiovascular health. Chronic exposure to these pollutants contributes to inflammation, oxidative stress, and endothelial dysfunction, further exacerbating the global burden of CVDs. Specifically, carbon monoxide (CO), ozone, particulate matter (PM_2.5), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), heavy metals, pesticides, and micro- and nanoplastics have been implicated in cardiovascular morbidity and mortality through various mechanisms. PM_2.5 exposure leads to inflammation and metabolic disruptions. Ozone and CO exposure induce oxidative stress and vascular dysfunction. NO₂ exposure contributes to cardiac remodeling and acute cardiovascular events, and sulfur dioxide and heavy metals exacerbate oxidative stress and cellular damage. Pesticides and microplastics pose emerging risks linked to inflammation and cardiovascular tissue damage. Monitoring and risk assessment play a crucial role in identifying vulnerable populations and assessing pollutant impacts, considering factors like age, gender, socioeconomic status, and lifestyle disorders. This review explores the impact of cardiovascular disease, discussing risk-assessment methods, intervention strategies, and the challenges clinicians face in addressing pollutant-induced cardiovascular diseases. It calls for stronger regulatory policies, public health interventions, and green urban planning.

Background: Beta-blockers are widely prescribed across cardiovascular indications, yet their real-world cardiovascular adverse-event profiles across drug generations remain incompletely characterised in large pharmacovigilance datasets. Objective: The objective was to describe and compare cardiovascular adverse-event reporting patterns for atenolol, bisoprolol and nebivolol in the FDA Adverse Event Reporting System (FAERS). Methods: We performed a retrospective disproportionality analysis of FAERS reports using OpenVigil 2.1, covering each drug’s available reporting history from the first quarter of 2004 (2007 for nebivolol) through the third quarter of 2025 (FAERS 2025 Q3). Cardiovascular events were defined as individual MedDRA Preferred Terms; signals were assessed with the Reporting Odds Ratio (ROR, 95% CI) and Information Component (IC) under Evans’ criteria. Individual case safety reports were also analysed for demographics, seriousness and outcomes. Results: Atenolol was most strongly associated with bradycardia (ROR = 10.513), followed by pericardial haemorrhage (ROR = 7.067) and ventricular hypertrophy (ROR = 6.999). Bisoprolol showed the highest signals for diastolic dysfunction (ROR = 24.875), atrial tachycardia (ROR = 23.283) and chronic cardiac failure (ROR = 23.222). Nebivolol had the lowest overall reporting volume, although counts were not adjusted for exposure; its strongest signals were bradycardia (ROR = 9.619) and coronary artery stenosis (ROR = 9.351). Paediatric reports (0–17 years) were uncommon for atenolol and bisoprolol and nearly absent for nebivolol; none of the three is FDA-approved in this group. Reports mainly involved older adults (60–89 years), and a substantial proportion were classified as serious. Conclusions: All three agents generated significant signals across a broad range of cardiovascular events. Nebivolol had the lowest reporting volume, but this should not be interpreted as evidence of a safer profile. Because FAERS disproportionality cannot establish causality, these findings are hypothesis-generating and require prospective confirmation before they can inform beta-blocker selection.

Background: Beta-blockers are widely prescribed across cardiovascular indications, yet their real-world cardiovascular adverse-event profiles across drug generations remain incompletely characterized in large pharmacovigilance datasets. Objective: To compare the cardiovascular safety profiles of atenolol, bisoprolol and nebivolol using the FDA Adverse Event Reporting System (FAERS). Methods: Retrospective disproportionality analysis of FAERS reports via OpenVigil 2.1, covering each drug’s available reporting history through January 1st, 2026. Cardiovascular events were identified with Standardized MedDRA Queries; signals were assessed with the Reporting Odds Ratio (ROR, 95% CI) and Information Component (IC) under Evans’ criteria. Individual case safety reports were analysed for demographics, seriousness and outcomes. Results: Atenolol was most strongly associated with bradycardia (ROR = 10.513) and left ventricular hypertrophy (ROR = 6.765). Bisoprolol showed the highest signals for diastolic dysfunction (ROR = 24.875), atrial tachycardia (ROR = 23.283) and chronic cardiac failure (ROR = 23.222), together with the highest bradycardia-associated mortality (14.9%). Nebivolol had the lowest overall reporting burden, though counts are not exposure-adjusted; its strongest signals were bradycardia (ROR = 9.619) and coronary artery stenosis (ROR = 9.351), with lower bradycardia mortality (12.6%). Pediatric reports (0–17 years) occurred for all three agents at similar proportions, none FDA-approved in this group. Reports predominantly involved older adults (60–89 years), with a substantial proportion classified as serious. Conclusion: All three agents generated significant signals across a broad range of cardiovascular events, with nebivolol showing the most favourable profile. Because FAERS disproportionality cannot establish causality, these hypothesis-generating findings may inform beta-blocker selection in older or higher-risk patients, particularly those prone to bradyarrhythmias or diastolic dysfunction, pending prospective confirmation.