The European Environment Agency (EEA) recently released their ‘Environmental noise in Europe 2025‘ report, highlighting the effect of noise pollution on human health across Europe.1 The report linked environmental noise to increased cardiovascular risk, underscoring the need to consider noise exposure in patient assessments and preventive care strategies. In this interview, Prof. Thomas Münzel (University Medical Center of Mainz, Germany), Chairman of the European Society of Cardiology (ESC) Environmental Sustainability Task Force, explores the findings of the EEA’s 2025 noise report, highlighting new scientific evidence linking chronic environmental noise to cardiovascular disease (CVD) and metabolic disease, and amplify calls for urgent regulatory action.
Q. What are the key mechanisms linking noise to cardiovascular disease?
Environmental noise, particularly from road, rail, and aircraft traffic, has emerged as a major cardiovascular and metabolic health threat in Europe, comparable in impact to traditional risk factors like smoking, diabetes, and hypertension. Recent evidence, including the EEA 2025 Report, indicates that chronic noise exposure contributes to 66,000 premature deaths and 50,000 new CVD cases annually across Europe, along with 22,000 cases of type 2 diabetes. The pathophysiological mechanisms involved are2,3:
- Autonomic nervous system imbalance: Noise activates the sympathetic nervous system (SNS), leading to increased heart rate, blood pressure, and vascular tone. Night time noise disrupts parasympathetic (vagal) recovery and promotes stress arousals.
- Sleep fragmentation and circadian disruption: Night noise disturbs deep sleep stages, reduces overall sleep quality, and interrupts nocturnal blood pressure dipping. Circadian misalignment increases risk for hypertension, metabolic syndrome, and systemic inflammation.
- Oxidative stress: Noise triggers the overproduction of reactive oxygen species (ROS) via NADPH oxidase (especially NOX2, enzyme in inflammatory cells such as macrophages), leading to vascular and myocardial damage.
- Systemic inflammation: Elevated levels of pro-inflammatory cytokines (e.g. IL-6, TNF-α) are found in noise-exposed subjects, contributing to endothelial dysfunction and atherosclerosis.
- Endothelial dysfunction: As an early marker of CVD, this involves impaired nitric oxide (NO) bioavailability, vascular stiffness, and reduced vasodilation in response to noise exposure.
Q. How does noise compare to traditional risk factors for cardiovascular disease?
Noise-induced vascular damage occurs even below current legal thresholds, starting at ~45 dB Lden, well below EU reporting levels (55 dB Lden). The burden of disease from noise is greater than that from second-hand smoke or lead and ranks just behind air pollution and heat in environmental health risk rankings. Unlike traditional risk factors, noise acts as an external, involuntary stressor; people cannot easily avoid it, especially in urban settings.
Environmental noise is a non-traditional but equally potent cardiovascular risk factor, operating through validated biological pathways shared with classic stressors. Its effects are particularly insidious due to chronic low-grade activation of stress systems, often during sleep, leading to cumulative vascular and metabolic harm. Recognition of noise as a cardiovascular risk factor is increasingly supported by both the scientific and cardiology communities and should be integrated into prevention guidelines and public health strategies.
Q. How should the new evidence on noise levels influence prevention guidelines?
The new evidence on noise levels, especially from the EEA 2025 report, WHO guidelines, and cardiovascular research, demands a paradigm shift in prevention guidelines.1,4,5 Prevention strategies should adapt by:
- Lowering thresholds in risk assessment:
Current EU Environmental Noise Directive (END) thresholds (55 dB Lden / 50 dB Lnight) are insufficiently protective. New studies show adverse cardiovascular effects begin at ~45 dB Lden, particularly for myocardial infarction, stroke, and hypertension. WHO 2018 noise guidelines recommend stricter limits (e.g., Lnight ≤ 40 dB for aircraft noise, Lden ≤ 53 dB for road noise); these should be incorporated as binding targets, not just voluntary guidance.5
Action: Prevention guidelines should adopt WHO noise thresholds as clinical cut-offs for environmental risk.
- Integrating noise into cardiovascular risk scores:
Despite being a proven modifiable risk factor, noise is absent from current cardiovascular risk assessment tools (e.g., SCORE2, Framingham). The cumulative vascular damage from chronic stress, oxidative stress, and sleep disruption justifies inclusion in primary prevention metrics.
Action: Introduce noise exposure (especially night time) into CVD risk calculators and patient anamnesis.
- Educating and training healthcare professionals:
Most clinicians are not trained to assess or discuss noise exposure. There is a disconnect between emerging evidence and clinical routine.
Action: Include environmental noise in medical curricula, continuing education, and ESC prevention guidelines.
- Promoting structural prevention (urban and transport policy):
Prevention is not limited to medication and lifestyle, it requires intersectoral action. Urban planners and cardiologists must collaborate to: implement quiet zones, green corridors, and building insulation, and enforce traffic calming, curfews for flights, and low-noise transport technologies.
Action: Cardiovascular prevention guidelines must advocate urban-level interventions as medical necessities.
- Emphasizing vulnerable populations:
Children, the elderly, and people with existing CVD are disproportionately affected by noise. Guidelines should prioritize protection for patients with hypertension, diabetes, and stroke risk, and pregnant women and children in learning environments.
Action: Tailor prevention efforts to high-risk groups and promote equitable noise mitigation.
Noise is no longer just a nuisance, it is a measurable, modifiable cardiovascular risk factor. Prevention guidelines should urgently reflect this reality by integrating:
- Stricter thresholds;
- Environmental anamnesis;
- Education of health professionals;
- Urban planning collaboration; and
- Targeted protection of vulnerable populations.
This is not just policy; it is clinical prevention. A Europe that listens will also be a Europe that protects the heart.
Q. What role should cardiologists play in addressing environmental noise?
Cardiologists have a critical, multifaceted role in addressing environmental noise; as clinicians, educators, advocates, and collaborators. With robust evidence linking transportation noise to CVD, it is no longer sufficient for cardiologists to focus solely on traditional risk factors like cholesterol or blood pressure. Cardiologists should:
- Recognize noise as a full-fledged cardiovascular risk factor
Cardiologists must treat chronic noise exposure as they would hypertension, smoking, or diabetes. Noise triggers oxidative stress, autonomic imbalance, circadian disruption, and endothelial dysfunction; all key pathways in CVD.
Action: Noise exposure history should be part of the routine patient anamnesis, especially in patients with unexplained hypertension, arrhythmias, or sleep disorders.
- Educate patients about risks and protective measures
Most patients are unaware that living near busy roads, railways, or flight paths may damage their cardiovascular system, even while asleep. Cardiologists should advise them on reducing night time exposure (e.g., closing windows, bedroom relocation), using soundproofing, white noise, or earplugs; and choosing low-noise housing when possible.
Action: Patient-centred counselling about noise exposure must become standard, especially for high-risk groups.
- Advocate for environmental health integration in guidelines
The ESC, AHA, and other societies must formally include environmental noise in their prevention and management guidelines. Cardiologists, particularly those in leadership roles, should push for this shift through task forces, position papers, and conference platforms.
Action: Cardiologists should promote evidence-based noise thresholds (e.g., WHO guidelines) as part of cardiovascular prevention frameworks.
- Collaborate with urban planners and policy makers
Clinical prevention cannot succeed in isolation; urban and transport policy must be part of the solution. Cardiologists can support flight curfews and traffic quiet zones; contribute to health impact assessments of urban development; and promote green and quiet infrastructure.
Action: Position noise mitigation as a medical intervention, not just urban design.
- Raise awareness among peers and the public
Environmental noise is under-recognized, even among health professionals. Cardiologists can write op-eds, join public discussions, and teach students about the cardiovascular costs of noise.
Action: Cardiologists should act as translators of science for policymakers and citizens alike.
Cardiologists are no longer just heart specialists, they must now also be defenders of cardiovascular environments. From clinic to city hall, their voices can help silence a major health threat. By integrating noise into risk assessments, educating patients, shaping guidelines, and influencing urban policy, cardiologists can play a leading role in preventing noise-related heart disease, and in building a Europe that listens.
Q. Which cardiac patients should be screened or counselled on noise exposure?
Cardiologists should screen and counsel a broad spectrum of cardiac patients on noise exposure, especially those most vulnerable to its vascular, metabolic, and neuroendocrine effects. Emerging evidence shows that noise is not just a nuisance but a silent trigger and amplifier of cardiovascular disease. High-priority groups for screening and counselling include:
- Patients with arterial hypertension
Noise exposure, especially at night, is strongly linked to increased systolic blood pressure, non-dipping patterns, and morning surges. Even “controlled” hypertensive patients may experience nocturnal blood pressure instability due to traffic or aircraft noise.
Action: Minimize night time noise (≤ 40 dB Lnight per WHO), improve sleep hygiene, and consider ambulatory BP monitoring.
- Post-myocardial infarction or heart failure patients
These patients are especially sensitive to sympathetic overdrive and endothelial dysfunction, both exacerbated by chronic noise exposure. Nocturnal aircraft or road noise can impair vascular repair, raise oxidative stress, and worsen outcomes.
Advice: Avoid sleeping near noise sources, use bedroom insulation, and consider shifting bedrooms away from street-facing façades.
- Patients with atrial fibrillation or other arrhythmias
Environmental noise causes autonomic imbalance, increasing catecholamines and vagal withdrawal, known arrhythmogenic mechanisms.
Advice: Reduce exposure to peak noise events (e.g., aircraft takeoffs), particularly during rest or sleep.
- Patients with type-2 diabetes or metabolic syndrome
Chronic noise is a recognized metabolic stressor, contributing to insulin resistance, inflammation, and visceral adiposity. New data from the EEA report attributes 22,000 annual diabetes cases to noise exposure in Europe.
Advice: Combine lifestyle counselling with environmental risk reduction, especially in urban settings.
- Sleep-impaired or shift-working patients
Noise-exacerbated sleep fragmentation increases cardiovascular risk independently. Those with obstructive sleep apnea, shift work, or poor sleep hygiene are highly susceptible to non-restorative sleep and cortisol dysregulation from noise.
Advice: Prioritize bedroom sound insulation, use of white noise or earplugs, and promote circadian-friendly routines.
- Patients living near high-noise infrastructure
Individuals living within 300 meters of highways, railways, or airports, or in high-density urban settings, should be asked about annoyance, sleep quality, and window habits.
Advice: Consider using noise exposure maps, smartphone apps, or municipal noise reports as part of exposure assessment.
Screening for noise exposure is especially relevant for patients with vascular instability (e.g., hypertension, heart failure); with metabolic disease, or in high-exposure environments. Cardiologists should counsel these patients proactively, not only with medications, but with practical strategies to reduce their exposome burden.
Final call to action: we need a Europe that listens
- Noise pollution is no longer an environmental nuisance; it is a medical emergency.
- The science is clear. The health impact is undeniable. The policy gap is unacceptable.
- Cardiovascular disease, stroke, diabetes, and metabolic disorders are increasingly driven by chronic noise exposure.
- If we are serious about prevention, noise reduction must become a cornerstone of cardiovascular health strategies across Europe.
- Clinicians, educators, and policymakers must act now.
- Aligning EU noise limits with WHO guidelines is no longer optional, it is a legal necessity and it is a cardiovascular prevention strategy.
- Without decisive action, millions of Europeans remain unaccounted for and unprotected, while avoidable disease and death continue to rise.
- Lowering exposure thresholds based on the latest scientific evidence will prevent early cardiovascular damage, improve sleep, and save lives.
To protect our hearts and our sleep, we need a Europe that listens. Let this report mark the beginning of silencing preventable harm.
References
- Münzel T, Sorensen M, Daiber A. Transportation noise pollution and cardiovascular disease. Nat Rev Cardiol. 2021;18:619–636. Doi: 10.1038/s41569-021-00532-5
- Münzel T, Molitor M, Kuntic M, et al. Transportation Noise Pollution and Cardiovascular Health. Circ Res. 2024;134:1113–1135. Doi: 10.1161/CIRCRESAHA.123.323584
- World Health Organization (WHO). Environmental noise. In: Compendium of WHO and other UN guidance on health and environment, 2022 update. Available at: https://www.who.int/tools/compendium-on-health-and-environment/environmental-noise (accessed
- Environmental noise guidelines for the European Region. Available at: https://iris.who.int/handle/10665/279952 (accessed
Further content in cardiovascular disease.
This content has been developed independently by Touch Medical Media for touchCARDIO. Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Editor: Victoria Smith, Senior Content Editor.
Cite: Thomas Münzel. The European Environment Agency Sounds the Alarm on Noise as a Cardiovascular Health Crisis. touchCARDIO. 2 July 2025.
Disclosures: This short article was prepared by touchCARDIO in collaboration with Thomas Münzel. touchCARDIO utilize AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No fees or funding were associated with its publication.
Thomas Münzel discloses receiving grant/research support from Mainz Science Foundation, and receiving honoraria from the German Society of Cardiology.
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