Expanding the exposome: Blind spots in cardiovascular risk prevention for women
Year: 2025
Type: article
Abstract: The exposome concept has shifted how we interpret influences on cardiovascular health,[1] especially among women. Studies have introduced frameworks that integrate social, environmental, and gender-specific factors to clarify women’s cardiovascular risks.[2] By stressing the interplay of socioeconomic status (SES), environmental pollution, and chronic stress, the literature highlights the key determinants that shape women’s health outcomes. However, while this growing body of research offers a synthesis, gaps remain. The oversimplification of intersectionality, methodological weaknesses in exposome measurement, and insufficient attention to practical prevention strategies limit its usefulness in the real-world applications. This commentary examines these oversights and suggests ways to refine the exposome framework for cardiovascular risk prevention in women. Recent evidence deserves recognition for the broad examinations of how the exposome affects cardiovascular health.[3] The inclusion of gender-specific factors, such as pregnancy and menopause, strengthens the focus and sets this work apart from gender-neutral cardiovascular studies.[3] In addition, the attention to social determinants, particularly SES and education, aligns well with evidence linking socioeconomic disparities to health inequities.[2] By incorporating environmental factors such as pollution and climate change, these studies set cardiovascular risk within global public health challenges. Despite these contributions, certain limitations reduce the practical applicability of this framework. While the research acknowledges SES as a major determinant, it often underestimates how race, ethnicity, and cultural background combine with SES to intensify cardiovascular risks. This shortcoming is problematic, as evidence indicates that women from marginalized racial or ethnic groups commonly face multiplied burdens.[4] These include greater exposure to environmental pollutants and systemic healthcare barriers. By neglecting intersectionality, the exposome framework risks obscuring the particular vulnerabilities of diverse populations. Although the conceptualization of the exposome in this field is generally robust, it often lacks the rigor needed to address the challenges of measuring cumulative exposures across time.[5] Advanced biomarkers, wearable technologies, and large-scale longitudinal cohort studies could greatly strengthen measurement precision.[6] Without these tools, the framework falls short of offering concrete insights for prevention. Many studies concentrate on urban settings, overlooking the distinct cardiovascular risks that rural populations encounter. Rural women often struggle with limited healthcare access, poor transportation infrastructure, and heightened exposure to agricultural pollutants.[7] Including these populations in exposome research is important for a more comprehensive understanding of cardiovascular health disparities. Although structural determinants are emphasized throughout the literature, pathways for individual or community-level interventions are not always explored in depth. Evidence shows that community health initiatives – including nurse-led programs and health literacy campaigns – can significantly reduce cardiovascular risks.[7] Without featuring these practical strategies, the exposome framework may remain a largely theoretical model. Meanwhile, discussions on climate change and cardiovascular risk frequently fail to connect global food policies that worsen nutritional disparities. Climate-driven food insecurity hits women hardest, particularly those in lower-income regions.[8] Strengthening the link between climate policy and cardiovascular prevention would offer a more practical route toward improved health outcomes. Central to women’s cardiovascular risk is the cumulative nature of the exposome. However, limited incorporation of life course data – especially regarding hormonal shifts during pregnancy and menopause – undermines a full understanding of risk profiles. For instance, adverse pregnancy outcomes, such as gestational hypertension, often serve as the early indicators of cardiovascular susceptibility.[3] More focus on these life course factors is essential for targeted prevention strategies. To address these gaps, we propose the following refinements to exposome research: (1) Broaden the framework to include intersectional analyses capturing the compounded effects of race, ethnicity, and cultural context on cardiovascular risk, (2) employ biomarkers, wearable technologies, and longitudinal studies to enhance the measurement of exposome components, (3) account for geographical diversity by examining rural populations’ distinctive vulnerabilities, (4) collaborate with community health organizations to establish evidence-based interventions that empower women in mitigating cardiovascular risks, (5) support food policies that widen access to healthy diets while acknowledging the environmental consequences of agriculture, and (6) prioritize investigations into the cumulative effects of hormonal changes and life stage-specific exposures on cardiovascular health. The current body of exposome research on women’s cardiovascular health makes a great contribution but falls short in several areas. By integrating intersectionality, refining methodological precision, and recommending actionable interventions, the exposome framework can advance to better serve diverse populations. Addressing these gaps is essential for establishing effective prevention strategies and reducing the global burden of cardiovascular disease among women. Ethical policy and institutional review board statement Not applicable. Data availability statement Data sharing is not applicable to this article as no datasets were generated and/or analyzed during the current study. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Environmental Disease
DOI: 10.4103/ed.ed_1_25
Author: Stephan Peronard Mayntz
Institutions: University of Southern Denmark, Odense University Hospital
Language: English
Subfield: Health, Toxicology and Mutagenesis
Field: Environmental Science
Domain: Physical Sciences
Open Access status: diamond
OpenAlex ID: W4408932817