The exposome in ischaemic heart disease: beyond traditional risk factors Ischaemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide, primarily due to the detrimental effects of traditional risk factors on the cardiovascular system. While interventions targeting conventional risk factors have reduced IHD incidence, it remains a major cause of death. Therefore, attention is now shifting to non-traditional risk factors in the built, natural, and social environments that contribute significantly to the disease burden. These complex factors interact non-linearly and unpredictably, often enhancing the detrimental effects of individual or combined factors. The 'exposome' concept has been introduced to define the totality of exposure to these new risk factors. Environmental pollution, including air, water, and soil pollution, is a major non-traditional risk factor for IHD. Air pollution, particularly PM2.5, is associated with increased cardiovascular events, such as heart failure hospitalizations, cardiac arrest, arrhythmias, ischaemic stroke, and myocardial infarction. Air pollutants can impair insulin sensitivity and promote the development of diabetes. The mechanisms by which air pollution contributes to cardiovascular disease include oxidative stress, inflammation, and endothelial dysfunction. Additionally, air pollution enhances thrombotic responses, as shown in experimental models. Climate change and non-optimal temperatures also play a significant role in IHD. Heat waves have been associated with increased cardiovascular mortality, and prolonged exposure to hot temperatures can lead to myocardial ischaemia. Soil pollution and water contamination can lead to heavy metal accumulation, which is linked to cardiovascular risk factors and adverse cardiac events. Light pollution, defined by artificial night-time sky illumination, is a novel environmental risk factor associated with increased IHD hospitalization and mortality. Light pollution disrupts circadian rhythms, leading to increased susceptibility to cardiovascular risk factors. Acoustic pollution, such as transportation noise, is a growing threat to human health, contributing to cardiovascular diseases. Social stress, including loneliness and social isolation, is also a significant risk factor for IHD. Mental health disorders, such as depression and anxiety, are associated with increased cardiovascular risk. Infectious diseases, including respiratory infections and the COVID-19 pandemic, have been shown to increase cardiovascular risk through direct and indirect mechanisms. The exposome concept is important for recognizing exposures and defining that exposures are not isolated but rather a network generating multiple ways to determine aggregate responses to health. The exposome includes environmental exposures such as air pollution, chemical exposure, light pollution, acoustic pollution, mental stress, depression, social isolation, infectious noxae, and pulmonary infections. The concept of the exposome highlights the need for a comprehensive approach to understanding and mitigating the impact of environmental factors on cardiovascular health. Potential mitigation strategies include reducing environmental pollution, promoting healthy lifestyles, and implementing policies to reduce car transport use and promote alternative modes of transport. Pharmacological strategies, such as anti-oxidant medications and statins, may help mitigate theThe exposome in ischaemic heart disease: beyond traditional risk factors Ischaemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide, primarily due to the detrimental effects of traditional risk factors on the cardiovascular system. While interventions targeting conventional risk factors have reduced IHD incidence, it remains a major cause of death. Therefore, attention is now shifting to non-traditional risk factors in the built, natural, and social environments that contribute significantly to the disease burden. These complex factors interact non-linearly and unpredictably, often enhancing the detrimental effects of individual or combined factors. The 'exposome' concept has been introduced to define the totality of exposure to these new risk factors. Environmental pollution, including air, water, and soil pollution, is a major non-traditional risk factor for IHD. Air pollution, particularly PM2.5, is associated with increased cardiovascular events, such as heart failure hospitalizations, cardiac arrest, arrhythmias, ischaemic stroke, and myocardial infarction. Air pollutants can impair insulin sensitivity and promote the development of diabetes. The mechanisms by which air pollution contributes to cardiovascular disease include oxidative stress, inflammation, and endothelial dysfunction. Additionally, air pollution enhances thrombotic responses, as shown in experimental models. Climate change and non-optimal temperatures also play a significant role in IHD. Heat waves have been associated with increased cardiovascular mortality, and prolonged exposure to hot temperatures can lead to myocardial ischaemia. Soil pollution and water contamination can lead to heavy metal accumulation, which is linked to cardiovascular risk factors and adverse cardiac events. Light pollution, defined by artificial night-time sky illumination, is a novel environmental risk factor associated with increased IHD hospitalization and mortality. Light pollution disrupts circadian rhythms, leading to increased susceptibility to cardiovascular risk factors. Acoustic pollution, such as transportation noise, is a growing threat to human health, contributing to cardiovascular diseases. Social stress, including loneliness and social isolation, is also a significant risk factor for IHD. Mental health disorders, such as depression and anxiety, are associated with increased cardiovascular risk. Infectious diseases, including respiratory infections and the COVID-19 pandemic, have been shown to increase cardiovascular risk through direct and indirect mechanisms. The exposome concept is important for recognizing exposures and defining that exposures are not isolated but rather a network generating multiple ways to determine aggregate responses to health. The exposome includes environmental exposures such as air pollution, chemical exposure, light pollution, acoustic pollution, mental stress, depression, social isolation, infectious noxae, and pulmonary infections. The concept of the exposome highlights the need for a comprehensive approach to understanding and mitigating the impact of environmental factors on cardiovascular health. Potential mitigation strategies include reducing environmental pollution, promoting healthy lifestyles, and implementing policies to reduce car transport use and promote alternative modes of transport. Pharmacological strategies, such as anti-oxidant medications and statins, may help mitigate the