Cardiovascular diseases remain the leading cause of global mortality, with the majority of deaths resulting from coronary heart disease, including myocardial infarction, and stroke. Cardiovascular diseases are often viewed through the lens of traditional cardiovascular risk factors such as hypertension, diabetes, smoking, and dyslipidemia. However, the risk–trigger–vulnerability model is a more comprehensive conceptual framework for understanding the occurrence of coronary heart disease and stroke by distinguishing between three key components: (1) risk factors that drive the long-term development of atherosclerosis, (2) trigger factors that precipitate acute events, and (3) vulnerability, which determines the severity of ischemic injury. Recent advances in exposome research offer new insights into how internal and external exposures contribute to the risk of coronary heart disease and stroke. The overall aim of this project is to integrate the exposome into the risk–trigger–vulnerability model, thereby contributing to a more holistic understanding of coronary heart disease, including myocardial infarction, and stroke, and supporting the development of more effective prevention strategies.
Among the various ongoing studies within this project, three major research efforts include: (1) a comprehensive umbrella review examining short-term environmental triggers of cardiovascular outcomes in adults and across various sociodemographic subgroups; (2) a cohort study investigating the cross-sectional and longitudinal associations between innovative blood-based measures of black carbon and cardiovascular and cardiometabolic health outcomes in adults; and (3) a nationwide registry-based case-crossover study investigating the association between ambient temperature and coronary heart disease events in adults.
Together, the studies in this project will provide complementary insights into the risk–trigger–vulnerability pathways underlying cardiovascular disease, with a particular focus on coronary heart disease, including myocardial infarction, and stroke.
Within Project 2F of EXPOSOME-NL, an additional research project has been embedded, funded by a Senior Scientist Dekker Grant from the Dutch Heart Foundation awarded to EXPOSOME-NL researcher Dr. Erik Timmermans (project number: 03-004-2025-0176).
This project aims to develop a neighbourhood walkability index specifically tailored to older adults. The index will be developed through a co-creation process involving older adults. In addition to a qualitative study, several quantitative studies will be conducted to examine the associations between neighbourhood walkability, walking behaviour, and cardiovascular health among older adults in the Netherlands. Furthermore, an interactive tool will be developed to visualize the extent to which neighbourhoods across the Netherlands support walking among older adults. This tool will inform older adults, policymakers, urban planners, public health professionals, and other stakeholders about neighbourhood walkability for older adults and may contribute to the development of heart-healthy and age-friendly environments in the future. More information about this project (in Dutch) can be found here: Dekkerlaureaten 2025 | Hartstichting.
The environment we live in has a dominant impact on our health. It explains an estimated seventy percent of the chronic disease burden. Where we live, what we eat, how much we exercise, the air we breathe and whom we associate with; all of these environmental factors play a role. The combination of these factors over the life course is called the exposome. There is general (scientific) consensus that understanding more about the exposome will help explain the current burden of disease and that it provides entry points for prevention and ...
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