Münzel, ThomasSørensen, MetteLelieveld, JosHahad, OmarAl-Kindi, SadeerNieuwenhuijsen, Mark J.Giles-Corti, BillieDaiber, AndreasRajagopalan, Sanjay T.2022-05-202022-05-202021Münzel T, Sørensen M, Lelieveld J, Hahad O, Al-Kindi S, Nieuwenhuijsen M, Giles-Corti B, Daiber A, Rajagopalan S. Heart healthy cities: genetics loads the gun but the environment pulls the trigger. Eur Heart J. 2021 Jul 1;42(25):2422-2438. DOI: 10.1093/eurheartj/ehab2350195-668Xhttp://hdl.handle.net/10230/53182The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.application/pdfeng© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.cominfo:eu-repo/semantics/articlehttp://dx.doi.org/10.1093/eurheartj/ehab235Air pollutionEnvironmental stressorsHeart healthy cityHeat islands effectsLight pollutionNoise pollutionUrban and transport planning and design interventionsinfo:eu-repo/semantics/openAccess