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  • Review Article
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Environmental sustainability in cardiovascular practice: current challenges and future directions

Nature Reviews Cardiology volume 22, pages 241–254 (2025)Cite this article

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Abstract

Cardiovascular disease is the leading cause of morbidity and mortality worldwide, with a substantial amount of health-care resources targeted towards its diagnosis and management. Environmental sustainability in cardiovascular care can have an important role in reducing greenhouse gas emissions and pollution and could be beneficial for improving health metrics and societal well-being and minimizing the cost of health care. In this Review, we discuss the motivations and frameworks for sustainable cardiovascular care with an emphasis on the reduction of the climate-related and environmental effects of cardiovascular care. We also provide an overview of greenhouse gas emissions related to the provision of health care, including their measurement and quantification, carbon accounting, carbon disclosures and climate effects. The principles of life-cycle assessment, waste prevention and circular economics in health care are discussed, and the emissions associated with various sectors of cardiovascular care as well as the rationale for prevention as a powerful approach to reduce these emissions are presented. Finally, we highlight the challenges in environmental sustainability and future directions as applicable to cardiovascular practice.

Key points

  • Cardiovascular health and environmental health are interlinked; sustainable cardiovascular care is crucial for reducing emissions and pollution while improving outcomes.

  • Cardiovascular care has a large environmental footprint owing to high energy use and waste from devices and procedures; this footprint needs further quantification.

  • Strategies such as energy efficiency, renewable energy, waste reduction, disease prevention, innovation and circular economy principles can reduce carbon emissions and costs.

  • Lack of transparency and regulatory levers hampers current sustainability efforts, but frameworks for disclosures, target setting and reporting emissions are emerging.

  • Health-care leaders should measure emissions, set reduction targets, redesign care and engage stakeholders to transition towards sustainable models that improve value, outcomes and planetary health.

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Fig. 1: Measuring greenhouse gas emissions and the carbon footprint of health care.
Fig. 2: Life-cycle assessment framework.
Fig. 3: Butterfly representation of the circular economy principle adapted for health care.

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Change history

  • 16 May 2025

    In the version of the article initially published, the Acknowledgements section was missing and has now been added to the HTML and PDF versions of the article.

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Acknowledgements

Work in the laboratory of A.B. was supported in part by NIH Grant #P42 ES023716.

Author information

Authors and Affiliations

  1. University Hospitals and Case Western Reserve University, Cleveland, OH, USA

    Sanjay Rajagopalan & Richard D. Pham

  2. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia

    Scott McAlister

  3. Centre for Health Policy, University of Melbourne, Parkville, Melbourne, Victoria, Australia

    Scott McAlister

  4. MIT Sloan School of Management and Sustainability Initiative at MIT Sloan, Cambridge, MA, USA

    Jason Jay

  5. Division of Cardiovascular Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA

    Robert D. Brook

  6. DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA

    Khurram Nasir & Sadeer Al-Kindi

  7. ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain

    Mark. J. Nieuwenhuijsen

  8. Program for Global Public Health and the Common Good, Boston College, Boston, MA, USA

    Philip Landrigan

  9. Centre Scientifique de Monaco, Monaco, Monaco

    Philip Landrigan

  10. Ohio Health, Columbus, OH, USA

    Allegra Wiesler

  11. Mazzetti Inc., San Francisco, CA, USA

    Christina Vernon Sanborn

  12. Eaton Corporation, Cleveland, OH, USA

    Justin R. Carron

  13. American Society for Health Care Engineering of the American Hospital Association, Chicago, IL, USA

    Kara Hammond Brooks

  14. University of Louisville, Kentucky, KY, USA

    Aruni Bhatnagar

  15. Center for Health and Nature, Houston, TX, USA

    Sadeer Al-Kindi

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Contributions

S.R. and S.A.-K. researched data for the article. S.R., S.M., R.D.P., R.D.B., K.N., M.J.N., P.L. and S.A.-K. substantially contributed to the discussion of content. S.R. and S.A.-K. wrote the article. All authors reviewed/edited the manuscript before submission.

Corresponding authors

Correspondence to Sanjay Rajagopalan or Sadeer Al-Kindi.

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Competing interests

C.V.S. is a salaried employee of Mazzetti. J.R.C. is a salaried employee of Eaton Corporation. K.H.B. is a salaried employee of the American Society for Health Care Engineering of the American Hospital Association. The views represented here are solely those of the authors and do not necessarily reflect the views of the authors’ employers. The other authors declare no competing interests.

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Rajagopalan, S., McAlister, S., Jay, J. et al. Environmental sustainability in cardiovascular practice: current challenges and future directions. Nat Rev Cardiol 22, 241–254 (2025). https://doi.org/10.1038/s41569-024-01077-z

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