Impact of environmental factors in industrial cities on the development, course, and outcomes of cerebrovascular condition in patients with metabolic syndrome: medical and social aspects

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Abstract

In the context of global urbanization and the increasing prevalence of metabolic syndrome (MetS), the impact of environmental factors characteristic of industrial cities on the incidence and severity of cerebrovascular diseases (CVD) has become particularly relevant. This narrative review analyzes the interaction between the pathophysiological components of MetS (insulin resistance, hypertension, dyslipidemia, and visceral obesity) and environmental factors specific to industrial cities. The available evidence demonstrates that these factors act synergistically to exacerbate key mechanisms of vascular injury, including systemic inflammation, oxidative stress, and endothelial dysfunction. This interaction contributes to the accelerated development and progression of atherosclerosis and cerebral microangiopathy, as well as to an increased risk of both first-ever and recurrent acute CVD. The review highlights the heightened vulnerability of patients with MetS to the adverse effects of air pollutants, which creates a vicious pathogenic cycle clinically manifested by more severe neurological deficits, poorer functional outcomes, accelerated cognitive decline, and reduced effectiveness of rehabilitation programs. It is also noted that existing prognostic scales (e.g., CHA₂DS₂-VASc) and medical–social disability assessment criteria do not account for exposures to environmental factors, thereby limiting their clinical utility and contributing to suboptimal rehabilitation outcomes in patients with CVD and its sequelae. Based on the analyzed data, there is a clear need to develop comprehensive predictive and preventive strategies that encompass not only individualized correction of metabolic disturbances and the implementation of personalized rehabilitation programs, but also large-scale environmental and urban planning interventions aimed at reducing air and noise pollution. In addition, the development of rehabilitation programs oriented to urban environmental conditions is required to reduce the medical, social, and economic burden on healthcare systems in industrial regions.

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About the authors

Kamila Sh. Adzhieva

Rostov State Medical University

Author for correspondence.
Email: adzhiewac@yandex.ru
ORCID iD: 0009-0006-3711-381X
Russian Federation, Rostov-on-Don

Inna R. Gukasyan

Rostov State Medical University

Email: Ennuigr@icloud.com
ORCID iD: 0009-0000-0517-0728
Russian Federation, Rostov-on-Don

Airat R. Galimov

Bashkir State Medical University

Email: airat.galim382@gmail.com
ORCID iD: 0000-0003-4403-0204
SPIN-code: 8742-4109

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Ufa

Zukhra Sh. Adamova

Rostov State Medical University

Email: zukhra.adamova@bk.ru
ORCID iD: 0009-0002-1601-0775
Russian Federation, Rostov-on-Don

Zaira I. Shikhalieva

Rostov State Medical University

Email: zairashikhalieva@mail.ru
ORCID iD: 0009-0009-1264-4704
Russian Federation, Rostov-on-Don

Anastasia R. Yukina

Rostov State Medical University

Email: kiiss.doffool@mail.ru
ORCID iD: 0009-0003-1254-3117
Russian Federation, Rostov-on-Don

Daniil I. Vashchenko

Rostov State Medical University

Email: Vaschenckodaniil@yandex.ru
ORCID iD: 0009-0005-7762-4297
Russian Federation, Rostov-on-Don

Anastasia V. Pogrebnyak

Rostov State Medical University

Email: Nastyena2002Pog@yandex.ru
ORCID iD: 0009-0007-3253-3062
Russian Federation, Rostov-on-Don

Ksenia S. Yakovleva

Rostov State Medical University

Email: jks-15@yandex.ru
ORCID iD: 0009-0008-2382-9141
Russian Federation, Rostov-on-Don

Sharapudin S. Magomedov

Rostov State Medical University

Email: msharap543@gmail.com
ORCID iD: 0009-0002-2195-0569
Russian Federation, Rostov-on-Don

Asiyat R. Barkaeva

Rostov State Medical University

Email: asya.barkayeva@mail.ru
ORCID iD: 0009-0008-0931-8898
Russian Federation, Rostov-on-Don

Valeria A. Knyazeva

Rostov State Medical University

Email: knyazevavaleria@icloud.com
ORCID iD: 0009-0006-7564-4128
Russian Federation, Rostov-on-Don

Amina E. Garifyanova

Bashkir State Medical University

Email: aminagarifyanova@yandex.ru
ORCID iD: 0009-0005-0225-4826
Russian Federation, Ufa

Albina A. Nib

Kuban State Medical University

Email: albinanib2@gmail.com
ORCID iD: 0009-0008-4307-9309
Russian Federation, Krasnodar

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