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Fine particulate matter (PM2.5) harms more than the lungs: pooled large population studies find that people who breathe dirtier air over the long term have more cardiovascular disease and more deaths, an observed association. By mechanism, the particles stir up oxidative stress and inflammation, damage the inner lining of blood vessels and make blood clot more easily. The 2021 World Health Organization (WHO) guideline lowered the annual PM2.5 guideline value to 5 micrograms per cubic metre, meaning lower is better.
The smaller the particle, the more easily it slips past the layered defences of the nose and airways and reaches the alveoli deep in the lung, and the finest fraction may cross the alveolar wall into the blood. Burnett 2018 estimated with a model that long-term exposure to outdoor PM2.5 is linked to a large number of deaths worldwide.