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

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.