Breathing dirty air is a threat to heart health, but few Canadians have made the connection, according to the Heart and Stroke Foundation.

Only 13 per cent of Canadians surveyed for this year's Report Card on Canadians' Health, which was released Monday, said air pollution affects heart health.

While nearly two-thirds of the 1,134 people surveyed said they believe air quality affects health, almost the same percentage, 61 per cent, do not let smog advisories affect what they do outdoors.

Additionally, only three per cent recognized pollution is a year-round problem.

'Air pollution is a pervasive and unavoidable health risk for heart disease that all Canadians face.'— Dr. Beth Abramson, Heart and Stroke Foundation

"Air pollution is a pervasive and unavoidable health risk for heart disease that all Canadians face — and most are unaware of its short and long-term impact," cardiologist Dr. Beth Abramson told CBCNews.ca.

She said she was surprised by the findings, adding that the connection between heart health and air pollution "was really under the radar screen."

While the precise risk factors of exposure to pollutants vary by study, she said the link with elevated risk of heart attack, stroke and congestive heart failure is consistent in all research.

"There is a clear association," she said. "We need to be cautious and ensure we're not exercising on high air pollution days and putting ourselves more at risk."

The report linked about 6,000 deaths every year in Canada to short-term exposure to air pollution, with 69 per cent of these related to cardio and cerebrovascular disease.

The foundation says the problem may be that many Canadians do not see that air pollution affects their community.

The survey found 64 per cent of respondents believe their air quality to be good to excellent, with:

• 84 per cent of those surveyed in the Prairies saying their air quality was good
• 75 per cent in Atlantic Canada
• 71 per cent in British Columbia
• 59 per cent in Quebec
• 53 per cent in Ontario

However, when the Heart and Stroke Foundation measured the provinces' air quality from 2002 to 2005, most provinces received poor marks for air pollution's impact on heart health.

Air quality and cardiovascular risk by province
Province	Grade: Impact on heart health
British Columbia	Interior: F/Lower Mainland : D
Alberta	D
Saskatchewan	Data not available
Manitoba	B+
Ontario	F
Quebec	F
New Brunswick	C
Nova Scotia	Data not available
Prince Edward Island	Data not available
Newfoundland and Labrador	B+

Ontario, Quebec and interior British Columbia all got failing grades while lower mainland B.C. and Alberta both got Ds. Manitoba and Newfoundland and Labrador got the best mark, with a B+.

The foundation said almost a third of Canadians are exposed to higher-than-acceptable levels of fine particulate matter, the tiny particles in the air from pollution sources such as factories or wood stove smoke.

To help improve the grades, and heart health, the foundation recommends rolling out the national Air Quality Health Index based on the Toronto, Nova Scotia and B.C. pilot programs, to give all Canadians access to daily air quality measures and recommendations on when and how to limit exposure.

It also called for incentives to reduce air pollution, investments in public transit and stronger legislation to ensure emission controls truly result in cleaner air.

Small steps can have big impact on reducing pollution

"Environment Canada has made great strides by setting a Canada-wide standard for particulate matter pollution," Stephen Samis, director of health policy for the foundation, said in a release, adding that it is "now essential for our governments to set policies that decrease emissions and reduce air pollution."

He said such investments "will not only address concerns about the environment, but may ultimately reduce the burden on our healthcare system."

Abramson said changes can also be made at the individual level, noting that nearly a third of air pollution can come from individual homes.

"While we have to make sure the government is aware of the trends," she said, "we can make small steps individually that will have a large impact on Canadians' heart health."

For example, walking instead of taking a car on a low air pollution day is not only good for our health, she said, but can also help others by lowering our emissions.

The report also recommends that Canadians who heat their homes by burning wood choose a stove approved by the Canadian Standards Association or the Environmental Protection Agency.