Emerging research suggests that noise impacts human health beyond simply the auditory system. There have been recent amendments to acceptable noise level thresholds within the occupational setting and new European Union directives for noise in the community from air and road sources. The purpose of this review will be to assess the relationship between noise and cardiovascular disease in different settings. Methods: A literature review was conducted using PubMed on noise and more cardiovascular

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... disease endpoints. All studies published in the English language between 2000 -present were included. Studies on noise annoyance were excluded. Results: There is a strong positive association between occupational noise exposure and cardiovascular outcomes. There is a moderate association with noise in the community setting from road sources and a weak association with aircraft noise. The strength of the association across settings is dependent on the outcome type, interaction with age and sex of subjects, and time of measurement. Road source noise had the strongest association with myocardial infarction, notably in women during night exposures. The association with hypertension and road noise, when stratified by sex, was significant in men during night-time exposures and in pregnant older women. Only nighttime aircraft noise was associated with statistically significant findings in adults. All sources of noise demonstrate a dose response relationship, which peaks at different noise thresholds. Occupational noise exposure had the strongest association with noise > 85 dB (A) and duration of exposure. Conclusion: There is sufficient evidence to warrant the precautionary public health principle to reduce noise at the population levels for industry workers through stronger leg-islation, regular compliance inspections, and health promotion. Where population wide noise legislation has not yet been enacted, noise exposure reduction at the individual level may be beneficial.