Air Pollution May Increase Coronary Artery Disease Risk, Particularly in Women: Study Finds
Canada: A recent study published in Radiology found that long-term exposure to common air pollutants, including fine particulate matter (PM2.5) and nitrogen dioxide (NO2), was associated with greater coronary artery calcium, increased plaque burden, and more advanced coronary artery disease on cardiac CT scans. The association appeared to be particularly pronounced among women, even at pollution levels commonly observed in high-income countries.
The study was conducted by Felipe Castillo of the Department of Medical Imaging, University of Toronto, and colleagues.
Air pollution is recognized as a major environmental contributor to cardiovascular disease worldwide. While previous studies have linked air pollution exposure to heart attacks, stroke, heart failure, and cardiovascular mortality, less is known about its relationship with coronary artery disease characteristics visible on cardiac CT imaging.
To investigate this, researchers performed a multisite retrospective study involving 11,128 adults who underwent outpatient cardiac CT for coronary artery disease evaluation between 2012 and 2023. The study population had a mean age of 59 years, and approximately 52% were men. Among them, 7,313 patients underwent coronary CT angiography.
The team assessed coronary artery calcium scores, total plaque burden, and the presence of obstructive coronary artery disease, defined as at least 70% narrowing of a coronary artery. Long-term exposure to PM2.5 and NO2 was estimated over the 10 years preceding the cardiac CT examination.
Median 10-year exposure levels were 7.5 μg/m³ for PM2.5 and 13.4 parts per billion for NO2. Despite these relatively moderate exposure levels, higher concentrations of both pollutants were associated with more extensive coronary atherosclerosis.
Key findings from the study included:
- Higher PM2.5 and NO2 exposure levels were independently associated with greater coronary artery calcium scores.
- Increased exposure to both pollutants was linked to a higher overall coronary plaque burden.
- Long-term exposure to PM2.5 and NO2 was associated with a greater likelihood of obstructive coronary artery disease in women.
- No significant association between air pollution exposure and obstructive coronary artery disease was observed in men.
The findings suggest that women may be more vulnerable to the cardiovascular effects of long-term air pollution exposure. The researchers observed that the relationship between pollutant exposure and obstructive coronary artery disease remained evident in women even after adjusting for multiple cardiovascular risk factors.
According to the investigators, the results highlight that air pollution may contribute to coronary atherosclerosis independently of traditional cardiovascular risk factors. The associations were detected despite exposure levels that generally fall within contemporary air quality standards in many developed countries.
The authors concluded that prolonged exposure to PM2.5 and NO2 is associated with more advanced coronary artery disease as detected by cardiac CT imaging. The findings add to growing evidence that air pollution should be considered an important and potentially modifiable cardiovascular risk factor, particularly for women, and underscore the need for continued efforts to reduce long-term exposure to harmful air pollutants.
Reference:
https://doi.org/10.1148/radiol.252086
Next Story