Association of Estimated Long-term Exposure to Air Pollution and Traffic Proximity With a Marker for Coronary Atherosclerosis in a Nationwide Study in China

• Type of Material: Article
• Authors: Meng Wang, State University of New York at Buffalo; Zhi-Hui Hou, Chinese Academy of Sciences; Hao Xu, Tsinghua University; Yang Liu, Emory University; Matthew J. Budoff, Harbor UCLA Medical Center; Adam A. Szpiro, University of Washington; Joel D. Kaufman, University of Washington; Sverre Vedal, University of Washington; Bin Lu, Chinese Academy of Sciences
• Language: English
• Date: 2019-06-01
• Publisher: JAMA Network
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Wang M et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2019.6553
• Title of Journal or Parent Work: JAMA Network Open
• ISSN: 2574-3805
• Volume: 2
• Issue: 6
• Start Page: e196553
• End Page: e196553
• Grant/Funding Information: Dr Wang was primarily supported by faculty startup funds from the University at Buffalo.; This study was supported by the Ministry of Science and Technology of China (grant 2016YFC1300400); Chinese National Key Research and Development Project (grant 2016-I2M-1-011); and US National Institute of Environmental Health Sciences (grant K24ES013195).
• Keywords: General & Internal Medicine; TRENDS; FINE PARTICULATE MATTER; PM2.5; CALCIUM; Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; EVENTS; ARTERY CALCIFICATION; DISEASE; SUBCLINICAL ATHEROSCLEROSIS; MAJOR ROADS; RESIDENTIAL PROXIMITY
• Research Categories: Health Sciences, Public Health; Environmental Sciences; Health Sciences, Medicine and Surgery

Abstract

Importance: Epidemiologic evidence of the mechanisms of the association between long-term exposure to air pollution and coronary heart disease (CHD) is limited and relies heavily on studies performed in Europe and the United States, where air pollution levels are relatively low. In particular, the association between air pollution and CHD in patients with underlying risks for CHD is understudied. Objective: To determine whether air pollution and proximity to traffic are associated with the coronary artery calcium (CAC) score, a key atherosclerotic marker. Design, Setting, and Participants: In this prospective, population-based cross-sectional study in a large-scale setting in China, 8867 consecutive patients aged 25 to 92 years with suspected CHD were recruited between November 17, 2015, and September 13, 2017. Participants were excluded if they had previous myocardial infarction, stenting, or coronary artery bypass grafting or incomplete risk factors and exposure data. Each participant underwent assessment of CAC and CHD risk factors at baseline. Data were analyzed from December 2017 to November 2018. Exposures: Annual means of fine particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) were estimated at the participants' residences using a validated geostatistical prediction model. Exposure to a nearby roadway was also estimated. Main Outcomes and Measures: Computed tomography measurement of CAC score. Results: The mean (SD) age of the 8867 participants was 56.9 (10.4) years; 4378 (53.6%) were men. Annual mean (SD) PM2.5, NO2, and O3 measurements were 70.1 (20.0), 41.4 (14.7), and 93.9 (10.5) μg/m3, respectively. The mean (SD) CAC score was 91.4 (322.2) Agatston units. Exposure to PM2.5 and NO2, adjusting for CHD risk factors and multiple pollutants, were independently associated with increases in CAC scores of 27.2% (95% CI, 10.8% to 46.1%) per 30 μg/m3 PM2.5 and 24.5% (95% CI, 3.6% to 49.7%) per 20 μg/m3 NO2. For PM2.5, odds of both detectable CAC (Agatston score >0; odds ratio, 1.28; 95% CI, 1.13 to 1.45) and severe CAC (Agatston score >400; odds ratio, 1.59; 95% CI, 1.20 to 2.12) were increased. Associations of CAC with PM2.5 and NO2 were greater among male participants (PM2.5: 42.2%; 95% CI, 24.3% to 62.7%; NO2: 45.7%; 95% CI, 25.3% to 69.5%) and elderly participants (PM2.5: 50.1%; 95% CI, 28.8% to 75.0%; NO2: 55.5%; 95% CI, 31.8% to 83.6%) and those with diabetes (PM2.5: 62.2%; 95% CI, 30.9% to 101.0%; NO2: 31.2%; 95% CI, 13.9% to 51.0%). Independent association with CAC score was 9.0% (95% CI,-1.4% to 20.4%) for O3 per 15 μg/m3 and 2.4% (95% CI,-0.6% to 5.4%) for distance near roadway per 50% decrease. Conclusions and Relevance: In this large Chinese study, long-term exposures to PM2.5 and NO2 were independently associated with severity of CAC. This finding may provide support for the pathophysiological role of coronary atherosclerosis through which air pollution exposure may be associated with CHD.