Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Air Pollution & Coronary Artery Calcification

Lancet; ePub 2016 May 24; Kaufman, Adar, et al

Publish date:: June 7, 2016

Progression in coronary calcification, consistent with acceleration of atherosclerosis, resulted from increased concentrations of particle matter less than 2 to 5 µm in diameter (PM_2-5) and traffic-related air pollution within metropolitan areas in the US. This according to a prospective 10-year cohort study that repeatedly measured coronary artery calcium by CT in 6,795 participants aged 45 to 84 years in 6 metropolitan areas in the US. Repeated scans were done for nearly all participants between 2002 and 2005, for a subset of participants between 2005 and 2007, and for half of all participants between 2010 and 2012. Researchers found:

• Coronary calcium increased on average by 24 Agatston units per year and intima-media thickness by 12 µm per year (10), before adjusting for risk factors or air pollutant exposures.

• Participant-specific pollutant concentrations averaged over the years 2000 to 2010 ranged from 9.2 to 22.6 µg PM_2-5/m³ and 7.2 to 139.2 parts per billion (ppb) nitrogen oxides (NO_x).

• For each 5 µg PM_2-5/m³ increase, coronary calcium progressed by 4.1 Agatston units per years and for each 40 ppb NO_x coronary calcium progressed by 4.8 Agatston units per year.

• Pollutant exposures were not associated with intima-media thickness change.

Citation: Kaufman JD, Adar SD, Barr RG, et al. Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): A longitudinal cohort study. [Published online ahead of print May 24, 2016]. Lancet. doi:http://dx.doi.org/10.1016/S0140-6736(16)00378-0.

Commentary: The relationship between air quality and both respiratory and cardiovascular outcomes has been described in many epidemiologic observational studies.¹ This study, supported by the US Environmental Protection Agency (EPA), looked at the rate of coronary artery calcification progression in different cities with different levels of air pollution. The development of coronary artery calcification is related to the atherosclerosis. The bottom line here is that air quality matters and worse air quality leads to the development not just of respiratory disease but of coronary disease as well. —Neil Skolnik, MD

1. Hoek G, Krishnan RM, Beelen R, et al. Long-term air pollution exposure and cardio-respiratory mortality: A review. Environ Health. 2013;12:43. doi:10.1186/1476-069X-12-43.

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