Cumulative exposure amount of PM2.5 in the ambient air is associated with coronary atherosclerosis - Serial coronary CT angiography study

  • Heesun Lee
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
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  • Jung Hye Kim
    Affiliations
    Department of Internal Medicine, Yonsei Health Promotion Internal Clinic, Seoul, South Korea
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  • Minkwan Kim
    Affiliations
    Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine and Cardiovascular Center, Yongin, Gyeonggi-do, South Korea
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  • Hyo Eun Park
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
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  • Su-Yeon Choi
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
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  • Hye Kyung Kim
    Affiliations
    Department of Family Medicine, Health Promotion Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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  • Byoung Kwon Lee
    Affiliations
    Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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  • Jin-Young Min
    Affiliations
    Institute of Health and Environment, Seoul National University, Seoul, South Korea
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  • Kyoung-Bok Min
    Affiliations
    Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, South Korea
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  • Author Footnotes
    1 SK and SPL contributed equally to this work as corresponding authors.
    Shinae Kang
    Correspondence
    Corresponding author. Department of Internal Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea.
    Footnotes
    1 SK and SPL contributed equally to this work as corresponding authors.
    Affiliations
    Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
    Search for articles by this author
  • Author Footnotes
    1 SK and SPL contributed equally to this work as corresponding authors.
    Seung-Pyo Lee
    Correspondence
    Corresponding author. Department of Internal Medicine & Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.
    Footnotes
    1 SK and SPL contributed equally to this work as corresponding authors.
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
    Search for articles by this author
  • Author Footnotes
    1 SK and SPL contributed equally to this work as corresponding authors.
Published:November 23, 2021DOI:https://doi.org/10.1016/j.jcct.2021.11.003

      Abstract

      Background

      We investigated the change of coronary atherosclerosis with long-term exposure to fine particulate matter of aerodynamic diameter <2.5μm (PM2.5) using coronary computed tomography angiography (CCTA).

      Methods

      Subjects undergoing serial CCTAs between January 2007 and December 2017 (n = 3,127) were analyzed. Each individual's cumulative amount of PM2.5 exposure between the two CCTAs was evaluated by Kriging interpolation and zonal analysis, considering the time interval between the two CCTAs. The main outcome was progression of coronary artery calcium (CAC) with additional semiquantitative analysis on the changes in the severity and composition of atherosclerotic plaques.

      Results

      The CAC scores increased by 30.8 Agatston units per-year under a median PM2.5 concentration 24.9μg/m3 and tended to increase with the cumulative amount of PM2.5 exposure (r = 0.321, p < 0.001). The CAC progressed in 1,361 (43.5%) subjects during a median 53 months follow-up. The cumulative amount of PM2.5 exposure was independently associated with CAC progression (adjusted OR 1.09, p < 0.001). By random forest analysis, the relative impact of cumulative amount of PM2.5 exposure on CAC progression was higher than that of traditional cardiovascular risk factors and the average concentration of PM2.5. The extent of coronary atherosclerosis and newly developed calcified plaque on follow-up were also significantly associated with the cumulative amount of PM2.5 exposure.

      Conclusions

      Cumulative exposure to air pollution is associated with the progression of diffuse coronary calcification, the importance of which may be more significant than other traditional cardiovascular risk factors. Further investigations into the causality between PM2.5 and coronary atherosclerosis are warranted to improve global cardiovascular health.

      Graphical abstract

      Keywords

      Abbreviations:

      AAP (ambient air pollution), CAC (coronary artery calcification), CACS (coronary artery calcium score), CAD (coronary artery disease), CCTA (coronary computed tomography angiography), CVD (cardiovascular disease), OR (odds ratio), PM2.5 (fine particulate matter of an aerodynamic diameter <2.5μm)
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