Long-term ambient air pollution and coronary atherosclerosis: Results from the Swedish SCAPIS study

Atherosclerosis. 2024 Oct:397:117576. doi: 10.1016/j.atherosclerosis.2024.117576. Epub 2024 May 8.

Abstract

Background and aims: Despite firm evidence for an association between long-term ambient air pollution exposure and cardiovascular morbidity and mortality, results from epidemiological studies on the association between air pollution exposure and atherosclerosis have not been consistent. We investigated associations between long-term low-level air pollution exposure and coronary atherosclerosis.

Methods: We performed a cross-sectional analysis in the large Swedish CArdioPulmonary bioImaging Study (SCAPIS, n = 30 154), a random general population sample. Concentrations of total and locally emitted particulate matter <2.5 μm (PM2.5), <10 μm (PM10), and nitrogen oxides (NOx) at the residential address were modelled using high-resolution dispersion models. We estimated associations between air pollution exposures and segment involvement score (SIS), coronary artery calcification score (CACS), number of non-calcified plaques (NCP), and number of significant stenoses, using ordinal regression models extensively adjusted for potential confounders.

Results: Median 10-year average PM2.5 exposure was 6.2 μg/m3 (range 3.5-13.4 μg/m3). 51 % of participants were women and 51 % were never-smokers. None of the assessed pollutants were associated with a higher SIS or CACS. Exposure to PM2.5 was associated with NCP (adjusted OR 1.34, 95 % CI 1.13, 1.58, per 2.05 μg/m3). Associations with significant stenoses were inconsistent.

Conclusions: In this large, middle-aged general population sample with low exposure levels, air pollution was not associated with measures of total burden of coronary atherosclerosis. However, PM2.5 appeared to be associated with a higher prevalence of non-calcified plaques. The results suggest that increased risk of early-stage atherosclerosis or rupture, but not increased total atherosclerotic burden, may be a pathway for long-term air pollution effects on cardiovascular disease.

Keywords: Air pollution; Atherosclerosis; Cardiovascular diseases; Coronary artery disease; Nitrogen oxides; Particulate matter.

MeSH terms

  • Adult
  • Aged
  • Air Pollutants / adverse effects
  • Air Pollution* / adverse effects
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / epidemiology
  • Coronary Artery Disease* / etiology
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / epidemiology
  • Cross-Sectional Studies
  • Environmental Exposure / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nitrogen Oxides / adverse effects
  • Nitrogen Oxides / analysis
  • Particulate Matter* / adverse effects
  • Plaque, Atherosclerotic / epidemiology
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Sweden / epidemiology
  • Time Factors
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / epidemiology

Substances

  • Particulate Matter
  • Air Pollutants
  • Nitrogen Oxides