title: Ambient Air Pollution Is Associated With the Severity of Coronary Atherosclerosis and Incident Myocardial Infarction in Patients Undergoing Elective Cardiac Evaluation.
abstract: The effect of air pollution exposure on atherosclerosis severity or incident clinical events in patients with coronary artery disease is not known.
  
  
  
  We conducted a prospective longitudinal cohort study of 6575 Ohio residents undergoing elective diagnostic coronary angiography. Multinomial regression and Cox proportional hazards models were used to assess the relationship between exposure to fine particulate matter <2.5 μm in diameter (PM2.5) and nitrogen dioxide on coronary artery disease severity at baseline and risk of myocardial infarction, stroke, or all-cause mortality over 3 years of follow-up. Among participants with coronary artery disease, exposure to PM2.5 levels was associated with increased likelihood of having coronary atherosclerosis that was mild (odds ratio 1.43, 95% CI 1.11-1.83, P=0.005) and severe (odds ratio 1.63, 95% CI 1.26-2.11, P<0.0001), with the effect on severe coronary artery disease being significantly increased compared with mild disease (Ptrend=0.03). Exposure to higher PM2.5 levels was also significantly associated with increased risk of incident myocardial infarction (hazard ratio 1.33, 95% CI 1.02-1.73, P=0.03) but not stroke or all-cause mortality. The association of PM2.5 with incident myocardial infarction was not affected after adjustment for Framingham Adult Treatment Panel III (ATP III) risk score or statin therapy. In comparison, there were no significant associations between nitrogen dioxide levels and all-cause mortality or risk of stroke after adjustment for Framingham ATP III risk score.
  
  
  
  Exposure to PM2.5 increased the likelihood of having severe coronary artery disease and the risk of incident myocardial infarction among patients undergoing elective cardiac evaluation. These results suggest that ambient air pollution exposure may be a modifiable risk factor for risk of myocardial infarction in a highly susceptible patient population.
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA Institute for Genetic Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Jaana
authors.initials: J
authors.lastname: Hartiala
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Carrie V
authors.initials: CV
authors.lastname: Breton
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Sonoma Technologies, Inc., Petaluma, CA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Lurmann
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Hazen
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Frank D
authors.initials: FD
authors.lastname: Gilliland
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA Institute for Genetic Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA hallayee@usc.edu.
authors.forename: Hooman
authors.initials: H
authors.lastname: Allayee
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D003324:Coronary Artery Disease / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000453:epidemiology; D009569:Nitric Oxide / Q000009:adverse effects; D009820:Ohio / Q000453:epidemiology; D052638:Particulate Matter / Q000009:adverse effects; D011446:Prospective Studies
chemical_list: D000393:Air Pollutants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D052638:Particulate Matter; D009569:Nitric Oxide
keywords: air pollution; coronary atherosclerosis; myocardial infarction