Abstract
BackgroundLong-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD). Calcifications of left-sided heart valves are also markers of CVD risk. We investigated whether air pollution was associated with valvular calcification and its progression.MethodsWe studied 6253 MESA participants aged 45–84 years who underwent two cardiac CT scans 2.5 years apart to quantify aortic valve calcium (AVC) and mitral annular calcium (MAC). CAC was included for the same timeframe for comparison with AVC/MAC. Ambient particulate matter <2.5 μm (PM2.5) and oxides of nitrogen (NOx) concentrations were predicted from residence-specific spatio-temporal models.ResultsThe mean age (SD) of the study sample was 62 (10) years, 39% were white, 27% black, 22% Hispanic, and 12% Chinese. The prevalence of AVC and MAC at baseline were 13% and 9% respectively, compared to 50% prevalence of CAC. The adjusted prevalence ratios of AVC and MAC for each 5 μg/m3 higher PM2.5 was 1.19 (95% CI 0.87, 1.62) and 1.20 (0.81, 1.77) respectively, and for CAC was 1.14 (1.01, 1.27). Over 2.5 years, the mean change in Agatston units/year for each 5 μg/m3 higher PM2.5 concentration was 0.29 (−5.05, 5.63) for AVC and 4.38 (−9.13, 17.88) for MAC, compared to 8.66 (0.61, 16.71) for CAC. We found no significant associations of NOx with AVC and MAC.ConclusionOur findings suggest a trend towards increased 2.5-year progression of MAC with exposure to outdoor PM2.5, although this association could not be confirmed. Additional well-powered studies with longer periods of follow-up are needed to further study associations of air pollution with valvular calcium.Trial registrationAlthough MESA is not a clinical trial, this cohort is registered at ClinicalTrials.gov Identifier: NCT00005487; Date of registration May 25, 2000.
Highlights
Long-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD)
Prior work from the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) reported an association of increased exposure to air pollution with progression of coronary artery calcification (CAC) [9], a powerful subclinical marker of absolute and relative CVD risk [10, 11]
CAC and calcification involving left-sided heart valves are located at different territories of the cardiovascular system, they are strongly associated [13] and have been shown to share similar traditional CVD risk factors [12, 14, 15]
Summary
Long-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD). Prior work from the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) reported an association of increased exposure to air pollution with progression of coronary artery calcification (CAC) [9], a powerful subclinical marker of absolute and relative CVD risk [10, 11]. CAC and calcification involving left-sided heart valves are located at different territories of the cardiovascular system, they are strongly associated [13] and have been shown to share similar traditional CVD risk factors [12, 14, 15]. Whether exposure to air pollution is associated with AVC and MAC is unknown
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