Ambient Air Pollution and Atherosclerosis in Los Angeles

By Kunzli, Nino; Jerrett, Michael et al. | Environmental Health Perspectives, February 2005 | Go to article overview

Ambient Air Pollution and Atherosclerosis in Los Angeles


Kunzli, Nino, Jerrett, Michael, Mack, Wendy J., Beckerman, Bernardo, LaBree, Laurie, Gilliland, Frank, Thomas, Duncan, Peters, John, Hodis, Howard N., Environmental Health Perspectives


Associations have been found between long-term exposure to ambient air pollution and cardiovascular morbidity and mortality. The contribution of air pollution to atherosclerosis that underlies many cardiovascular diseases has not been investigated. Animal data suggest that ambient particulate matter (PM) may contribute to atherogenesis. We used data on 798 participants from two clinical trials to investigate the association between atherosclerosis and long-term exposure to ambient PM up to 2.5 pan in aerodynamic diameter (P[M.sub.2.5]). Baseline data included assessment of the carotid intima-media thickness (CIMT), a measure of subclinical atherosclerosis. We geocoded subjects' residential areas to assign annual mean concentrations of ambient P[M.sub.2.5]. Exposure values were assigned from a P[M.sub.2.5] surface derived from a geostatistical model. Individually assigned annual mean P[M.sub.2.5] concentrations ranged from 5.2 to 26.9 pg/[m.sub.3] (mean, 20.3). For a cross-sectional exposure contrast of 10 [micro]g/[m.sup.3] P[M.sub.2.5], CIMT increased by 5.9% (95% confidence interval, 1-11%). Adjustment for age reduced the coefficients, but further adjustment for covariates indicated robust estimates in the range of 3.9-4.3% (p-values, 0.05-0.1). Among older subjects ([greater than or equal to] 60 years of age), women, never smokers, and those reporting lipid-lowering treatment at baseline, the associations of P[M.sub.2.5] and CIMT were larger with the strongest associations in women [greater than or equal to] 60 years of age (15.7%, 5.7-26.6%). These results represent the first epidemiologic evidence of an association between atherosclerosis and ambient air pollution. Given the leading role of cardiovascular disease as a cause of death and the large populations exposed to ambient P[M.sub.2.5], these findings may be important and need further confirmation. Key words: air pollution, atherosclerosis, particulate matter. Environ Health Perspect 113:201-206 (2005). doi:10.1289/ehp.7523 available via http://dx.doi.org/[Online 22 November 2004]

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A large body of epidemiologic evidence suggests associations between ambient air pollution and cardiovascular mortality and morbidity (Peters and Pope 2002; Pope et al. 2004). All of these studies focus on events occurring at a late stage of vascular disease processes. The impact of air pollution on the underlying preclinical conditions remains poorly understood. We hypothesize that current levels of ambient particulate matter (PM) up to 2.5 pm in aerodynamic diameter (P[M.sub.2.5]) may contribute to atherosclerosis, leading to subclinical anatomical changes that play a major role in cardiovascular morbidity and mortality later in life. Animal studies support our hypothesis by showing that inhalation of ambient PM promotes oxidative lung damage, including alveolar and systemic inflammatory responses (Becker et al. 1996; Dye et al. 2001; Fujii et al. 2002; Goto et al. 2004; Suwa et al. 2002; van Eeden et al. 2001).

We investigated the association between residential ambient P[M.sub.2.5] and carotid artery intima-media thickness (CIMT) using pre-randomization baseline data from two recent clinical trials conducted in Los Angeles, California (Hodis et al. 2002). CIMT is a well-established quantitative measure of generalized atherosclerosis that correlates well with all of the major cardiovascular risk factors, with coronary artery atherosclerosis, and with clinical cardiovascular events (Mack et al. 2000). It is an established tool for investigating the contribution of long-term exposures such as smoking or passive smoking to subclinical stages of atherosclerosis at any given age (Diez-Roux et al. 1995; Howard et al. 1994, 1998). This is the first study to assess the association of atherosclerosis with air pollution.

Materials and Methods

Population and health assessment. We used baseline health data from two randomized, double-blind, placebo-controlled clinical trials conducted at the University of Southern California Atherosclerosis Research Unit (Hodis et al. …

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