Exposure to Small Particulate Air Pollution Tied to Obstructive CAD
Exposure to Small Particulate Air Pollution Tied to Obstructive CAD TCTMD
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An analysis of the PROMISE trial suggests such exposure should be considered an additional CV risk factor.
BOSTON, MA—When exposed to high levels of small particulate air pollution, individuals with stable chest pain and a low-to-intermediate cardiovascular risk are more likely to have obstructive coronary disease on coronary CT angiography (CTA), an analysis of PROMISE trial participants shows.
Exposure to Small Particulate Air Pollution and Obstructive CAD
People who lived in an area with a high versus low average exposure to small particulate matter were more likely to have CT-detected obstructive CAD (15.6% vs 12.5%; P = 0.007), according to Marcel Langenbach, MD (Massachusetts General Hospital, Boston, and University Hospital Cologne, Germany).
A greater risk of obstructive disease remained even after accounting for traditional CV risk factors and socioeconomic determinants of health, he reported here at the 2023 Society of Cardiovascular Computed Tomography (SCCT) meeting.
“Air pollution should be considered as an additional CV risk factor” that can be taken into account, for example, when seeing a patient with stable chest pain who lives in an area with high pollution levels, Langenbach told TCTMD.
Moreover, he concluded during his presentation, this information “could help to build prevention strategies in patients with stable chest pain.”
Expert Commentary
Speaking with TCTMD, Marcus Chen, MD (National Heart, Lung, and Blood Institute, Bethesda, MD), one of the moderators of the session at which Langenbach presented the results, highlighted some strengths and weaknesses of the study, saying, “It’s great to look at what environmental factors may play a role in coronary artery disease.”
But there are some limitations, he said, pointing to the fact that the coronary CTs in PROMISE were performed back in 2010 and the use of zip codes to derive much of the information used in the study, including socioeconomic variables and exposure to pollution. When assessing CAD, the disease process likely started many years earlier, and an individual could have been living somewhere else at that time, for instance.
“I think environmental factors might play a role” in coronary disease, Chen commented, and unlike things like diet, exercise, or control of blood pressure or diabetes, “environment is something that we unfortunately can’t really control.”
Still, he said, it’s probably premature to recommend including exposure to air pollution as a factor to consider when assessing an individual patient’s risk.
Air Pollution and CAD in PROMISE
Prior research has linked increased exposure to air pollution to greater risks of major adverse cardiovascular events and mortality in the broader population, presumably due to local and systemic inflammatory reactions—which are known to contribute to the development of CAD—sparked when the small particles enter the alveoli and bloodstream.
The PROMISE data set provided an opportunity to assess associations between air pollution and CT-derived metrics of coronary disease, specifically in patients with stable chest pain and a low-to-intermediate CV risk, Langenbach noted.
For the study, the investigators focused on patients in the CT arm of the trial, which showed that use of coronary CTA as a first-line test didn’t improve clinical outcomes compared with functional testing. The analysis included 3,854 participants (mean age 61 years; 48% men) living in 2,020 unique US zip codes; their median atherosclerotic CVD risk was 14.2%.
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SDGs, Targets, and Indicators Analysis
1. Which SDGs are addressed or connected to the issues highlighted in the article?
- SDG 3: Good Health and Well-being
- SDG 11: Sustainable Cities and Communities
- SDG 13: Climate Action
The article discusses the impact of air pollution on cardiovascular health, specifically obstructive coronary disease. This connects to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. It also relates to SDG 11, which focuses on creating sustainable cities and communities, including addressing air pollution. Additionally, SDG 13, which addresses climate action, is relevant as air pollution is a result of environmental factors.
2. What specific targets under those SDGs can be identified based on the article’s content?
- SDG 3.9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination.
- SDG 11.6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management.
- SDG 13.1: Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.
The article highlights the impact of air pollution on cardiovascular health, indicating the need to reduce deaths and illnesses caused by air pollution (SDG 3.9). It also emphasizes the importance of addressing air quality in cities to reduce adverse environmental impacts (SDG 11.6). Additionally, as air pollution is a result of climate-related factors, it aligns with the need to strengthen resilience to climate-related hazards (SDG 13.1).
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
- Exposure to small particulate matter (PM2.5) levels
- Prevalence of obstructive coronary disease on coronary CT angiography
- Association between air pollution exposure and obstructive CAD risk
The article mentions the exposure to small particulate matter (PM2.5) as a relevant indicator of air pollution levels. It also discusses the prevalence of obstructive coronary disease on coronary CT angiography as an indicator of cardiovascular health. Furthermore, the article highlights the association between air pollution exposure and the risk of obstructive coronary artery disease, which can be used to measure progress towards reducing the impact of air pollution on cardiovascular health.
4. Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | SDG 3.9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination. | – Prevalence of obstructive coronary disease on coronary CT angiography – Association between air pollution exposure and obstructive CAD risk |
| SDG 11: Sustainable Cities and Communities | SDG 11.6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management. | – Exposure to small particulate matter (PM2.5) levels |
| SDG 13: Climate Action | SDG 13.1: Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries. | – Exposure to small particulate matter (PM2.5) levels |
The table summarizes the identified SDGs, targets, and indicators based on the analysis of the article. It provides a clear overview of the connection between the article’s content and the relevant SDGs, targets, and indicators.
Behold! This splendid article springs forth from the wellspring of knowledge, shaped by a wondrous proprietary AI technology that delved into a vast ocean of data, illuminating the path towards the Sustainable Development Goals. Remember that all rights are reserved by SDG Investors LLC, empowering us to champion progress together.
Source: tctmd.com
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