Association between coronary artery calcification score and air pollutant exposure: An explorative hospital-based study using microenvironmental modeling

Abstract

Background and Objective: This study aimed to explore the association between coronary artery calcification and air pollutant exposure from all potential sources using microenvironment modeling. Methods: The present study recruited consecutive consenting patients, who visiting the radiology division of the tertiary cardiac specialty hospital for coronary artery calcification (CAC) evaluation, after obtaining institutional human ethics approval. Fifty participants each with CAC scores <100, 100–399, and ≥400, categorized as low, intermediate, and high risk, respectively, were recruited. Details on basic demographics and exposure to the potential sources of air pollutants from individual microenvironments, namely indoors, workplace, and outdoors, were collected by interview, using prevalidated, semi-structured questionnaire by trained staff. The cumulative exposure was reported as exposure risk hours, from the individual microenvironments and total exposure was estimated using mathematical modeling. In addition, cumulative (particulate matter) PM2.5 exposure for participants residing adjacent to air monitoring stations was estimated. The association between exposure to air pollutants and risk for coronary artery disease was evaluated with standard statistics. Results: Basic demographics revealed a significant association between CAC groups and age (i.e., “low,” “intermediate,” and “high” risk were, respectively, 54.7 ± 10.12, 58.52 ± 8.89, and 64.38 ± 8.74 years, respectively) and gender; wherein higher age and male sex were associated with higher CAC scores. Cumulative PM2.5 exposure was significantly different among the risk categories (i.e., “low,” “intermediate,” and “high” risk were, respectively, 976.14 ± 371.7, 975.78 ± 433.2, and 1215.58 ± 265.5 units). Further, exposure to the potential pollutants at outdoors and at workplace was independently associated with high CAC risk with statistical significance (P < 0.05). While exposure to the potential pollutants recorded at indoors during the transit/commute to residence and workplace was not statistically associated with the CAC risk categories (P > 0.05). Conclusion: Exposure to air pollutants from the workplace and outdoors was significantly associated with higher coronary artery calcification, thereby increasing the risk for coronary artery diseases.