Pollutant composition modification of the effect of air pollution on progression of coronary artery calcium: the Multi-Ethnic Study of Atherosclerosis

Environ Epidemiol. 2018 Sep;2(3):e024. doi: 10.1097/EE9.0000000000000024. Epub 2018 Jul 9.


Background: Differences in traffic-related air pollution (TRAP) composition may cause heterogeneity in associations between air pollution exposure and cardiovascular health outcomes. Clustering multi-pollutant measurements allows investigation of effect modification by TRAP profiles.

Methods: We measured TRAP components with fixed-site and on-road instruments for two two-week periods in Baltimore, Maryland. We created representative TRAP profiles for cold and warm seasons using predictive k-means clustering. We predicted cluster membership for 1005 participants in the Multi-Ethnic Study of Atherosclerosis and Air Pollution with follow-up between 2000 and 2012. We estimated cluster-specific relationships between coronary artery calcification (CAC) progression and long-term exposure to fine particulate matter (PM2.5) and oxides of nitrogen (NOX).

Results: We identified two clusters in the cold season, notable for higher ratios of gases and ultrafine particles, respectively. A 5 μg/m3 difference in PM2.5 was associated with 17.0 (95% Confidence Interval [CI]: 7.2, 26.7) and 42.6 (95% CI: 25.7, 59.4) Agatston units/year CAC progression among participants in clusters 1 and 2, respectively (effect modification p=0.006). A 40ppb difference in NOX was associated with 22.2 (95% CI: 7.7, 36.7) and 41.9 (95% CI: 23.7, 60.2) Agatston units/year CAC progression in clusters 1 and 2, respectively (p=0.08). Similar trends occurred using clusters identified from warm season measurements. Clusters correlated highly with baseline pollution level.

Conclusions: Clustering TRAP measurements identified spatial differences in composition. We found evidence of greater CAC progression rates per unit PM2.5 exposures among people living in areas characterized by high ratios of ultrafine particle counts relative to NOX concentrations.