Exposure to ambient air pollution and calcification of the mitral annulus and aortic valve: the multi-ethnic study of atherosclerosis (MESA)

Martin Tibuakuu, Miranda R Jones, Ana Navas-Acien, Di Zhao, Eliseo Guallar, Amanda J Gassett, Lianne Sheppard, Matthew J Budoff, Joel D Kaufman, Erin D Michos, Martin Tibuakuu, Miranda R Jones, Ana Navas-Acien, Di Zhao, Eliseo Guallar, Amanda J Gassett, Lianne Sheppard, Matthew J Budoff, Joel D Kaufman, Erin D Michos

Abstract

Background: Long-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.

Methods: We 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.

Results: The 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.

Conclusion: Our 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 registration: Although MESA is not a clinical trial, this cohort is registered at ClinicalTrials.gov Identifier: NCT00005487; Date of registration May 25, 2000.

Keywords: Air pollution; Aortic valve calcification; Epidemiology; Mitral annulus calcification; Prevention; Valvular calcification.

Conflict of interest statement

Ethics approval and consent to participate

This study was conducted under the guiding principles of the Declaration of Helsinki for the protection of human subjects. Institutional Review Boards of all participating MESA sites approved the study, and all participants signed informed consent.

Consent for publication

Not applicable. (No individual person’s data is included. MESA study data was de-identified and presented in aggregate.

Competing interests

Dr. Michos has received an honorarium from Siemens Healthcare Diagnostics (unrelated to topic). Dr. Budoff has received research funds from GE Healthcare.

No other authors declare a conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
A flow diagram illustrating the number of participants included in prevalence analysis at baseline and progression analyses after a mean follow-up of 2.5 years
Fig. 2
Fig. 2
Adjusted* associations (with 95% CI) of air pollutants with prevalent AVC and MAC, compared to CAC, at the MESA baseline exam (2000–2002) *Adjusted for Model 3 covariates.
Fig. 3
Fig. 3
Adjusted* associations (with 95% CI) of annual averages of PM2.5 and NOx with annual change in AVC and MAC over follow-up, compared to CAC *Adjusted for Model 3 covariates.

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