Impact of Residential Exposome on Coronary Artery Obstruction and Myocardial Ischemia
Overview
This study evaluated the independent effects of air and noise pollution and residential green exposure on coronary artery obstruction and myocardial ischemia using coronary computed tomography angiography (CCTA) in 2620 patients. No strong overall associations were found between environmental factors and coronary obstruction or ischemia, but proximity to airports was linked to coronary artery disease via cardiovascular and socio-economic factors, and proximity to major roads was associated with myocardial ischemia in high-risk patients.
Background
Environmental exposures such as air pollution, noise, and residential green space have been implicated in cardiovascular disease risk through mechanisms including oxidative stress and inflammation. Prior studies have linked particulate matter and traffic proximity to coronary artery calcification, a marker of atherosclerosis, but these do not fully capture coronary lumen obstruction or myocardial ischemia. Coronary computed tomography angiography (CCTA) combined with fractional flow reserve (FFRCT) provides detailed anatomical and functional assessment of coronary artery disease, enabling investigation of environmental impacts on coronary obstruction and ischemia beyond calcification scores.
Odds ratio for OCAD per 1 km increase in airport distance (univariable)
0.983 (95% CI 0.974–0.992)
Odds ratio for abnormal FFRCT per 1 km increase in major road distance (high-risk patients, PS-adjusted)
0.634 (95% CI 0.421–0.926)
Key Findings
No significant associations were found between residential PM2.5, NO2, or green space exposure and obstructive coronary artery disease (OCAD) after propensity score adjustment.
Patients with OCAD lived significantly closer to airports, but this association was driven by higher cardiovascular and socio-economic risk factors rather than direct environmental effects.
In high cardiovascular risk patients, greater distance from major roads was independently associated with a lower risk of abnormal fractional flow reserve (FFRCT ≤80%), indicating reduced myocardial ischemia.
Environmental stressors did not show significant associations with coronary obstruction or ischemia in the overall population after adjustment for confounders.
Subgroup analyses suggest differential environmental impacts based on baseline cardiovascular risk profiles.
Clinical Implications
Clinicians should consider that proximity to airports may reflect underlying socio-economic and cardiovascular vulnerabilities rather than direct environmental harm when assessing coronary artery disease risk. In patients with high cardiovascular risk, living closer to major roads may increase the risk of myocardial ischemia, highlighting the need for targeted environmental and lifestyle interventions in this subgroup. Overall, environmental exposures should be integrated with traditional risk factors for comprehensive cardiovascular risk assessment.
Conclusion
This study found no clear independent associations between residential air and noise pollution or green space and coronary artery obstruction or myocardial ischemia in the general population. However, airport proximity correlates with coronary artery disease through socio-economic and cardiovascular risk factors, and major road proximity is linked to myocardial ischemia in high-risk patients, warranting further investigation.
References
Impact of Residential Exposome on Coronary Artery Obstruction and Myocardial Ischemia Evaluated via Coronary Computed Tomography, 2024
by Tom De Potter, Andreea Motoc, Els Verachtert, Hans Hooyberghs, Kaoru Tanaka, Dries Belsack, Diederik De Cock, Frans Fierens, Toshimitsu Tsugu, Tim Nawrot, Marc Claeys, Bernard Cosyns, Jean-François Argacha
Patients with gout who reached serum urate targets had modestly higher 5-year cardiovascular event-free survival, with associations strongest among high-risk patients
