Tertiary hospital cardiovascular imaging and diagnostic setting
Key Highlights
No significant association between air pollution, noise, residential green exposure and coronary artery obstruction or myocardial ischemia in the overall population after adjustment.
Proximity to airports linked to higher coronary artery obstruction risk mediated by cardiovascular and socio-economic vulnerabilities rather than direct environmental effects.
In high cardiovascular risk patients, living closer to major roads independently associated with increased myocardial ischemia risk.
Guideline-Based Recommendations
Diagnosis
Use coronary computed tomography angiography (CCTA) to assess coronary artery obstruction and myocardial ischemia.
Apply fractional flow reserve derived from CCTA (FFRCT) for functional evaluation of intermediate coronary stenosis.
Management
Consider cardiovascular and socio-economic risk factors when evaluating environmental exposure impacts on coronary artery disease.
Further investigate environmental stressors in high-risk patients, especially those with diabetes and active smoking.
Monitoring & Follow-up
Monitor patients with high cardiovascular risk for myocardial ischemia, particularly those living near major roads.
Assess environmental exposure as part of comprehensive cardiovascular risk evaluation.
Risks
Environmental exposures may contribute indirectly to coronary artery disease via socio-economic and cardiovascular risk factors.
Proximity to major roads and airports may increase cardiovascular risk in vulnerable populations.
Patient & Prescribing Data
Patients with stable chest pain undergoing CCTA, including subgroups stratified by Framingham 10-year coronary heart disease risk
Environmental factors alone were not independently associated with coronary obstruction or ischemia; management should focus on traditional cardiovascular risk factors and socio-economic vulnerabilities.
Clinical Best Practices
Incorporate CCTA and FFRCT in diagnostic pathways for stable chest pain to evaluate anatomical and functional coronary disease.
Adjust cardiovascular risk assessment for socio-economic and environmental factors, especially in high-risk patients.
Recognize that environmental exposures may have indirect effects mediated by traditional risk factors rather than direct causation.
Prioritize lifestyle and risk factor modification in patients living near major roads or airports with elevated cardiovascular risk.
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
