DOI: 10.1161/circ.148.suppl_1.16466 ISSN: 0009-7322

Abstract 16466: Sex-Specific Risks of Air Pollution on Coronary Artery Disease and Adverse Events: Insights From the PROMISE Trial

Isabel L Langenbach, Thomas Mayrhofer, Marcel Langenbach, Michael T Lu, Julia Karady, Neha J Pagidipati, Svati H Shah, Maros Ferencik, Alison Motsinger-Reif, Pamela S Douglas, Borek Foldyna
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Sex-specific differences in coronary artery disease (CAD) have significant implications, yet the potential sex-specific impact of air pollution on CAD and adverse outcomes remains unexplored.

Hypothesis: The association between air pollution and CT-derived CAD phenotype or cardiovascular (CV) events varies by sex.

Methods: We assessed annual average exposure to particulate matter (PM 2.5 & PM 10 ) and ozone by home zip codes in the CT arm of the PROMISE trial. Pollutant exposure was related to CAD measures on CT (any plaque, obstructive CAD (stenosis ≥50%), high-risk plaque (HRP)) and composite endpoint (death, myocardial infarction, unstable angina), adjusting for age, obesity, ASCVD risk, and Socioeconomic Determinants of Health, using sex-stratified regression analyses.

Results: We analyzed 2,252 (52%) women and 2,091 (48%) men (62±8 vs. 59±8 years, p<0.001) with intermediate ASCVD risk (12% vs. 17%, p<0.001). Women were less frequently exposed to PM 2.5 ≥9.5 μm/m 3 (45.1% vs. 48.8%, p=0.011) but more frequently to ozone >45 ppb (40.5% vs. 36.8%, p=0.011) compared to men. Exposure to PM 2.5 ≥9.5 μm/m 3 related to 42% higher odds of obstructive CAD (aOR 1.42, 95%CI: 1.02-1.97, p=0.040) in women but not in men. High PM 10 and ozone exposures did not relate to stenosis or HRP in either sex (p>0.14) (Figure 1a) . Exposure to ozone >45 ppb was related to a higher hazard of events in men (aHR 2.20, 95%CI: 1.36-3.55, p=0.001) but not in women (aHR 1.05, 95%CI: 0.58-1.90, p=0.88). Exposure to high PM 2.5 and PM 10 levels was not associated with events in sex-stratified analysis (Figure 1b) .

Conclusions: Sex significantly influences pollutant impact on CAD. High PM 2.5 exposure increases obstructive CAD risk exclusively in women, while high ozone exposure raises CV event risk in men. Findings stress the need for sex-specific strategies in combating pollution's cardiovascular effects.

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