Fine Particulate Air Pollution and the Progression of Carotid Intima-Medial Thickness: A Prospective Cohort Study from the Multi-Ethnic Study of Atherosclerosis and Air Pollution

Background: Fine particulate matter (PM_2.5) has been linked to cardiovascular disease, possibly via accelerated atherosclerosis. We examined associations between the progression of the intima-medial thickness (IMT) of the common carotid artery, as an indicator of atherosclerosis, and long-term PM_2.5 concentrations in participants from the Multi-Ethnic Study of Atherosclerosis (MESA). Methods and Results: MESA, a prospective cohort study, enrolled 6,814 participants at the baseline exam (2000-2002), with 5,660 (83%) of those participants completing two ultrasound examinations between 2000 and 2005 (mean follow-up: 2.5 years). PM_2.5 was estimated over the year preceding baseline and between ultrasounds using a spatio-temporal model. Cross-sectional and longitudinal associations were examined using mixed models adjusted for confounders including age, sex, race/ethnicity, smoking, and socio-economic indicators. Among 5,362 participants (5% of participants had missing data) with a mean annual progression of 14 μm/y, 2.5 μg/m³ higher levels of residential PM_2.5 during the follow-up period were associated with 5.0 μm/y (95% CI 2.6 to 7.4 μm/y) greater IMT progressions among persons in the same metropolitan area. Although significant associations were not found with IMT progression without adjustment for metropolitan area (0.4 μm/y [95% CI -0.4 to 1.2 μm/y] per 2.5 μg/m³), all of the six areas showed positive associations. Greater reductions in PM_2.5 over follow-up for a fixed baseline PM_2.5 were also associated with slowed IMT progression (-2.8 μm/y [95% CI -1.6 to -3.9 μm/y] per 1 μg/m³ reduction). Study limitations include the use of a surrogate measure of atherosclerosis, some loss to follow-up, and the lack of estimates for air pollution concentrations prior to 1999. Conclusions: This early analysis from MESA suggests that higher long-term PM_2.5 concentrations are associated with increased IMT progression and that greater reductions in PM_2.5 are related to slower IMT progression. These findings, even over a relatively short follow-up period, add to the limited literature on air pollution and the progression of atherosclerotic processes in humans. If confirmed by future analyses of the full 10 years of follow-up in this cohort, these findings will help to explain associations between long-term PM_2.5 concentrations and clinical cardiovascular events. Please see later in the article for the Editors' Summary.