Mon, Feb 13, 2017, noon:
Daniel Almirall, "Getting SMART about adaptive interventions"
Adar, Sara D., Lianne Sheppard, Sverre Vedal, Joseph F. Polak, Paul D. Sampson, Ana Diez Roux, Matthew Budoff, David R. Jacobs, Jr., R. Graham Barr, Karol Watson, and Joel D. Kaufman. 2013. "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." PLOS Medicine, 10(4): e1001430.
Background: Fine particulate matter (PM2.5) 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 PM2.5 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). PM2.5 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 mu m/y, 2.5 mu g/m(3) higher levels of residential PM2.5 during the follow-up period were associated with 5.0 mu m/y (95% CI 2.6 to 7.4 mu m/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 mu m/y [95% CI -0.4 to 1.2 mu m/y] per 2.5 mu g/m(3)), all of the six areas showed positive associations. Greater reductions in PM2.5 over follow-up for a fixed baseline PM2.5 were also associated with slowed IMT progression (-2.8 mu m/y [95% CI -1.6 to -3.9 mu m/y] per 1 mu g/m(3) 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 PM2.5 concentrations are associated with increased IMT progression and that greater reductions in PM2.5 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 PM2.5 concentrations and clinical cardiovascular events.
PMCID: PMC3637008. (Pub Med Central)