Air pollution is not just background exposure — this evidence map shows how PM2.5 and traffic-related pollution repeatedly align with CIMT progression, coronary calcium, plaque phenotype, cardiovascular events, and mechanistic vascular injury. Built from 96 references and 186 original studies, the full map gives a practical view of which vascular endpoints are most consistently affected, which populations appear vulnerable, and where prevention or exposure-reduction research should move next.
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Abstract: To map and synthesize original research on the relationship between air pollution exposure and atherosclerosis, emphasizing vascular imaging outcomes, clinical atherosclerotic disease, susceptible populations, and mechanistic pathways supported by human, animal, and laboratory evidence. The review uses 96 references and builds its evidence map from 186 original studies with 1807331 total participants/sample observations (topic-deduplicated ΣN). This scoping review indicates that long-term exposure to air pollution, particularly PM2.5 and traffic-related mixtures, is consistently associated with subclinical and clinical atherosclerosis across imaging, biomarker, and outcome studies. The most recurrent signal links higher PM2.5 with accelerated vascular injury, exemplified by 5.0 µm/year greater carotid intima-media thickness progression per 2.5 µg/m³ PM2.5 and a hazard ratio of 1.77 for incident atherosclerosis under long-term multi-pollutant exposure. Converging mechanistic evidence supports a role for oxidative stress, systemic inflammation, and endothelial dysfunction as plausible biological intermediaries, while susceptibility appears heightened in children, menopausal women, and patients with established coronary disease. Although some lower-exposure cohorts reported null associations, the overall pattern supports integrating exposure history into cardiovascular prevention. Future work should prioritize harmonized longitudinal imaging studies and intervention trials testing whether exposure reduction meaningfully slows atherosclerotic progression.
Final search date and database lock: 2026-05-15 07:33:56 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 467
Downloaded Abstracts/Papers: 467
Included original and non-original Abstracts/Papers (all): 189
Included original Abstracts/Papers (Vote counting by direction of effect): 186
Reference Index (links used in paper): 96
Total participants/sample observations (topic deduplicated ΣN): 1807331
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The Evidence Object JSON is a separate machine-readable evidence product: a concentrated synthesis of results, topic-level evidence, and discussion across original and non-original studies. It can be directly input into your LLM, agent, or RAG workflow.
Reference Index (96)
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[69] Association of chemical constituents and pollution sources of ambient fine particulate air pollution and biomarkers of oxidative stress associated with atherosclerosis: A panel study among young adults in Beijing, China. — https://doi.org/10.1016/j.chemosphere.2015.04.096
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[76] Chronic residential exposure to particulate matter air pollution and systemic inflammatory markers. — https://doi.org/10.1289/ehp.0800362
[77] 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. — https://doi.org/10.1371/journal.pmed.1001430
[82] Long-Term Exposure to Ambient Ozone and Progression of Subclinical Arterial Disease: The Multi-Ethnic Study of Atherosclerosis and Air Pollution. — https://doi.org/10.1289/ehp3325
[83] Urban particulate matter air pollution is associated with subclinical atherosclerosis: results from the HNR (Heinz Nixdorf Recall) study. — https://doi.org/10.1016/j.jacc.2010.04.065
[84] Pollutant composition modification of the effect of air pollution on progression of coronary artery calcium: the Multi-Ethnic Study of Atherosclerosis. — https://doi.org/10.1097/ee9.0000000000000024
[85] CD36-dependent 7-ketocholesterol accumulation in macrophages mediates progression of atherosclerosis in response to chronic air pollution exposure. — https://doi.org/10.1161/circresaha.115.304666
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[89] Urban Fine Particulate Matter and Elements Associated with Subclinical Atherosclerosis in Adolescents and Young Adults. — https://doi.org/10.1021/acs.est.1c06347
[93] Short-term exposure to ambient air pollution, gut microbiota, and pro-atherosclerotic responses in healthy adults: A prospective panel study. — https://doi.org/10.1016/j.envres.2026.124532
[98] Association between joint exposure to ambient air pollutants and carotid plaque: The mediating role of cardiometabolic risk factors. — https://doi.org/10.1016/j.ecoenv.2025.117755
[99] Associations of time-weighted individual exposure to ambient particulate matter with carotid atherosclerosis in Beijing, China. — https://doi.org/10.1186/s12940-023-00995-8
[100] Does residential exposure to air pollutants influence mortality and cardiovascular morbidity of older people from primary care? — https://doi.org/10.1186/s12889-023-16166-w
[105] Long-term exposure to ambient air pollution is associated with coronary artery calcification among asymptomatic adults. — https://doi.org/10.1093/ehjci/jeaa073
[107] Residential Exposure to PM and Ozone and Progression of Subclinical Atherosclerosis Among Women Transitioning Through Menopause: The Study of Women's Health Across the Nation. — https://doi.org/10.1089/jwh.2018.7182
[111] Five-year exposure to PM and ozone and subclinical atherosclerosis in late midlife women: The Study of Women's Health Across the Nation. — https://doi.org/10.1016/j.ijheh.2018.09.001
[113] Household air pollution exposure in adult women is associated with increased carotid intima-media thickness: A cross-sectional study of the Household Air Pollution Intervention Network trial. — https://doi.org/10.1016/j.ijheh.2025.114649
[118] Increased vascular stiffness in children exposed in utero but not children exposed postnatally to emissions from a coal mine fire. — https://doi.org/10.1097/ee9.0000000000000309
[122] Associations of exposure to residential green space and neighborhood walkability with coronary atherosclerosis in Chinese adults. — https://doi.org/10.1016/j.envpol.2021.118347
[135] Ultrafine particulate matter exposure induces gut microbiota dysbiosis together with ER stress in the liver and worsened atherosclerosis. — https://doi.org/10.1016/j.envint.2025.109964
[136] Effects of coal-fired PM on the expression levels of atherosclerosis-related proteins and the phosphorylation level of MAPK in ApoE mice. — https://doi.org/10.1186/s40360-020-00411-8
[137] Increased risk of carotid atherosclerosis for long-term exposure to indoor coal-burning pollution in rural area, Hebei Province, China. — https://doi.org/10.1016/j.envpol.2019.113320
[141] Residential exposure to urban traffic is associated with increased carotid intima-media thickness in children. — https://doi.org/10.1155/2015/713540
[142] Cumulative exposure amount of PM in the ambient air is associated with coronary atherosclerosis - Serial coronary CT angiography study. — https://doi.org/10.1016/j.jcct.2021.11.003
[154] Reactive oxygen species production by BP-1,6-quinone and its effects on the endothelial dysfunction: Involvement of the mitochondria. — https://doi.org/10.1016/j.toxlet.2020.01.011
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[169] Relationship between life-time exposure to ambient fine particulate matter and carotid artery intima-media thickness in Australian children aged 11-12 years. — https://doi.org/10.1016/j.envpol.2021.118072
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