Air pollution and subclinical cardiovascular disease

Air pollution (AP) is a major, yet poorly understood determinant of cardiovascular events. This research aims to comprehensively investigate the relationship between exposure to AP and subclinical cardiovascular disease (CVD), a prelude to cardiovascular events, to determine (1) how AP may influence the development of CVD, (2) possible mechanisms underlying this relationship, and (3) potential treatment to reduce cardiovascular effects induced by exposure to AP. This cardiovascular epidemiology program includes three major observational studies and one intervention study to address the aforementioned objectives. They are: • Study 1: To investigate the associations of exposure to AP with measures of subclinical coronary artery disease measured by cardiac computed tomography and subclinical cardiac dysfunction and remodelling measured by echocardiography • Study 2: To investigate the long-term relationship between exposure to AP in childhood and subclinical CVD in adulthood, and to investigate any critical periods in this relationship, using unique data from a longitudinal cohort with 35 years of follow-up • Study 3: To explore the possible causal pathways between AP and subclinical coronary artery disease, and between AP and subclinical cardiac dysfunction and remodelling • Study 4: To test the effects of a potential treatment (statins) in reducing cardiovascular effects induced by exposure to AP, through a randomised controlled trial Findings from this program will improve outcomes for many Australians who are exposed to AP. By focusing on subclinical CVD as the primary outcome, we will (1) identify disease many years before an adverse event occurs, (2) differentiate contribution of AP to the development of CVD from triggering acute events, (3) explore specific causal pathways which is much more challenging when studying established CVD, and (4) provide evidence to guide early treatment for prognosis improvement.