RSNA: CCTA Study Reveals Link Between Common Air Pollutants and Coronary Artery Stenosis

Emerging coronary computed tomography angiography (CCTA) research reveals that long-term exposure to the common air pollutants gaseous nitrogen oxide (NO₂) and fine particulate matter (PM_2.5) may be linked to higher risks for coronary artery stenosis and obstructive coronary artery disease (CAD) in men.

For the retrospective study, recently presented at the Radiological Society of North America (RSNA) conference, researchers reviewed CCTA data in 2,172 patients (mean age of 58.2) as well as mean 10-year exposure rates to NO₂ and PM_2.5based on data from the nearest monitoring stations to patient residence. According to the study, the mean 10-year exposures to NO₂ and PM_2.5 in the patient cohort were 12.2 parts per billion (ppb) and 7.5μg/m³ respectively.

Overall, the study authors found that a 1 μg/m³ increase in 10-year exposure to PM_2.5 was associated with a 24 percent higher likelihood of moving to a higher CAD-RADS stenosis category and a 33 percent higher risk of obstructive CAD. The researchers also noted a 4 percent higher risk of obstructive CAD for each 1 ppb increase in 10-year exposure to NO_2..

“This is one of the largest studies to link long-term gaseous and particulate air pollution at contemporary exposure levels with multiple markers of coronary artery disease assessed by cardiac CT,” noted senior study author Kate Hanneman, M.D., M.P.H., an associate professor and vice chair of research with the Department of Medical Imaging at the University of Toronto. “Heart disease is the number one cause of death globally. The results of this study add to the growing body of evidence that air pollution is a modifiable cardiovascular risk factor and reinforce the need for further research to understand why these associations differ between men and women.”

(Editor’s note: For additional coverage of the RSNA conference, click here.)

For men, there was a 47 increased likelihood of moving to a higher CAD-RADS stenosis category with a 1μg/m³ increase in ten-year exposure to PM_2.5 but there was no significant association with CAD-RADS stenosis assessment in women. Lead study author Felipe Castillo Aravena, M.D., noted other findings with men and women with respect to 10-year exposure to PM_2.5.

"In women, long-term exposure to fine particulate matter was linked to higher calcium scores and more severe narrowing of the arteries. In men, higher long-term exposure to fine particulate matter was associated with higher calcium scores and higher plaque burden,” added lead study author Felipe Castillo Aravena, M.D., a cardiothoracic imaging fellow in the Department of Medical Imaging at the University of Toronto.

(Editor’s note: For related content, see “Integrating AI into Radiology Practice to Enhance Lung Disease Prediction and Diagnosis,” “Lung Cancer Screening: Challenges and Opportunities” and “Study Shows Merits of CT Vascular Sign for Differentiating Solid Pulmonary Nodules.”)

Reference

1. Aravena FC, DesRoche C, Delaney S, et al. Sex-specific associations of long-term air pollution exposure with coronary artery stenosis on cardiac CT. Presented at the Radiological Society of North America (RSNA) annual meeting, November 30-December 4, 2025, Chicago.