The association of chronic air pollutants with coronary artery spasm, vasospastic angina, and endothelial dysfunction

Byoung Geol Choi, Jiwon Lee, Suhng Wook Kim, Min Woo Lee, Man Jong Baek, Yang Gi Ryu, Se Yeon Choi, Jae Kyeong Byun, Ahmed Mashaly, Yoonjee Park, Won Young Jang, Woohyeun Kim, Jah Yeon Choi, Eun Jin Park, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog SeoDong Joo Oh, Seung-Woon Rha

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background We evaluated the effect of chronic exposure to air pollutants (APs) on coronary endothelial function and significant coronary artery spasm (CAS) as assessed by intracoronary acetylcholine (ACH) provocation test. Patients and methods A total of 6430 patients with typical or atypical chest pain who underwent intracoronary ACH provocation test were enrolled. We obtained data on APs from the Korean National Institute of Environmental Research ( APs are largely divided into two types: Particulate matter with aerodynamic diameter of less than or equal to 10 μm in size (PM 10) and gaseous pollutants such as nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone. The primary endpoint is the incidence of significant CAS and its associated parameters during ACH provocation test. Results The incidence of CAS was positively correlated with an exposure duration of PM 10, whereas nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone were shown to be unrelated to CAS. During the ACH provocation test, as PM 10 increased, the frequency of CAS was increased, and the incidence of transient ST-segment elevation was also increased. There was a trend toward higher incidence of spontaneous spasm as PM 10 increased. The mean exposure level of PM 10 was 51.3±25.4 μg/m 3. The CAS risk increased by 4% when the level of PM 10 increased by 20 μg/m 3 by an adjusted Cox regression analysis. Conclusion CAS incidence is closely related to exposure to PMs but not to gaseous pollutants. Particularly, higher exposure concentrations and longer exposure duration of PM 10 increased the risk of CAS. These important findings provide a plausible mechanism that links air pollution to vasospastic angina and provide new insights into environmental factors.

Original languageEnglish
Pages (from-to)336-343
Number of pages8
JournalCoronary Artery Disease
Issue number4
Publication statusPublished - 2018 Jan 1


  • air pollution
  • angina
  • coronary artery disease
  • coronary artery spasm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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