Ambient air pollution, covert cerebrovascular disease and cognition: results from the ISSYS study

• Published in: European journal of neurology Vol. 31; no. 10; pp. e16404 - n/a
• Main Authors: Ballvé, A., Pizarro, J., Maisterra, O., Riba‐Llena, I., Pujadas, F., Jiménez‐Balado, J., Palasi, A., Cirach, M., Turner, M. C., Sunyer, J., Delgado, P.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.10.2024; John Wiley and Sons Inc
• Subjects: Absorbance; Aged; Aged, 80 and over; Air pollution; Air Pollution - adverse effects; Air Pollution - statistics & numerical data; Brain; brain infarction; Cerebrovascular disease; Cerebrovascular diseases; cerebrovascular disorders; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - etiology; Cognition; Cognition & reasoning; Cognition - physiology; Cognitive ability; Cognitive Dysfunction - epidemiology; Cognitive Dysfunction - etiology; cognitive impairment; Confidence intervals; Dementia disorders; Female; Humans; Land use; Male; Middle Aged; Nitrogen dioxide; Nitrogen oxides; Original; Particulate matter; Particulate Matter - adverse effects; Population studies; Prospective Studies; Regression models; Spain - epidemiology; Statistical analysis; Stroke; Substantia alba; Spain; particulate matter; air pollution; cognitive impairment; brain infarction; cerebrovascular disorders
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.16404

Background and purpose Although air pollution (AP) has been associated with stroke and dementia, data regarding its relationship with covert cerebrovascular disease (cCVD) and cognition over time are sparse. The aim of this study was to explore these relationships. Methods A prospective population‐based study of 976 stroke‐free and non‐demented individuals living in Barcelona, Spain, was conducted during 2010–2016. A land use regression model was used to estimate the exposure of each participant to AP: NOx, NO2, PM2.5, PM10, PMcoarse and PM2.5 absorbance. Cognitive function and cCVD were assessed at baseline (n = 976) and 4 years after (n = 317). Multivariate‐adjusted models were developed. Results At baseline, 99 participants (10.1%) had covert brain infarcts and 91 (9.3%) had extensive periventricular white matter hyperintensities (WMHs). Marked subcortical WMH progression was seen in 19.7%; the incidence of other covert cerebrovascular lessons ranged between 5% and 6% each. PM2.5 was related to higher odds of having a covert brain infarct (odds ratio [OR] 2.21; 95% confidence interval [CI] 1.06–4.60). PM2.5 absorbance was related to higher odds of having extensive subcortical WMHs (OR 1.72; 95% CI 1.13–2.60), whereas NO2 was related to higher odds of having extensive subcortical (OR 1.66; 95% CI 1.17–2.35) or periventricular (OR 1.96; 95% CI 1.10–3.50) WMHs and to higher odds of developing marked subcortical WMH progression (OR 1.40; 95% CI 1.05–1.90). NOx was related to incident cerebral microbleeds (OR 1.36; 95% CI 1.04–1.79). There was no association between AP and cognition. Conclusions Air pollutant predicts the presence and accumulation of cCVD. Its impact on cognitive impairment remains to be determined. The association between exposure to air pollution, calculated using a land use regression model, and the presence and accumulation over time of covert cerebral vascular disease, assessed by cerebral magnetic resonance imaging, was investigated in a cohort of hypertensive, otherwise healthy, outpatient‐based individuals. Exposure to several of the main air pollutants is associated with an increased risk of cerebrovascular disease at baseline and in the follow‐up 4 years after.