Air pollution is associated with increased risk of venous thromboembolism: the Multi-Ethnic Study of Atherosclerosis

Air pollution exposure may induce procoagulant effects, and chronic exposure may be linked to greater risk of venous thromboembolism (VTE). We tested the hypothesis that air pollution is associated with increased VTE risk in the prospective Multi-Ethnic Study of Atherosclerosis, which has well-characterized air pollution measures and information on potential confounding factors. We included 6651 participants recruited in 2000 to 2002 (baseline age range, 45-84 years; 53% female). Air pollution was assessed with a validated spatiotemporal model that incorporates cohort-specific monitoring. Four indexes of air pollution updated each fortnight over follow-up were averaged to estimate participant-level chronic exposure: fine particulate matter ≤2.5 micrometers in aerodynamic diameter (PM_2.5), oxides of nitrogen (NO_x), nitrogen dioxide (NO₂), and ozone (O₃). Mean±SD PM_2.5 was 13.5±3.0 μg/m³, NO₂ 17.9±8.2 parts per billion (ppb), NO_x 36.1±19.6 ppb, and O₃ 22.2±3.7 ppb. Incident VTE was identified using hospitalization discharge codes through 2018. A total of 248 VTE events accrued over a median follow-up of 16.7 years. After adjustment for baseline demographics, health behaviors, and body mass index, the hazard ratio (95% confidence interval) for incident VTE associated per 3.6 μg/m³ higher PM_2.5 was 1.39 (1.04-1.86); per 13.3 ppb higher NO₂ concentration was 2.74 (1.57-4.77); and per 30 ppb higher NO_x was 2.21 (1.42-3.44). O₃ was not related. In this prospective community-based cohort with individual-level estimation of chronic air pollution exposure, higher average ambient concentrations of PM_2.5, NO₂, and NO_X were associated with greater risk of developing VTE. Findings add to accumulating evidence of adverse health effects attributed to air pollution exposure.