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Association Between Long-Term PM2.5 Exposure and Subclinical Atherosclerosis in Middle-Aged Women

Zhu, Lei (2020) Association Between Long-Term PM2.5 Exposure and Subclinical Atherosclerosis in Middle-Aged Women. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Air pollution (AP) is associated with an increased risk of cardiovascular disease (CVD). Subclinical atherosclerosis (SCA), a pre-clinical stage of CVD, is measured using coronary artery calcification (CAC). Agatston score correlates to the degree of SCA. Particulate matter (≤2.5μm[PM2.5]), a major component of AP, is known to affect CVD. We focused on two unique groups to study the association between PM2.5 and CAC, including a group of women with polycystic ovary syndrome (PCOS), and women undergoing the menopausal transition (MT).
The first paper is a review of long-term PM2.5 and SCA. The focus was on the epidemiological designs, populations, exposure measurement methodologies and results of the studies of PM2.5 and SCA with an emphasis on women. Two studies that employed spatiotemporal exposure assessment provided evidence of an effect of PM2.5 on CAC, whereas the remaining five did not provide such evidence. Postmenopausal women showed stronger associations between PM2.5 and CAC. Overall, these investigations did not address the association of PM2.5 and CAC risk in a systematic and rigorous way.
The second paper involved a case-control study of women with PCOS and their controls, a Pittsburgh based study (N=301). There was an association between long-term PM2.5 and CAC in women with PCOS (OR=1.44; 95%CI: 1.02-2.05), adjusting for age and BMI, but this was not evident among controls. Interaction test of PCOS and PM2.5 on CAC suggest the positive association is stronger among PCOS women.
The last paper studied CAC and PM2.5 in women undergoing MT using both a cross-sectional and a longitudinal design within the Study of Women Health Across the Nation (SWAN) Heart (N=366). There was no association between PM2.5 and CAC. With a 2.2-year follow-up, MT (measured by menopausal status and time to final menstrual period) did not have significant effect on the association of PM2.5 and CAC presence or progression in middle-aged women.
These findings suggest the need for further in-depth study of the association between long-term PM2.5 and CAC during MT and of metabolically vulnerable populations like women with PCOS, as the public health impact of PM2.5 to these populations might contribute to the burden of disease.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Zhu, Leilez32@pitt.edulez32
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairTalbott, Evelyn
Committee MemberEl Khoudary, Samar
Committee MemberAdibi, Jennifer
Committee MemberYouk, Ada
Date: 30 July 2020
Date Type: Publication
Defense Date: 20 April 2020
Approval Date: 30 July 2020
Submission Date: 20 November 2019
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 225
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Air pollution, Coronary artery calcification, Menopausal transition, Middle-aged women, Polycystic ovary syndrome, Subclinical atherosclerosis
Date Deposited: 30 Jul 2020 21:32
Last Modified: 30 Jul 2020 21:32


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