Air Pollution and Risk of Future Major Adverse CV Events

A 73-year-old male patient has a history of an acute myocardial infarction (MI) 18 months ago that was treated with a drug-eluting stent deployed in the proximal left circumflex coronary artery. He presents to your clinic for a 6-month evaluation. His most recent echocardiogram shows a left ventricular ejection fraction of 45%. He is currently treated with the following cardiovascular secondary prevention medications:

  • Angiotensin-converting enzyme inhibitor
  • Beta-blocker
  • High-intensity statin
  • Aspirin

He is obese and takes metformin for type II diabetes mellitus, which is well-controlled. He has never smoked and has no history of lung disease. He is on no other medications. He has a strong family history of coronary artery disease (CAD), including a sister who died after her second heart attack at the age of 69. He completed a structured cardiac rehabilitation program and feels well. He walks daily 2-3 miles around the neighborhood with his wife and dog, maintaining a pace such that he can easily carry on a conversation with his wife. He is highly motivated to prevent any further heart problems from occurring and so has instituted a strict vegetarian diet, through which he has lost 30 pounds over the past 18 months. He thinks his stamina is better than ever. He does not use a wood-burning stove for heating or cooking. He has recently been hearing news stories about how air pollution may be bad for the heart and may be especially severe during the winter months. He wonders whether, during days with high levels of air pollution, he should alter his exercise routine to further prevent future cardiovascular events.

Which of the following would you recommend to this patient regarding air pollution and cardiovascular risk?

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