Metabolic Signatures of Air Pollution and Major Adverse Cardiovascular Events in Patients Undergoing Cardiac Catheterization

BACKGROUND: ), nitrogen oxide (NOx), and carbon monoxide (CO) to coronary artery disease prognosis remains unclear. OBJECTIVES: The objective of the study was to investigate the molecular pathways linking air pollution to cardiovascular risk by analyzing the metabolome, focusing on the mediating role of metabolites. METHODS: , NOx, CO) were estimated based on residence. Linear regression assessed pollutant-metabolite associations, adjusting for demographics and clinical factors. Competing risk models examined major adverse cardiovascular events (MACE), and Cox models evaluated all-cause mortality. Pathway and mediation analyses explored pollution-related metabolites. RESULTS: (sHR: 1.05; 95% CI: 0.86-1.30; P = 0.62) and NOx (sHR: 1.19; 95% CI: 0.99-1.44; P = 0.068) suggested a modest but not significant elevated risk. Both NOx and CO demonstrated associations with cardiovascular mortality, whereas NOx was associated with congestive heart failure. 1-oleoyl-rac-glycerol was associated with all pollutants and linked to myocardial infarction and stroke. Mediation analysis showed NOx's effect on MACE was mediated by choline. CONCLUSIONS: Air pollution links to metabolic changes that contribute to cardiovascular disease progression and MACE.