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Study finds association between air pollution, coronary atherosclerosis in Chinese population

Researchers from the University at Buffalo (UB), with colleagues in the US and China, have provided pathophysiologic evidence of the effect of air pollution on cardiovascular disease in China. Their findings also suggests that China may need to revise its standard for one type of pollutant.


Spatial Distribution of Estimated Annual Pollution Concentrations in 2015 in China. A, Concentration of particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5) per 1 × 1 km2. B, Concentration of nitrogen dioxide (NO2) per 1 × 1 km2. Wang et al.

Researchers found that long-term exposure to particulate matter and nitrogen dioxide, as well as proximity to vehicular traffic, were associated with severity of coronary artery calcium, or the buildup of plaque in the artery walls. The study was conducted on 8,867 Chinese adults aged 25 to 92.

The findings, published in an open-access paper in JAMA Network Open, are significant because, while similar studies have been conducted in the US and Europe, this one is the first to investigate the connection between air pollution and coronary artery calcium in China. The country has focused more recently on reducing the extremely high levels of air pollution that exist in some regions, particularly northern China.

This finding should contribute to an understanding of air pollutant effects worldwide, providing both much-needed, locally generated data and supportive evidence to inform the air pollution standard setting process on a global scale.

—first author, Meng Wang

Dr. Wang is assistant professor of epidemiology and environmental health in UB’s School of Public Health and Health Professions and is also a faculty member in the UB RENEW (Research and Education in eNergy, Environment and Water) Institute.

Atherosclerosis refers to the build-up of plaque, or fatty deposits, in the artery walls, which, over time, restricts blood flow through the arteries. This can cause a blood clot resulting in a heart attack or stroke.

Atherosclerosis is a lifelong process. As such, the effects of air pollution exposure on atherosclerosis are likely to be chronic.

—Meng Wang

If an association between this condition and air pollution were established, Wang added, it could provide an opportunity for local-level efforts to control people's exposure to pollution before it becomes harmful to health.

The study centered on levels of nitrogen dioxide and PM2.5. The study also looked at proximity to traffic and used nitrogen dioxide as a more precise indicator of vehicular emissions.

It showed that the risk of a higher coronary artery calcium score increased by 24.5% for every 20 micrograms per cubic meter of air increase in nitrogen dioxide.

Air pollution remains a significant issue in China. In 2015, more than 95% of the Chinese population was exposed to concentrations of PM2.5 and nitrogen dioxide greater than the minimum level of the study, according to Wang.

Since more than 40 percent of all deaths are attributable to cardiovascular disease, the potential contribution of air pollutants to cardiovascular disease in China is very large.

—Meng Wang

Improving air quality to the Chinese national standards of 35 and 40 micrograms per cubic meter of air for PM2.5 and nitrogen dioxide, respectively, may help people live longer, Wang said.

Still, the effect of nitrogen dioxide exposure on coronary artery calcium persisted even when researchers restricted their analysis to concentrations below 40 micrograms per cubic meter of air.

This suggests that the current air pollution standard may need to be re-evaluated.

—Meng Wang

The study involved researchers from the University of Washington, Seattle; Chinese Academy of Medical Sciences; Tsinghua University; Emory University; and Harbor UCLA Medical Center.


  • Wang M, Hou Z, Xu H, et al. Association of Estimated Long-term Exposure to Air Pollution and Traffic Proximity With a Marker for Coronary Atherosclerosis in a Nationwide Study in China. JAMA Netw Open. Published online June 28, 20192(6):e196553. doi:10.1001/jamanetworkopen.2019.6553



A great deal of this is due to coal combustion.

The Chinese would literally be better off had they built RBMK reactors instead of coal-fired plants.  Even if they did something as stupid as at Chernobyl and blew one up, they would have far less total harm to the public.


Coal is the cheapest fuel in China and gas is in short supply so in many households coal is used for cooking as well as heating. The Government is pushing RE with the desire to provide clean electricity as the more common form of energy...that'll take a long time. regardless of the good progress to date.


Not surprised. We are progressively killing ourself and most living creature with pollution, industrial products and GHGs.

Yes, replacing CPPs, NGPPs and ICEVs with a mix of NPPs, 24/7 REs and electrified vehicles would be a good solution.


AlzHarvey, "renewables" are defined as wind and solar.  There is NO SUCH THING as "24/7 REs".


Sorry SAEP. Hydro is still one of the major RE (at 20+%) and it is practically a 24/7 source. I have to admit that Solar and Wind are growing much faster and will both probably surpass Hydro by 2035/2045 or so.

Hydro is still one of the major RE (at 20+%)

Hydro is excluded from "renewable portfolio standards".  It can't scale and the land for new reservoirs is either protected or unaffordable anyway.

I have to admit that Solar and Wind are growing much faster

Solar plus wind have still not exceeded hydro in the USA.  The sum of all "renewables" is still behind nuclear.

Nuclear is producing only about 20% of US electric power.  Electric power includes almost no transportation energy, very little heating energy, and just a fraction of industrial energy.  Trying to close down nuclear in favor of "renewables" is ecocidal.


Sorry SAEP but Hydro is the number one among all REs with about 20% of the world e-energy production. The water used is NOT consumed like in CPPs, NGPPs and NPPs. It is therefore very renewable.

It is much closer to Wind/Solar REs.

I agree that Hydro is limited to available waters with certain elevation differences. Only about 50% of the world potential is presently harnessed. Where you have hills/mountains and reasonable rainfall you have the essentials. The initial installation cost is very variable, specially where you have to create large water reservoirs, but Hydro installations can last for 100+ years with low ongoing maintenance. Water flow regulation with Hydro plants can be very beneficial for irrigation and to better controlled flooding..

Hydro is the number one among all REs with about 20% of the world e-energy production.

Argue with the people who define what "renewable" means in "renewable portfolio standards".  They say hydro doesn't qualify.

The water used is NOT consumed like in CPPs, NGPPs and NPPs. It is therefore very renewable.

None of those things consume water either.  They may return warmer water to the environment, or they may evaporate some and it falls as rain a short time later.  The water remains water.

Dams, OTOH, are great big solar collectors and large sources of evaporation.  They also kill off runs of migratory fish and warm the water substantially, changing ecosystems radically.


Reducing REs to mostly Wind/Solar is a definition created by USA's fossil fuel energy firms to block importation of clean Hydro energy. Don't thing that SAEP should repeat that falsehood.


RBMKs ran OK after Chernobyl, once they figured out their operating parameters etc properly. Probably wouldn't do too well with a terrorist attack, though.

It is easy enough to do safe nuclear, or cheap nuclear. The trick is to do safe, cheap nuclear.

Reducing REs to mostly Wind/Solar is a definition created by USA's fossil fuel energy firms to block importation of clean Hydro energy.

Also to block a proliferation of small hydro operators and handing incentives to existing ones not to decommission.  Gee, why would fossil interests want THAT?  Avoid competition for their gas turbines burning cheap shale gas, maybe?  Same as their push to get rid of nuclear?

Don't thing that SAEP should repeat that falsehood.

What falsehood?  The definitions in RPSs are the definitions.  But you're edging awfully close to the truth about just WHO is providing the money and the agenda for "Greens", AlzHarvey.

It is easy enough to do safe nuclear, or cheap nuclear. The trick is to do safe, cheap nuclear.

Chernobyl was the consequence of the operators doing what the designers of the RBMK explicitly told operators NOT to do.  The control system was printing warning messages; those DON'Ts were literally written into the software.  Yet the clown in charge pressed on, and the operators did not have the authority to say no to him.  There was no safety culture in the USSR.

Obedience cultures have caused fatalities in many other situations; I recall an airliner crash that was caused by the captain flying directly into very adverse weather, and because of the authority of the captain all the co-pilot could say was something like "the weather radar looks interesting today".  The captain ignored the hint and they both died, along with everyone else on board.

RBMKs would have been operated safely in the USA.  The US nuclear industry and aircraft industries both have strong safety cultures.


Even with the best safety features, one of the Three Miles Island unit came very close to disaster.

The Japan units had major problems to handle earth quakes and related high waves. Where they in installed in the wrong place at the wrong time?

Fully safe clean production units are not easy to design, build and install, that is why strict controls and standards are required.


Three Mile Island was a consequence of water getting into a compressed air system.  It was about the worst POSSIBLE accident with a PWR, and there were 0 fatalities, 0 injuries.  That's safe enough; all the pointless "safety upgrades" since then have made us LESS safe, by entrenching more dangerous energy.

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