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Background  Long-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD). Calcifications of left-sided heart valves are also markers of CVD risk. We investigated whether air pollution was associated with valvular calcification and its progression.    Methods  We studied 6253 MESA participants aged 45–84 years who underwent two cardiac CT scans 2.5 years apart to quantify aortic valve calcium (AVC) and mitral annular calcium (MAC). CAC was included for the same timeframe for comparison with AVC/MAC. Ambient particulate matter <2.5 μm (PM 2.5 ) and oxides of nitrogen (NO x ) concentrations were predicted from residence-specific spatio-temporal models.    Results  The mean age (SD) of the study sample was 62 (10) years, 39% were white, 27% black, 22% Hispanic, and 12% Chinese. The prevalence of AVC and MAC at baseline were 13% and 9% respectively, compared to 50% prevalence of CAC. The adjusted prevalence ratios of AVC and MAC for each 5 μg/m 3  higher PM 2.5  was 1.19 (95% CI 0.87, 1.62) and 1.20 (0.81, 1.77) respectively, and for CAC was 1.14 (1.01, 1.27). Over 2.5 years, the mean change in Agatston units/year for each 5 μg/m 3  higher PM 2.5  concentration was 0.29 (−5.05, 5.63) for AVC and 4.38 (−9.13, 17.88) for MAC, compared to 8.66 (0.61, 16.71) for CAC. We found no significant associations of NOx with AVC and MAC.    Conclusion  Our findings suggest a trend towards increased 2.5-year progression of MAC with exposure to outdoor PM 2.5 , although this association could not be confirmed. Additional well-powered studies with longer periods of follow-up are needed to further study associations of air pollution with valvular calcium.    Trial registration  Although MESA is not a clinical trial, this cohort is registered at  ClinicalTrials.gov  Identifier: NCT00005487; Date of registration May 25, 2000.

Exposure to ambient air pollution and calcification of the mitral annulus and aortic valve: the multi-ethnic study of atherosclerosis (MESA)