Black patients have been shown to receive coronary artery calcium scoring (CAC) tests eight times less frequently than white patients. The test reveals whether people at moderate risk for developing heart disease have calcium deposits in their heart arteries and physicians should recommend preventative medications for them, such as statins.

This summer, second-year medical students Brown and Ballenger created a video and questionnaire to help physicians understand and overcome potential barriers Black patients have experienced in obtaining the CAC test. With the help of Dinesh Kalra, chief of cardiology, and other physicians in the , the video and survey were sent to physicians in the UofL Department of Medicine and other UofL providers.

“It reminds physicians about when this preventive test should be ordered, much like screening for blood glucose, cholesterol or cancers. Hopefully after that, we will be able to show that the gap we were seeing in African Americans getting tested less often will be eliminated,” Kalra said.

The survey revealed that the study increased physicians’ confidence in CAC testing and understanding of its role in predicting the risk of future heart attacks. After providers watched the educational video and reviewed guidelines for the test, they reported a greater willingness to order the test and understanding of implicit bias in medicine, which may drive such disparities in health care between Blacks and whites. Kalra’s team hopes to apply these findings in other diseases affected by such disparities, such as heart failure or blood pressure control.

Brown and Ballinger worked on the study as part of the UofL cohort of the national . Winn CIPP offers a six-week summer service-learning experience for medical students who are underrepresented in medicine and committed to a career path that addresses diversity, equity, and inclusion in clinical trial studies.

Brown and Ballinger both have a personal or family history of heart disease, so they understand the need for preventative care delivered through the calcium scoring test. They see this summer’s project as a chance to improve their research skills to benefit their future patients.

“As medical students, we don’t get a lot of instruction on research in our classes,” Brown said. “This program has provided a great opportunity for me to learn as much as I can about research and how to ask questions and how to think and how to analyze data.”

Ballinger believes her experience in Winn CIPP will help her increase trust in research among Black and other underrepresented patients.

“The community aspect of reaching back and providing education and offering education to the community and creating trust in clinical research in general is really important to us moving forward in our career,” Ballinger said.

Seven medical students participated in four mentored projects with , five of whom are UofL students. UofL first hosted the Winn CIPP program in 2023 and is one of nine sites for 2024.

“Everyone sleeps and it’s fascinating to me. We know so little about sleep scientifically that it really piqued my interest, and my project is right at the intersection of cardiovascular health and neurodevelopment, so it is kind of the perfect niche for my interest,” said Sears, assistant professor of environmental medicine, a researcher in the University of Louisville’s and a UofL alumna.

Sears is leading a project to discover how exposure to mixtures of common chemicals and pollutants during gestation and infancy affects sleep health in adolescence. Ultimately, she believes the exposures may be linked to cardiovascular issues later in life. Her work is part of research at the Envirome Institute to understand relationships between the environment and human health.

“Sleep is increasingly recognized to be central to cardiovascular health. We know that a variety of lifestyle choices and environmental factors affect sleep, but we know little about the effects of chemical exposure and pollutants,” said Aruni Bhatnagar, professor of medicine and director the Envirome Institute. “Clara’s work could provide new knowledge about factors that affect sleep, particularly in adolescents, so that we can improve their quality of sleep and future cardiovascular health.”

Sears’ team is examining exposure to combinations of phthalates (common components of plastics), metals and per-/polyfluoroalkyl substances (PFAS – known as “forever chemicals”). People are frequently exposed to these toxicants through their diet, as well as use of consumer goods and household products. Sears said they chose to study mixtures rather than individual chemicals because most people in the U.S. are exposed to them in combination.

“We know pregnant women and children are exposed to these chemicals in mixtures and sometimes they can affect similar biological pathways, or they can interact in ways that may magnify an effect on a health outcome,” Sears said. “So, if we study them in isolation, it is hard to get the real-world relevance of how they interact with each other to affect health.”

The work is funded by a five-year, $2.1 million grant from the National Institutes of Health to determine whether there are connections between these early exposures and poor sleep quality and increases in allostatic load in adolescents. Allostatic load is the cumulative burden of “wear and tear” on the body resulting from stressors that eventually can disrupt an individual’s immune, cardiovascular and metabolic functions. A person’s allostatic load can be assessed through biomarkers and other measures such as inflammation and body composition.

Sears is working with experts in pediatric environmental health, sleep and cardiometabolic health to analyze data from two long-term studies that track prenatal and early life exposures and other health information. The Health Outcomes and Measures of the Environment Study and the Maternal-Infant Research on Environmental Chemicals Study have documented exposures and other health measures in more than 550 children from before birth through pre-teen and teen years, along with sleep health in adolescence.

Sears hopes the study will lead to understanding the link between early life environmental factors and cardiovascular health later in life, informing efforts to improve the environment for infants and children so that they can be healthier into adulthood.

“Sleep impacts every aspect of your health and your day-to-day functioning, so if we can find ways to improve sleep it can have huge impacts on health overall.”

See previous sleep research from the Envirome Institute: Reduced sleep linked to environmental factors | UofL News.

Researchers in UofL’s surveyed more than 700 people on a broad spectrum of psychological well-being factors and at the same time, tested the participants’ cardiovascular disease risk factors, including cholesterol levels, blood pressure, triglyceride levels and arterial stiffness, which is associated with the progression of heart disease. They found that participants who scored higher on the well-being survey also had lower levels of cardiovascular disease risk factors.

One of the strongest findings in the study, which was published in the , was that well-being moderated the association between age and arterial stiffness. While study participants with the lowest well-being scores were more likely to have increased arterial stiffness with age, there was no association between age and arterial stiffness for those with high levels of well-being.

Previous studies have showed a correlation between optimism and happiness and lower risk of cardiovascular health events. The survey for this study took a broader approach to assess psychological well-being, said Alison McLeish, associate professor of clinical psychology at UofL and first author of this study.

“In addition to happiness and optimism, overall well-being includes something we call flourishing. It’s when you’re doing things in your work or in your personal life that use your personal strengths and in which you’re striving to reach a goal,” McLeish said. “It might not always bring you happiness in the moment, but there’s an outcome that is exciting and brings you joy and a sense of accomplishment.”

The study’s authors suggested that health care providers may want to incorporate psychological well-being evaluation when assessing cardiovascular risk and recommend well-being interventions to mitigate the effects of age-related decline in cardiovascular health.

Rachel Keith, UofL associate professor of medicine and co-author who coordinated cardiovascular health assessments for the study, said that having an additional option to reduce heart disease that does not involve medication is appealing.

“When clinicians address heart health without medications we typically think about diet, exercise and tobacco cessation. Given that cardiovascular disease is so prevalent in our society, incorporating new and novel approaches that address risk, such as assessing and educating on ways to improve psychological well-being, may provide exciting opportunities to increase health, especially in an aging population,” Keith said.

Individuals can take steps on their own to maximize psychological well-being. McLeish suggested practicing mindfulness activities, for one. This could be seated meditation or intentionally being present in the moment while doing daily tasks such as walking, washing the dishes or even eating. In addition, she suggested what she calls positive psychology interventions.

“Part of that is identifying your strengths and your values so you can start to craft your life and your activities to build on those strengths and utilize them in different ways. You can do activities that use those strengths as a way to feel a sense of accomplishment as well as joy and happiness,” McLeish said.

McLeish said that while more research is needed to determine the extent to which improving well-being will improve cardiovascular disease risk, this study supports the idea that improving mental health can have a positive impact on physical health.

“The absence of disease doesn’t necessarily indicate health or well-being. It just gets you to neutral,” McLeish said. “A lot of times, both clinical psychology as well as medicine are focused on the absence of disease. We are trying to say let’s go a little bit further than that.”

The five-year funding renewal represents a 62% increase over the previous funding cycle for the UofL center, one of just across the U.S. conducting research into the health effects of chemicals and compounds found at hazardous waste disposal sites known as Superfund sites.

UofL was named one of five new superfund research centers in 2017. Since that time, UofL researchers in the center conducted research into the health effects of volatile organic compounds (VOCs), gases emitted by combustion and from liquid and solid chemicals, found at the Lee’s Lane Superfund Site in southwest Louisville.

“This funding ensures that UofL researchers will continue and accelerate the important work to reduce the effects of these toxins on the health of residents in Jefferson County, our state and our country,” said Lori Stewart Gonzalez, interim president of UofL. “The significant increase in funding shows just how successful our center has been in advancing this knowledge under the leadership of Dr. Sanjay Srivastava.”

The Superfund program, created in 1980, is part of a federal government effort to clean up land contaminated by hazardous waste and identified by the U.S. Environmental Protection Agency as a potential risk to human health or the environment. The program was started in part due to the discovery of a waste site near Louisville in Bullitt County known as the “Valley of the Drums,” which contained thousands of steel drums and contamination from 140 different chemicals.

Superfund Research Centers conduct multidisciplinary research in the detection and investigation of the health effects of specific chemicals and compounds and train young investigators in this area of research. The research at the UofL center is focused on understanding how exposure to VOCs contributes to heart disease, inflammation and liver disease, collectively called cardiometabolic disease.

During its first five-year cycle, the UofL Superfund Research Center engaged in three key project areas where they:

• Developed two portable devices to detect airborne volatile organic compounds in neighborhoods and homes
• Assessed effects of VOCs and other toxins on cardiovascular and immune health in human participants
• Conducted lab studies of health effects of VOCs including acrolein, benzene, xylene, vinyl chloride and trichloroethylene

UofL researchers developed two types of technology to detect and monitor VOCs in the environment. First, collaborating with investigators at Washington University in St. Louis, they designed and built a portable device to monitor and measure VOCs inside and outside of homes to compare indoor and outdoor exposure levels.

Second, chemists and chemical engineers at UofL developed a small “lab on a chip” that can be used in a wearable device to monitor an individual’s exposure in various environments, capturing VOCs for analysis in the lab.

Field studies with both technologies will begin in January 2023.

To study health effects of VOC exposure, UofL researchers enrolled about 700 individuals living in south and west Louisville in a human study program to assess exposure and health changes over time. The initial results of this study indicated that low-level exposure to VOCs could increase blood pressure and damage blood vessels and impair their repair. These effects are important markers for heart disease.

Although planned follow-up studies for the human study were delayed by the pandemic, laboratory and animal studies confirmed these effects.

“This research is revealing and decoding the factors that affect our health outcomes,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “By better understanding these factors, such as VOC exposure, we can develop new interventions that help people here in Louisville and around the world live lives that are not just longer, but healthier and more resilient.”

Next studies expand area, add wastewater monitoring and address mitigation

Over the next five years, center researchers will apply the tools and data from the initial phase to expand the studies. They will broaden the human study to include 1,200 participants across Jefferson County, begin monitoring wastewater for VOCs and launch research to develop VOC mitigation methods.

The broader human health study will enable researchers to compare health changes and exposure levels in different parts of the metro area. Participants will be reassessed periodically over several years for changes in their health and to determine whether the toxins have greater impact on older or younger individuals and those with existing health conditions.

The team will begin monitoring wastewater in Jefferson County for the presence of both VOCs and metabolites shed by individuals, indicating exposure to VOCs. It also may reveal sources of VOC contamination.

“We will measure the metabolites of VOCs in the urine of the participants and in the wastewater, so we will have the environmental exposures and personal exposures. Then we will look at all the health outcomes and see the associations,” said Sanjay Srivastava, professor of medicine and director of the center. “We hope to gain better knowledge of how these chemicals exert toxicity and at what levels the toxicity occurs, as well as how exposures may exacerbate other conditions.”

Technology to monitor wastewater for VOCs and metabolites is an outgrowth of methods developed during the pandemic to detect COVID-19 and its variants in wastewater.

Center investigators also will launch remediation research. They will collaborate with researchers at Yale University who are developing methods to break down VOCs using heat to reduce or eliminate VOCs at hazardous waste sites or in a home or business.

In conjunction with the , UofL researchers also are investigating whether increasing the tree canopy will decrease levels of VOCs and other toxins and improve the health of residents in the area.

“Our work is unique in that it focuses on the effects of these toxins on heart disease,” said Aruni Bhatnagar, director of the Christina Lee Brown Envirome Institute. “Most people have heard of cancer-causing chemicals, but we are finding that these chemicals also lead to heart disease, the leading cause of death in the world.”

The research, led by Aruni Bhatnagar, professor of medicine and director of the UofL Christina Lee Brown Envirome Institute, was published ahead of print in the .

Previous studies have shown that proximity to green space — trees and other vegetation — can lower blood pressure levels and the risk of heart disease. A number of environmental factors may come into play, including increased opportunity for outdoor exercise, reduced mental stress and socioeconomic status. However, the relationship between vascular (blood vessel) health, green space and air pollution has not been fully explored.

In this , researchers looked at the arterial stiffness of adult volunteers with co-occurring conditions such as obesity, high blood pressure, diabetes and high cholesterol, that put the volunteers in the moderate-to-severe risk category for heart disease.

“Although we have known for a long time that exposure to air pollution has adverse effects on our blood vessels, this study shows that those who live in greener neighborhoods may be less affected,” Bhatnagar said. “Therefore, one way of preventing the harmful health effects of air pollution may be to make neighborhoods more green.”

Using study participants’ residential addresses and data from the U.S. Geological Survey and local Environmental Protection Agency monitoring stations, the research team analyzed environmental factors where the volunteers lived, including:

• Vegetation index, including the amount of and variation in greenness levels within 200-meter and one-kilometer (0.62 miles) radii around each volunteer’s home.
• Particulate matter, tiny toxic particles invisible to the naked eye, in the air.
• Levels of ozone, a colorless, toxic gas and significant air pollutant.

At times when the particulate matter and ozone levels were high, participants had higher levels of arterial stiffness, however, those who lived in areas with more flora had better blood vessel function. Trees and other greenery offset vascular dysfunction that air pollution causes, the researchers explained.

In previous work, the researchers found that individuals who live in areas with a large amount of greenness show lower exposure to volatile chemicals and have greater household income. In the current study, they explored the relationships between greenery, air pollution and arterial stiffness and found a similar correlation between the U.S. Geological Survey’s normalized difference vegetation index and average household income. Even when adjusting for self-reported lifestyle habits such as exercise and smoking — 70% of the volunteers were nonsmokers — the researchers found that “the effects of green spaces on hemodynamic function are largely independent of median household income, physical activity levels and tobacco use.”

“These findings indicate that living in green areas may be conducive for vascular health and that the [favorable] effects of greenness may be attributable, in part, to attenuated exposure to air pollutants such as [particulate matter] and ozone,” said Daniel Riggs, UofL biostatistician and the study’s first author.

This research was conducted in conjunction with the Green Heart Project, a first-of-its-kind study of the effects of plants on human health, led by researchers at the .

The Nature Conservancy is overseeing the planting of approximately 8,000 trees and shrubs in the designated neighborhoods. Researchers with the University of Louisville’s Christina Lee Brown Envirome Institute will compare data about the health of people living in the neighborhoods and air pollution levels collected before the plantings with data collected two years after the vegetation is planted. The results will provide insight into how the additional vegetation affects the health of people in the community.

“Our primary objective is to understand how increasing greenness affects the risk of heart disease within the community,” said Aruni Bhatnagar, PhD, director of the at the University of Louisville, who oversees the project. “Heart disease remains the leading cause of death throughout the world. We can treat heart disease with stents and statins, but we cannot prevent the disease. If we can show that putting in more trees will lower the incidence of the disease, even by a fraction of what it is, that would be a major achievement.”

The Nature Conservancy is planting the trees and shrubs in designated residents’ yards at no charge to property owners.

“We’re excited to enter the next phase of the Green Heart project,” said David Phemister, state director for in Kentucky. “Tree plantings at this scale require strong partnerships and deep engagement with the community. Green Heart is not just a science experiment – it is a deep investment to bring more nature to neighborhoods in the heart of Louisville.”

The residents’ health is being assessed by UofL researchers through the Health, Environment and Action in Louisville (HEAL) Study. The HEAL researchers obtained health information from approximately 700 participating residents of the Taylor-Berry, Jacobs, Hazelwood, Oakdale, Wilder Park and Beechmont neighborhoods before the planting began. They collected information such as blood pressure, cholesterol, heart health and other health indicators. The same participants will be evaluated again in two years to determine if these health indicators have changed.

“We wanted Louisville to become maybe one of the first cities in the country that makes its decisions through the lens of all forms of health,” said Christina Lee Brown, benefactor of the Envirome Institute. “That is the Envirome’s objective. This project is a magnificent example of healing our community from the roots up.”

In addition to the Envirome Institute and The Nature Conservancy, the project is funded by the National Institutes of Health and is supported by partnerships with Metro Louisville, Louisville Grows, Washington University in St. Louis, Hyphae Design Laboratory and the United States Forest Service. The total cost of the five-year project is more than $15 million.

A UofL video about this project is available on .

In this study, the first of its kind, researchers from the University of Louisville investigated the impact of neighborhood greenspaces on individual-level markers of stress and cardiovascular disease risk.

Over five years, blood and urine samples were collected from 408 people of varying ages, ethnicities and socioeconomic levels, then assessed for biomarkers of blood vessel injury and the risk of having cardiovascular disease. The participants were recruited from the and were largely at elevated risk for developing cardiovascular diseases.

The density of the greenspaces near the participants’ residences were measured using the Normalized Difference Vegetation Index (NDVI), a tool that indicates levels of vegetation density created from satellite imagery collected by NASA and USGS. Air pollution levels also were assessed using particulate matter from the EPA and roadway exposure measurements.

Researchers found living in areas with more green vegetation was associated with:

• Lower urinary levels of epinephrine, indicating lower levels of stress;
• Lower urinary levels of F2-isoprostane, indicating better health (less oxidative stress);
• Higher capacity to repair blood vessels.

They also found that associations with epinephrine were stronger among women, study participants not taking beta-blockers – which reduce the heart’s workload and lower blood pressure – and people who had not previously had a heart attack.

“Our study shows that living in a neighborhood dense with trees, bushes and other green vegetation may be good for the health of your heart and blood vessels,” said Aruni Bhatnagar, PhD, lead study author and professor of medicine and director of the UofL and the . “Indeed, increasing the amount of vegetation in a neighborhood may be an unrecognized environmental influence on cardiovascular health and a potentially significant public health intervention.”

The findings were independent of age, sex, ethnicity, smoking status, neighborhood deprivation, use of statin medications and roadway exposure.

Previous studies also have suggested that neighborhood greenspaces are associated with positive effects on overall physical and psychosocial health and well-being, as well as reduced rates of death from cardiovascular and respiratory diseases and improved rates of stroke survival, according to Bhatnagar. However, these reports are largely limited by their reliance on self-reported questionnaires and area-level records and evaluations, Bhatnagar said.

Co-authors of this study are Ray Yeager, Ph.D.; Daniel W. Riggs, M.S.; Natasha DeJarnett, Ph.D.; David J. Tollerud, Ph.D.; Jeffrey Wilson, Ph.D.; Daniel J. Conklin, Ph.D.; Timothy E. O’Toole, Ph.D.; James McCracken, Ph.D.; Pawel Lorkiewicz, Ph.D.; Xie Zhengzhi, Ph.D.; Nagma Zafar, M.D., Ph.D.; Sathya S. Krishnasamy, M.D.; Sanjay Srivastava, Ph.D.; Jordan Finch, M.S.; Rachel J. Keith, Ph.D.; Andrew DeFilippis, M.D.;  Shesh N. Rai, Ph.D. and Gilbert Liu, M.D. Author disclosures are on the manuscript.

The WellPoint Foundation and the National Institute of Environmental Health Sciences of the National Institutes of Health supported the study. View the manuscript .

The editorial by , director of Cardiovascular Disease Prevention at the UofL School of Medicine and a cardiologist with UofL Physicians, and Patrick Trainor, a data scientist on DeFilippis’ research team, accompanied a study of a new risk prediction model that could improve the guideline-recommended scoring systems for who is at risk.

That study, by a group of researchers from Stanford University, the University of Michigan, the University of Washington, the University of Mississippi and Harvard Medical School, showed a widely used scoring system that helps physicians identify who is at risk for heart disease may inaccurately estimate risk, especially for certain patients, such as African-Americans. The scoring system, last updated in 2013, is recommended by the American College of Cardiology and the American Heart Association.

DeFilippis said that accurate risk predication is needed to effectively balance the risks and benefits of medicines used to prevent heart disease, and is important to help doctors decide who needs a statin, blood pressure medications or aspirin.

“Doctors must balance the risk of medication side effects with the risk of disease,” DeFilippis said. “Medications are expensive, and unnecessary treatment also costs the healthcare system, which is not an endless resource.”

DeFilippis has led efforts to evaluate cardiovascular disease risk prediction scoring systems, analyzing how they perform using data from clinical studies. He said that while this new study is helpful, risk scoring must continue to evolve based on demographic and societal trends and the availability of new biomarkers for assessing cardiovascular disease.

“Risk prediction is of tremendous benefit,” DeFilippis said. “The guideline-recommended scoring models were created from data collected from groups of patients decades ago. This new study used more modern patient groups and new methods for making the risk calculations.”

He noted that as heart disease is the leading killer of Americans, assessing risk is a critical issue. And while the calculator isn’t perfect, “there is no question these calculators are better than the eyeball test and certainly outperform a physician just saying ‘I think this person is high or low risk’ after looking at them.”

In previous studies, DeFilippis and other researchers at the University of Louisville, Johns Hopkins University and the University of Washington looked at the 2013 scoring system, along with three others, in a study of different ethnic groups. They collected information on patients who began participating in 2000-2002 and followed them for 10 years, evaluating the accuracy of the 2013 scoring model and publishing the results in 2015 in the Annals of Internal Medicine. That study found that the guideline-recommended calculator overestimated a person’s risk.

A 2017 study in the journal The BMJ (formerly the British Medical Journal) noted more than one in five Americans between the ages of 40 and 75 takes a statin. It has been hotly debated who should take statins, and several studies have questioned the accuracy of the risk calculator.

DeFilippis said the new study published this week rebuilds the risk score using a different statistical approach. It re-analyzed data from participants in multiple large studies. The new risk prediction model was shown to make more accurate predictions of risk for many patients, especially for some ethnicities, though further validation is needed.

Because of the need to continually update data, the team in the study that was published this week made the statistical model and computer code public so other scientists could evaluate them.

DeFilippis said that ultimately, “the decision on who should take statins or other medications to reduce risk should be a conversation between doctor and patient.”

While the guidelines still generally recommend them for some groups with a particular score, he said treatment should be individualized.

At the 2^nd Annual Knock Out Stroke event, medical experts from the University of Louisville Stroke Program, the state’s first Certified Comprehensive Stroke Center, will share tips on how to manage high blood pressure and other risk factors related to heart disease and stroke. Guests will learn how to monitor their blood pressure, the importance of physical activity and how to incorporate it into their daily routine, recognizing the symptoms of stroke and understanding the latest treatment options. Plus, WAVE 3’s Dawne Gee will share her personal experience in suffering a stroke.

Knock out Stroke is May 12, 2017 from 10:30 a.m. to 2 p.m. at the Muhammed Ali Center, 144 N. Sixth St. The event is free and open to the public and includes lunch, door prizes and the opportunity to tour the Muhammad Ali Center museum at your leisure. Attendees are asked to .  

Family Health Centers and the UofL Department of Neurology host the program in conjunction with Stroke Awareness Month. Additional partners include the Kentucky Department of Public Health Heart Disease and Stroke Prevention Program, Louisville Department of Health and Wellness, UofL School of Medicine, and UofL Signature Partnership Health & Quality of Life division.

The UofL Stroke Program is a collaboration of University of Louisville Hospital, a part of KentuckyOne Health, UofL Physicians and the UofL School of Medicine.

“These findings suggest that living in a polluted environment could promote the development of high blood pressure, heart disease and stroke more pervasively and at an earlier stage than previously thought,” said Aruni Bhatnagar, PhD, study co-author and the at the University of Louisville. “Although we have known for some time that air pollution can trigger heart attacks or strokes in susceptible, high-risk individuals, the finding that it could also affect even seemingly healthy individuals suggests that increased levels of air pollution are of concern to all of us, not just the sick or the elderly.”

“These results substantially expand our understanding about how air pollution contributes to cardiovascular disease by showing that exposure is associated with a cascade of adverse effects,” said C. Arden Pope, PhD, study lead author and Mary Lou Fulton Professor of Economics at Brigham Young University in Provo, Utah.

is known to contribute to cardiovascular disease and related deaths. In 2004, the American Heart Association released a , updated in 2010, warning of the risk and recommending that people talk to their doctor about avoiding exposure to air pollution specific to their area. What remained unclear, however, was how air pollution actually affects the blood vessels to increase the risk of disease.

For this study, investigators analyzed the component of air pollution known as fine particulate matter — the tiny pieces of solid or liquid pollution emitted from motor vehicles, factories, power plants, fires and smoking. They found that periodic exposure to fine particulate matter was associated with several abnormal changes in the blood that are markers for cardiovascular disease. As air pollution rose, they found:

• Small, micro-particles indicating cell injury and death significantly increased in number;
• Levels of proteins that inhibit blood vessel growth increased; and
• Proteins that signify blood-vessel inflammation also showed significant increases.

Study participants included 72 healthy, nonsmoking adults in Provo, Utah. Their average age was 23, most were white and more than half were male. During the winters of 2013, 2014 and 2015, participants provided blood samples, which researchers then tested for markers of cardiovascular disease. Due to the unique weather and geographical features of Provo, they were able to evaluate these informative blood markers with various levels of air pollution.

However, researchers noted that the third study year, 2015, was relatively unpolluted, which could have affected the results.

The other co-authors from the study were also from UofL and include: James P. McCracken, PhD; Wesley Abplanalp, PhD; Daniel J. Conklin, PhD; and Timothy O’Toole, PhD. The National Institutes of Health funded the study.