Pollution and cardiovascular risk: COATED-AIR tests an individual strategy, with no results available yet

Two questions in one trial

COATED-AIR involves patients with atherosclerotic cardiovascular disease who are already taking low-dose aspirin. Its factorial design allows two comparisons within a single trial: enteric-coated versus chewable aspirin, and a strategy to reduce the effects of pollution versus usual care.

The comparison of aspirin formulations is double-blind. According to the abstract, any difference between them in cardiovascular and gastrointestinal events remains uncertain. The widespread use of an enteric-coated formulation is therefore not enough to establish its superiority.

Recruitment was completed on January 28, 2026. The planned median follow-up is two years. The abstract states that clinical follow-up and blinded event assessment are still ongoing, without specifying the number of participants recruited.

Alerts paired with several recommendations

The pollution-reduction strategy combines an educational leaflet, real-time air quality alerts by text message, and recommendations for high-pollution days: limit outdoor activities, wear a KN95 mask outdoors, or increase citrus fruit consumption.

These recommendations make up the experimental intervention. Their inclusion in the protocol does not prove that they reduce cardiovascular events. In particular, this abstract does not justify presenting citrus fruit as proven protection against pollution.

The trial evaluates this package of measures. This comparison alone will not allow any potential benefit to be attributed separately to text messages, masks, changes in activity, or citrus fruit.

Clinical events, but no answer yet

For the aspirin formulation comparison, the primary endpoint includes fatal or nonfatal ischemic strokes, certain myocardial infarctions, and acute limb ischemia. For the pollution-reduction strategy, other causes of cardiovascular death are also included. The focus is therefore on clinical events, not just a measure of exposure.

Future conclusions will primarily apply to the patients studied. People with conditions including active or recent bleeding, or those receiving triple antithrombotic therapy, are excluded. These criteria mean the results cannot be extrapolated to everyone exposed to pollution.

What we can take away

COATED-AIR asks an important practical question, but provides no evidence of effectiveness yet. This protocol does not justify switching aspirin formulations or adopting its recommendations as proven cardiovascular protection.