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Kanagasabai T, Xie W, Yan L, Zhao L, Carter E, Guo D, Daskalopoulou SS, Chan Q, Elliott P, Ezzati M, Yang X, Xie G, Kelly F, Wu Y, Baumgartner J. Household Air Pollution and Blood Pressure, Vascular Damage, and Subclinical Indicators of Cardiovascular Disease in Older Chinese Adults. Am J Hypertens 2022; 35:121-131. [PMID: 34505873 PMCID: PMC8807175 DOI: 10.1093/ajh/hpab141] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Limited data suggest that household air pollution from cooking and heating with solid fuel (i.e., coal and biomass) stoves may contribute to the development of hypertension and vascular damage. METHODS Using mixed-effects regression models, we investigated the associations of household air pollution with blood pressure (BP) and vascular function in 753 adults (ages 40-79 years) from 3 diverse provinces in China. We conducted repeated measures of participants' household fuel use, personal exposure to fine particulate air pollution (PM2.5), BP, brachial-femoral pulse wave velocity (bfPWV), and augmentation index. Ultrasound images of the carotid arteries were obtained to assess intima-media thickness (CIMT) and plaques. Covariate information on sociodemographics, health behaviors, 24-h urinary sodium, and blood lipids was also obtained. RESULTS Average estimated yearly personal exposure to PM2.5 was 97.5 µg/m3 (SD: 79.2; range: 3.5-1241), and 65% of participants cooked with solid fuel. In multivariable models, current solid fuel use was associated with higher systolic (2.4 mm Hg, 95% CI: -0.4, 4.9) and diastolic BP (1.4 mm Hg, 95% CI: -0.1, 3.0) and greater total area of plaques (1.7 mm2, 95% CI: -6.5, 9.8) compared with exclusive use of electricity or gas stoves. A 1 - ln(µg/m3) increase in PM2.5 exposure was associated with higher systolic (1.5 mm Hg, 95% CI: 0.2, 2.7) and diastolic BP (1.0 mm Hg, 95% CI: 0.4, 1.7) and with greater CIMT (0.02 mm, 95% CI: 0.00, 0.04) and total area of plaques (4.7 mm2, 95% CI: -2.0, 11.5). We did not find associations with arterial stiffness, except for a lower bfPWV (-1.5 m/s, 95% CI: -3.0, -0.0) among users of solid fuel heaters. CONCLUSIONS These findings add to limited evidence that household air pollution is associated with higher BP and with greater CIMT and total plaque area.
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Affiliation(s)
- Thirumagal Kanagasabai
- Institute for Health and Social Policy, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Li Yan
- Department of Epidemiology and Biostatistics, and MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Liancheng Zhao
- Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China
| | - Ellison Carter
- Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Dongshuang Guo
- Department of Cardiology,Yuxian Hospital, Yuxian, Shanxi, China
| | - Stella S Daskalopoulou
- Department of Medicine, Division of Internal Medicine and Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, and MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, and MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, and MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, China
| | - Gaoqiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Frank Kelly
- Environmental Research Group, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Jill Baumgartner
- Institute for Health and Social Policy, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Platt JM, Keyes KM, Galea S. Efficiency or equity? Simulating the impact of high-risk and population intervention strategies for the prevention of disease. SSM Popul Health 2016; 3:1-8. [PMID: 29349199 PMCID: PMC5769005 DOI: 10.1016/j.ssmph.2016.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/27/2016] [Accepted: 11/14/2016] [Indexed: 12/04/2022] Open
Abstract
Maximizing both efficiency and equity are core considerations for population health. These considerations can result in tension in population health science as we seek to improve overall population health while achieving equitable health distributions within populations. Limited work has explored empirically the consequences of different population health intervention strategies on the burden of disease and on within- and between-group differences in disease. To address this gap, we compared the impact of four simulated interventions using data from the National Health and Nutrition Examination Survey. In particular, we focus on assessing how population and high-risk primary prevention and population and high-risk secondary interventions efforts to reduce smoking behavior influence systolic blood pressure (SBP) and hypertension, and how such strategies influence inequalities in SBP by income. The greatest reductions in SBP mean and standard deviation resulted from the population secondary prevention. High-risk primary and secondary prevention and population secondary prevention programs all yielded substantial reductions in hypertension prevalence. The effect of population primary prevention did little to decrease population SBP mean and standard deviation, as well as hypertension prevalence. Both high-risk strategies had a larger impact in the low-income population, leading to the greatest narrowing the income-related gap in disease. The population prevention strategies had a larger impact in the high-income population. Population health approaches must consider the potential impact on both the whole population and also on those with different levels of risk for disease within a population, including those in under-represented or under-served groups. A central goal in population health is to maximize overall population health, while minimizing health inequalities within populations. A greater understanding of these potential trade-offs can be gained through simulations and sensitivity analyses. This study sought to understand the implications of four different strategies on the population prevalence and distribution of high systolic blood pressure. The greatest reduction in SBP mean and standard deviation resulted from the population secondary prevention, while high-risk primary and secondary prevention and population secondary prevention all yielded substantial reductions hypertension. Efforts to improve overall population health may disadvantage some groups; whether equity or efficiency is preferable is in part a matter of values.
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Affiliation(s)
- Jonathan M Platt
- Department of Epidemiology, Columbia University, New York, NY, USA
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Abstract
Dietary salt has long been recognized as a major factor affecting blood pressure such that sodium intake is a component of lifestyle modification guidelines for control of high blood pressure. These recommendations are based on results from epidemiologic observational studies and clinical trials of various sodium diets among normotensives and hypertensives. Nonetheless, results from the different studies vary such that specific recommendations regarding sodium intake are difficult to interpret. The results from several recent major trials indicated greater associations of blood pressure and sodium intake than earlier studies as well as meta-analyses of numerous clinical trials. The studies of sodium intake and blood pressures are complicated by measurements of intake, salt sensitivity, hypertension treatment, effects of sodium independent of blood pressure, and length of interventions. Limitations in the methodology of different studies have reduced the value of the results to provide specific and reliable sodium intake levels essential for clinical and lifestyle guidelines.
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Affiliation(s)
- Daniel T Lackland
- Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425, USA.
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Patel SN, Kettner NW. Abdominal aortic aneurysm presenting as back pain to a chiropractic clinic: a case report. J Manipulative Physiol Ther 2006; 29:409.e1-7. [PMID: 16762671 DOI: 10.1016/j.jmpt.2006.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 07/28/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to discuss a patient with abdominal aortic aneurysm (AAA) who presented to a chiropractic teaching clinic and review the pathophysiology, therapeutic strategies, and complications associated with treatment of AAA. CLINICAL FEATURES A 69-year-old male patient experienced right-sided low back pain with radiation into the right leg for 3 weeks. The radiologic examination of the lumbar spine showed a 7.0-cm AAA and degenerative joint disease in the lumbar spine. Real-time ultrasonography showed an approximately 6.0-cm (transverse diameter), 4.1-cm (anteroposterior diameter), and approximately 7.0-cm (long) infrarenal AAA. Computed tomographic angiography showed additional bilateral iliac artery aneurysms. INTERVENTION AND OUTCOME This patient was treated with an endovascular stent graft repair of the abdominal aorta and bilateral iliac artery aneurysms. He has done well after surgery. CONCLUSION This article provides a case study and an overview of AAA. Rupture of an aortic aneurysm is preventable by cautious surveillance and the recognition of suspicious physical and radiographic findings in the population at risk. Early detection reduces mortality because repair is elective rather than emergent.
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Affiliation(s)
- Sanjay N Patel
- Department of Radiology, Logan College of Chiropractic, Chesterfield, Mo 63006-1065, USA
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