Lack of association between chronic exposure to biomass fuel smoke and markers of right ventricular pressure overload at high altitude

Association of household fuel use with hypertension and blood pressure among adult women in rural Bangladesh: A cross-sectional study

OBJECTIVES

This study aimed to determine the association of household fuel use with hypertension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) among adult women.

METHODS

A cross-sectional survey through face-to-face interviews and blood pressure (BP) measurement were conducted among 2182 randomly selected women (1236 solid fuel users and 946 clean fuel users) in rural areas of Bangladesh.

RESULTS

Overall, 21% of women were hypertensive. Mean SBP and DBP for the study population were 121.27 mmHg (SD ± 15.43) and 76.18 mmHg (SD ± 12.00), respectively. Hypertension was found significantly (p = .006) higher among solid fuel users (23%) compared to clean fuel users (18%). Women using solid fuels have a 35% higher chance (AOR: 1.35, CI: 1.10-1.80) of having hypertension and have more than twice the risk of developing elevated SBP (AOR: 2.01, CI: 1.55-2.95) relative to women using clean fuels for their daily cooking. The probability of hypertension (AOR: 1.39, CI: 1.17-1.60) and elevated SBP (AOR: 1.35, CI: 1.10-1.61) increased significantly for every hour of fuel use.

CONCLUSIONS

Using clean fuel, reducing the duration of daily cooking time, and improved cooking facilities may help minimizing hypertension and ultimately cardiovascular disease risk among women.

Association between solid fuel combustion and diabetes mellitus: a systematic review and meta-analysis

In recent years, many epidemiological studies have investigated the relationship between solid fuel combustion and diabetes mellitus (DM). This meta-analysis was performed to explore the potential association between solid fuel combustion and DM. A comprehensive literature search was conducted to identify all relevant studies published prior to January 14, 2022. The pooled odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the effect of solid fuel combustion on DM. The I square value (I²) was used to assess heterogeneity. Due to the heterogeneity of the studies (I² = 66.70%), a random-effect model was used as the pooling method. A total of 9 articles (10 available datasets) were used for this systematic review and meta-analysis, involving 45,620 study subjects. The results of the meta-analysis showed a statistically positive relationship between household solid fuel combustion and the risk of DM (OR = 1.46, 95% CI = 1.09-1.97). Subgroup analysis based on fuel type revealed a statistically significant association in the mixed solid fuel group (OR = 2.03, 95% CI = 1.59-2.59), but not in the single biomass group (OR = 1.04, 95% CI = 0.73-1.49). This meta-analysis suggests that solid fuel combustion may be associated with an increased risk of DM.

Household cooking fuels associated with elevated blood pressure among adult women: a national-wide assessment in Bangladesh

Household air pollution from cooking fuel may have adverse health effects, particularly among women from countries like Bangladesh, where women participate in most household cooking activities. However, little is known about how cooking fuel influences adult women's blood pressure (BP) status in Bangladesh. This study assessed the association between household cooking fuel and women's BP in Bangladesh. Data of 6543 women (aged ≥18 years) from the latest nationally representative Bangladesh Demographic and health survey 2017-18 were used in this study. This survey collected data on various variables, including women's BP and cooking fuel. Multivariable regression models were used for this evaluation. About 82.3% of women were living in households using solid cooking fuel. Women's average systolic BP (SBP) and diastolic BP (DBP) were 121.5 mmHg and 80.7 mmHg, respectively, and 25% had elevated BP. Women residing in a household using solid fuel had significantly higher SBP (β 3.76 mmHg, 95 confidence interval (CI) 2.00, 5.51) and DBP (β 1.17 mmHg, 95% CI 0.17, 2.18) relative to women from households using clean fuel. The odds of elevated BP was 58% higher (adjusted odds ratio, 1.58, 95% CI 1.19, 2.11) among women residing in households using solid fuels compared to their counterparts. Usage of solid cooking fuel was predominantly high and negatively impacted women's BP status in Bangladesh. In addition to other lifestyle change interventions, improved cooking facilities and clean cooking fuel provision and monitoring could be important initiatives to reduce the burden of elevated BP among women.

Prenatal Particulate Matter (PM) Exposure and Natriuretic Peptides in Newborns from Mexico City

(1) Background: The aim of this study was to assess associations between particulate matter (PM) exposure and natriuretic peptide concentrations in cord blood from newborns. (2) Methods: we conducted a cross-sectional study in Mexico City with 101 pregnant women from CIMIGEN Hospital. Atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and C-type natriuretic peptide (CNP) were measured in plasma from cord blood in 51 newborns by ELISA. We estimated PM exposure (PM2.5 and PM10) at first, second and third trimester of pregnancy. (3) Results: The median and interquartile range for ANP, BNP and CNP plasma concentrations were 66.71 (46.92-80.23), 98.23 (73.64-112.30) and 1129.11 (944.10-1452.02) pg/mL, respectively. PM2.5 and PM10 levels for the whole pregnancy period were 22.2 µg/m³ and 41.63 µg/m³, respectively. Employing multivariable linear regression models adjusted for maternal age, newborn sex, smoking before pregnancy, maternal occupation and newborns' length and height, we observed a 2.47 pg/mL (95%CI: -4.67, -0.27) decrease in BNP associated with PM2.5 exposure during second trimester. Adjusted for the same set of confounders, third trimester PM10 exposure was inversely associated with ANP concentrations (beta estimate: -0.90; 95% CI: -1.80, -0.03). Neither PM10 nor PM2.5 were associated with CNP at any trimester of pregnancy. (4) Conclusions: Prenatal exposure to particulate matter was associated with ANP and BNP decrease in newborns.

Indoor air pollution from solid fuels and hypertension: A systematic review and meta-analysis

Cardiovascular diseases (CVD) are leading global health issue. More studies have linked indoor air pollution from solid fuel usage to hypertension risk, a leading risk factor for CVD. We conducted a systematic review and meta-analysis of observational studies assessing the relationship of indoor air pollution from solid fuel with hypertension risk. Using a protocol standardized a priori, two independent reviewers searched PubMed, the Cochrane Library, Ovid MEDLINE, Web of Science and EMBASE for available studies published before Dec.1, 2019. A random effects model was used to analyse the pooled results. Out of 3740 articles, 47 were reviewed in depth and 11 contributing to this meta-analysis. The use of household solid fuel was significantly associated with an increased risk of hypertension (OR = 1.52, 95% CI = 1.26 to 1.85). The smoking-controlled group (OR = 2.38, 95% CI = 1.58 to 3.60) had greater effect size of hypertension than the uncontrolled group (OR = 1.11, 95% CI = 1.10 to 1.11). These findings implicate that indoor air pollution from solid fuel may be an important risk factor for hypertension.

Implementation of clean cookstove interventions and its effects on blood pressure in low-income and middle-income countries: systematic review

OBJECTIVE

A review of the implementation outcomes of clean cookstove use, and its effects on blood pressure (BP) in low-income and middle-income countries (LMICs).

DESIGN

Systematic review of studies that reported the effect of clean cookstove use on BP among women, and implementation science outcomes in LMICs.

DATA SOURCES

We searched PubMed, Embase, INSPEC, Scielo, Cochrane Library, Global Health and Web of Science PLUS. We conducted searches in November 2017 with a repeat in May 2018. We did not restrict article publication date.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included only studies conducted in LMICs, published in English, regardless of publication year and studies that examined the use of improved or clean cookstove intervention on BP. Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search terms: high BP, hypertension and or household air pollution, LMICs, cookstove and implementation outcomes.

RESULTS

Of the 461 non-duplicate articles identified, three randomised controlled trials (RCTs) (in Nigeria, Guatemala and Ghana) and two studies of pre-post design (in Bolivia and Nicaragua) met eligibility criteria. These articles evaluated the effect of cookstove use on BP in women. Two of the three RCTs reported a mean reduction in diastolic BP of -2.8 mm Hg (-5.0, -0.6; p=0.01) for the Nigerian study; -3.0 mm Hg; (-5.7, -0.4; p=0.02) for the Guatemalan study; while the study conducted in Ghana reported a non-significant change in BP. The pre-post studies reported a significant reduction in mean systolic BP of -5.5 mm Hg; (p=0.01) for the Bolivian study, and -5.9 mm Hg (-11.3, -0.4; p=0.05) for the Nicaraguan study. Implementation science outcomes were reported in all five studies (three reported feasibility, one reported adoption and one reported feasibility and adoption of cookstove interventions).

CONCLUSION

Although this review demonstrated that there is limited evidence on the implementation of clean cookstove use in LMICs, the effects of clean cookstove on BP were significant for both systolic and diastolic BP among women. Future studies should consider standardised reporting of implementation outcomes.

Biomass fuel smoke exposure was associated with adverse cardiac remodeling and left ventricular dysfunction in Peru

While household air pollution from biomass fuel combustion has been linked to cardiovascular disease, the effects on cardiac structure and function have not been well described. We sought to determine the association between biomass fuel smoke exposure and cardiac structure and function by transthoracic echocardiography. We identified a random sample of urban and rural residents living in the high-altitude region of Puno, Peru. Daily biomass fuel use was self-reported. Participants underwent transthoracic echocardiography. Multivariable linear regression was used to examine the relationship of biomass fuel use with echocardiographic measures of cardiac structure and function, adjusting for age, sex, height, body mass index, diabetes, physical activity, and tobacco use. One hundred and eighty-seven participants (80 biomass fuel users and 107 non-users) were included in this analysis (mean age 59 years, 58% women). After adjustment, daily exposure to biomass fuel smoke was associated with increased left ventricular internal diastolic diameter (P=.004), left atrial diameter (P=.03), left atrial area (four-chamber) (P=.004) and (two-chamber) (P=.03), septal E' (P=.006), and lateral E' (P=.04). Exposure to biomass fuel smoke was also associated with worse global longitudinal strain in the two-chamber view (P=.01). Daily biomass fuel use was associated with increased left ventricular size and decreased left ventricular systolic function by global longitudinal strain.

Environmental Exposures and Cardiovascular Disease: A Challenge for Health and Development in Low- and Middle-Income Countries

Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes, including hypertension, coronary heart disease, stroke, and cardiovascular mortality. Although populations in low- and middle-income countries are disproportionately exposed to environmental pollution, evidence linking these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures.

Coronary heart disease and household air pollution from use of solid fuel: a systematic review

BACKGROUND

Evidence is emerging that indoor air pollution (IAP) from use of solid fuels for cooking and heating may be an important risk factor for coronary heart disease (CHD).

SOURCES OF DATA

We searched the Ovid Medline, Embase Classic, Embase and Web of Science databases from inception through to June 12, 2015, to identify reports of primary epidemiological research concerning the relationship of CHD to IAP from solid fuel, the likely magnitude of any increase in risk, and potential pathogenic mechanisms.

AREAS OF AGREEMENT

The current balance of epidemiological evidence points to an increased risk of CHD from IAP as a consequence of using solid, and especially biomass, fuels for cooking and heating. Relative risks from long-term exposure could be 2- to 4-fold.

AREAS OF CONTROVERSY

The evidence base is still limited, and although an association of CHD with such IAP from solid fuel is consistent with the known hazards from smoking, environmental tobacco smoke and ambient air pollution, and supported by evidence of effects on inflammatory processes, atherosclerosis and blood pressure, it requires confirmation by larger and more robust studies.

GROWING POINTS

The completion of two relatively small case-control studies on CHD and IAP from use of biomass fuel demonstrates the feasibility of such research, and is an encouragement to further, larger studies using similar methods.

AREAS TIMELY FOR DEVELOPING RESEARCH

The need for such research is particularly pressing because the incidence of CHD in developing countries is rising, and IAP may interact synergistically with the risk factors that are driving that increase. Furthermore, relatively cheap methods are available to reduce IAP from use of solid fuels, and there are indications from intervention studies that these may impact beneficially on CHD as well as other diseases caused by such pollution.

Health effects of carbon-containing particulate matter: focus on sources and recent research program results

Air pollution is a complex mixture of gas-, vapor-, and particulate-phase materials comprised of inorganic and organic species. Many of these components have been associated with adverse health effects in epidemiological and toxicological studies, including a broad spectrum of carbonaceous atmospheric components. This paper reviews recent literature on the health impacts of organic aerosols, with a focus on specific sources of organic material; it is not intended to be a comprehensive review of all the available literature. Specific emission sources reviewed include engine emissions, wood/biomass combustion emissions, biogenic emissions and secondary organic aerosol (SOA), resuspended road dust, tire and brake wear, and cooking emissions. In addition, recent findings from large toxicological and epidemiological research programs are reviewed in the context of organic PM, including SPHERES, NPACT, NERC, ACES, and TERESA. A review of the extant literature suggests that there are clear health impacts from emissions containing carbon-containing PM, but difficulty remains in apportioning responses to certain groupings of carbonaceous materials, such as organic and elemental carbon, condensed and gas phases, and primary and secondary material. More focused epidemiological and toxicological studies, including increased characterization of organic materials, would increase understanding of this issue.

Association between serum concentrations of hypoxia inducible factor responsive proteins and excessive erythrocytosis in high altitude Peru

Painschab, Matthew S., Gary E. Malpartida, Victor G. Davila-Roman, Robert H. Gilman, Todd M. Kolb, Fabiola Leon-Velarde, J. Jaime Miranda, and William Checkley. Association between serum concentrations of hypoxia inducible factor responsive proteins and excessive erythrocytosis in high altitude Peru. High Alt Med Biol 16:26-33, 2015.-Long-term residence at high altitude is associated with the development of chronic mountain sickness (CMS), which is characterized by excessive erythrocytosis (EE). EE occurs under chronic hypoxia, and a strongly selected mutation in hypoxia-inducible factor 2α (HIF2A) has been found in native Tibetans that correlates with having a normal hemoglobin at high altitude. We sought to evaluate differences in plasma levels of four HIF-responsive proteins in 20 participants with EE (hemoglobin >21 g/dL in men and >19 in women) and in 20 healthy, age- and sex-matched participants without EE living at high altitude in Puno, Peru. We performed ELISA to measure plasma levels of the four HIF-responsive proteins: vascular endothelial growth factor (VEGF), soluble VEGF receptor 1 (sVEGF-R1), endothelin-1, and erythropoietin. As a secondary aim, we evaluated the association between HIF-responsive proteins and echocardiography-estimated pulmonary artery systolic pressure (PASP) in a subset of 26 participants. sVEGF-R1 was higher in participants with vs. without EE (mean 107 pg/mL vs. 90 pg/mL; p=0.007). Although plasma concentrations of endothelin-1, VEGF, and erythropoietin were higher in participants with vs. without EE, they did not achieve statistical significance (all p>0.25). Both sVEGF-R1 (p=0.04) and erythropoietin (p=0.04) were positively associated with PASP after adjustment for age, sex, and BMI. HIF-responsive proteins may play a pathophysiological role in altitude-related, chronic diseases but our results did not show consistent changes in all measured HIF-responsive proteins. Larger studies are needed to evaluate for additional genetic and environmental risk factors.

Building a platform for translational research in chronic noncommunicable diseases to address population health: lessons from NHLBI supported CRONICAS in Peru

The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the U.S. National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognized center of excellence conducting quality and innovative research and generating high-impact evidence for health. The center's identity is embedded in its core values: generosity, innovation, integrity, and quality. This review has been structured to describe the development of the CRONICAS Centre, with a focus on highlighting the ongoing translational research projects and capacity-building strategies. The CRONICAS Centre of Excellence is not a risk-averse organization: it benefits from past experiences, including past mistakes, and improves upon them and thus challenges traditional research approaches. This ethos and environment are key to fostering innovation in research.