Elsevier

American Heart Journal

Volume 168, Issue 5, November 2014, Pages 731-738
American Heart Journal

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

https://doi.org/10.1016/j.ahj.2014.06.030Get rights and content

Background

Chronic exposure to biomass fuel smoke has been implicated in the development of pulmonary hypertension and right ventricular pressure/volume overload through activation of inflammation, increase in vascular resistance, and endothelial dysfunction. We sought to compare N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and echocardiography-derived pulmonary artery systolic pressure (PASP) levels in a high-altitude population-based study in Peru with and without chronic exposure to biomass fuel smoke.

Methods

NT-pro-BNP levels were measured in 519 adults (275 with and 244 without chronic exposure to biomass fuel smoke). Participants answered sociodemographics and clinical history questionnaires, underwent a clinical examination and blood testing for cardiopulmonary biomarkers. PASP was measured in a subgroup of 153 (31%) subjects.

Results

The study group consisted of 280 men (54%) and 239 women (46%). Average age was 56 years and average body mass index was 27 kg/m2. In multivariable analysis, there was no association between chronic exposure to biomass fuel smoke and NT-pro-BNP (P = .31) or PASP (P = .31). In the subgroup in which both NT-pro-BNP levels and PASP were measured, there was strong evidence of an association between these two variables (ρ = 0.24, 95% CI 0.09-0.39; P = .003). We found that age, high sensitivity C-reactive protein, being male, and systolic blood pressure were positively associated with NT-pro-BNP levels whereas body mass index, low-density/high-density lipoprotein ratio, and Homeostasis Model of Assessment-Insulin Resistance were negatively associated (all P ≤ .02).

Conclusions

In this population-based study in a high-altitude setting, neither NT-pro-BNP levels nor echocardiography-derived PASP were associated with chronic exposure to biomass fuel smoke.

Section snippets

Study setting

The study population was comprised of adults (aged ≥35 years) living in Puno, Peru (population ~150, 000), and surrounding rural communities at 3, 825 m above sea level. City-dwellers work chiefly in commerce and education and cook predominantly with clean fuels including liquid-propane gas, kerosene, and electricity. Rural-dwellers live as subsistence farmers and cook indoors almost exclusively with traditional, open-fire stoves, and use combinations of wood, animal dung, and crop residue as

Participant characteristics

We did not find differences in age (P = .64), location (P = .23), or socioeconomic status (P = .55) between the 519 participants enrolled in this ancillary study and the remaining participants of the cohort; however, there was a greater proportion of males in this ancillary study (54% vs 44%; P < .001). Participant characteristics stratified by fuel type are shown in Table II. All participants in the clean fuel group were from urban areas where liquid-propane gas was used as fuel in 98% of

Discussion

In this study, we sought to determine whether chronic exposure to biomass fuel smoke is associated with right ventricular pressure/volume overload and pulmonary hypertension in 519 participants living at high altitude in Puno, Peru. We used NT-pro-BNP levels and echocardiographically-derived PASP as surrogate biomarkers and found no association between either NT-pro-BNP levels or PASP and chronic exposure to biomass fuel smoke.

Prior studies have shown that natriuretic peptides are increased in

Conclusions

In this large, population-based study, neither NT-pro-BNP nor echocardiographically-derived PASP levels were associated with chronic exposure to biomass fuel smoke. There is a need for more studies to better understand the role of biomass fuel smoke exposure on cardiac structure and function, and to identify biomarkers that predict cardiovascular risk due to chronic biomass fuel smoke exposure.

Acknowledgments

We would like to thank David Danz and Lilia Cabrera for assistance in management of field activities.

References (45)

  • A. Fijalkowska et al.

    Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension

    Chest

    (2006)
  • G.S. Bloomfield et al.

    Conditions that predispose to pulmonary hypertension and right heart failure in persons exposed to household air pollution in LMIC

    Glob Heart

    (2012)
  • E. Rehfuess et al.

    Assessing household solid fuel use: multiple implications for the Millennium Development Goals

    Environ Health Perspect

    (2006)
  • J.Y. Po et al.

    Respiratory disease associated with solid biomass fuel exposure in rural women and children: systematic review and meta-analysis

    Thorax

    (2011)
  • R.D. Brook et al.

    American Heart Association Council on Epidemiology and Prevention, Council on the Kidney in Cardiovascular Disease, and Council on Nutrition, Physical Activity and Metabolism: Matter Air Pollution and Cardiovascular Disease. An update to the scientific statement from the American Heart Association

    Circulation

    (2010)
  • A. Nemmar et al.

    Passage of inhaled particles into the blood circulation in humans

    Circulation

    (2002)
  • M.S. Dove et al.

    The impact of Massachusetts smoke free workplace laws 2010

    Am J Public Health

    (2010)
  • R.P. Sargent et al.

    Reduce incidence in MI infarction associated with public smoking band

    BMJ

    (2004)
  • M.S. Painschab et al.

    Chronic exposure to biomass fuel is associated with increased carotid artery intima-media thickness and a higher prevalence of atherosclerotic plaques

    Heart

    (2013)
  • J. Baumgartner et al.

    Indoor Air pollution and blood pressure in adult women living in rural China

    Environ Health Perspect

    (2011)
  • M.S. Lee et al.

    In-home solid fuel use and cardiovascular disease: a cross-sectional analysis of the Shanghai Putuo study

    Environ Health

    (2012)
  • A. Dutta et al.

    Hypertension with elevated levels of oxidized low-density lipoprotein and anticardiolipin antibody in the circulation of premenopausal Indian women chronically exposed to biomass smoke during cooking

    Indoor Air

    (2010)
  • Cited by (14)

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

      2020, Environmental Pollution
      Citation Excerpt :

      Table 2 summarized the general characteristics of these included studies. Seven papers only studied women (Dutta et al., 2011; Young et al., 2019; Ofori et al., 2018; Arku et al., 2018; Neupane et al., 2015; Dutta et al., 2012; Fatmi et al., 2019), while four studies included both women and men (Lee et al., 2012; Yan et al., 2016; Burroughs Peña et al., 2015; Caravedo et al., 2014). All studies were carried out in developing countries, which included China (n = 2), India (n = 2), Peru (n = 2), Honduras (n = 1), Nigeria (n = 1), Nepal (n = 1), Pakistan (n = 1) and ten resource-poor countries (n = 1).

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

      2017, Cardiology Clinics
      Citation Excerpt :

      In addition, a cross-sectional study of 266 individuals in Puno, Peru found that chronic exposure to biomass fuel smoke was associated with increased carotid intima media thickness and a higher prevalence of carotid atherosclerotic plaques.109 However, contrary to what was previously hypothesized, in a sample from the same Peruvian cohort, there was no association between biomass fuel use with elevated NT pro-BNP or right ventricular systolic pressure by echocardiography.110 A small echocardiography study in a single hospital in Turkey observed that biomass fuel users had increased right ventricular systolic pressure and decreased left and right ventricular myocardial indices, indicating decreased biventricular systolic function.111

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

      2015, Global Heart
      Citation Excerpt :

      Late stage (T3 and T4) translational research is defined as “investigations that seek to establish in real world settings the effectiveness of proven efficacious interventions, including ensuring the appropriate adoption and implementation of such interventions with sustainable investment models.” T4 translational research ensures that evidence-based interventions are broadly applied and accessible to those who need them most, with a strong emphasis on dissemination and implementation in real world settings [9,10]. In this section, we describe different initiatives directly related to late-stage translational research being conducted by our center, within Peru (Figure 1) and internationally (Figure 2).

    View all citing articles on Scopus

    Conflicts of interest: The authors have no conflicts of interest to disclose.

    Sources of funding: This work was supported by the Center for Global Health of Johns Hopkins University. Additionally, it was supported in part with Federal funds from the National Heart, Lung, and Blood Institute, US National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN268200900033C. Dr. Davila-Roman was funded in part by the Barnes-Jewish Hospital Foundation. Dr. Checkley was supported by a Pathway to Independence Award (R00HL096955) from the National Heart, Lung and Blood Institute, National Institutes of Health.

    View full text