Clinical InvestigationHeart FailureLack of association between chronic exposure to biomass fuel smoke and markers of right ventricular pressure overload at high altitude
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.
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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.