长期接触生物质燃料与颈动脉内膜中层厚度增加和动脉粥样硬化斑块发生率升高有关。
Chronic exposure to biomass fuel is associated with increased carotid artery intima-media thickness and a higher prevalence of atherosclerotic plaque.
机构信息
School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
出版信息
Heart. 2013 Jul;99(14):984-91. doi: 10.1136/heartjnl-2012-303440. Epub 2013 Apr 25.
BACKGROUND
Biomass fuels are used for cooking in the majority of rural households worldwide. While their use is associated with an increased risk of lung diseases and all-cause mortality, the effects on cardiovascular disease (CVD) are not well characterised. Exposure to biomass fuel smoke has been associated with lung-mediated inflammation and oxidative stress, which may increase the risk of atherosclerosis as evaluated by carotid intima-media thickness (CIMT), carotid atherosclerotic plaque prevalence and blood pressure.
METHODS
A cross-sectional study was performed in 266 adults aged ≥35 years in Puno, Peru (3825 m above sea level). We stratified participants by their long-term history of exposure to clean fuel (n=112) or biomass fuel (n=154) and measured 24 h indoor particulate matter (PM2.5) in a random subset (n=84). Participants completed questionnaires and underwent a clinical assessment, laboratory analyses and carotid artery ultrasound. The main outcome measures were CIMT, carotid plaque and blood pressure.
RESULTS
The groups were similar in age and gender. The biomass fuel group had greater unadjusted mean CIMT (0.66 vs 0.60 mm; p<0.001), carotid plaque prevalence (26% vs 14%; p=0.03), systolic blood pressure (118 vs 111 mm Hg; p<0.001) and median household PM2.5 (280 vs 14 µg/m(3); p<0.001). In multivariable regression, the biomass fuel group had greater mean CIMT (mean difference=0.03 mm, 95% CI 0.01 to 0.06; p=0.02), a higher prevalence of carotid plaques (OR=2.6, 95% CI 1.1 to 6.0; p=0.03) and higher systolic blood pressure (mean difference=9.2 mm Hg, 95% CI 5.4 to 13.0; p<0.001).
CONCLUSIONS
Chronic exposure to biomass fuel was associated with increased CIMT, increased prevalence of atherosclerotic plaques and higher blood pressure. These findings identify biomass fuel use as a risk factor for CVD, which may have important global health implications.
背景
生物质燃料被全球大多数农村家庭用于烹饪。虽然它们的使用与肺部疾病和全因死亡率增加有关，但对心血管疾病（CVD）的影响尚未得到很好的描述。暴露于生物质燃料烟雾与肺部介导的炎症和氧化应激有关，这可能会增加颈动脉内膜中层厚度（CIMT）、颈动脉粥样硬化斑块发生率和血压评估的动脉粥样硬化风险。
方法
在秘鲁普诺进行了一项横断面研究，纳入了 266 名年龄≥35 岁的成年人（海拔 3825 米）。我们根据参与者长期使用清洁燃料（n=112）或生物质燃料（n=154）的情况进行分层，并在随机亚组（n=84）中测量了 24 小时室内细颗粒物（PM2.5）。参与者完成了问卷调查，并接受了临床评估、实验室分析和颈动脉超声检查。主要结局指标为 CIMT、颈动脉斑块和血压。
结果
两组在年龄和性别上相似。生物质燃料组的未经调整的平均 CIMT 更高（0.66 比 0.60 毫米；p<0.001），颈动脉斑块发生率更高（26%比 14%；p=0.03），收缩压更高（118 比 111 毫米汞柱；p<0.001），家庭中位数 PM2.5 更高（280 比 14 微克/立方米；p<0.001）。在多变量回归中，生物质燃料组的平均 CIMT 更高（平均差异=0.03 毫米，95%置信区间 0.01 至 0.06；p=0.02），颈动脉斑块发生率更高（比值比=2.6，95%置信区间 1.1 至 6.0；p=0.03），收缩压更高（平均差异=9.2 毫米汞柱，95%置信区间 5.4 至 13.0；p<0.001）。
结论
慢性暴露于生物质燃料与 CIMT 增加、动脉粥样硬化斑块发生率增加和血压升高有关。这些发现表明，使用生物质燃料是 CVD 的一个危险因素，这可能对全球健康具有重要意义。
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