Underhill Lindsay J, de Las Fuentes Lisa, Nicolaou Laura, Hossen Shakir, Diaz-Artiga Anaite, Pillarisetti Ajay, Papageorghiou Aris T, Ndagijimana Florien, Rosa Ghislaine, Thangavel Gurusamy, McCracken John P, Balakrishnan Kalpana, Mukhopadhyay Krishnendu, Steenland Kyle, Thompson Lisa M, Waller Lance A, Clark Maggie L, Johnson Michael A, Garg Sarada, Sambandam Sankar, Simkovich Suzanne M, Aravindalochanan Vigneswari, Williams Kendra N, Ye Wenlu, Peel Jennifer L, Clasen Thomas F, Checkley William, Davila-Roman Victor G
Cardiovascular Division and Global Health Center, Washington University School of Medicine, St. Louis, MO, USA.
Cardiovascular Division and Global Health Center, Washington University School of Medicine, St. Louis, MO, USA; Center for Biostatistics and Data Science, Institute for Informatics, Data Science, and Biostatistics (I2BD), Washington University School of Medicine, St. Louis, MO, USA.
Int J Hyg Environ Health. 2025 Sep 1;270:114649. doi: 10.1016/j.ijheh.2025.114649.
Cardiovascular disease is the leading cause of global morbidity and mortality, disproportionately affecting people in low- and middle-income countries (LMICs). Biomass fuels used for cooking in LMICs contribute significantly to household air pollution (HAP), which has been associated with inflammation, oxidative stress, and other pathways linked to atherosclerosis. We evaluate the association between HAP exposure and atherosclerosis by use of carotid artery ultrasound.
An exposure-response analysis was conducted using cross-sectional baseline data from 397 women aged 40-79 years from the Household Air Pollution Intervention Network (HAPIN) trial in Guatemala, India, Peru, and Rwanda. Participants underwent ultrasound evaluation of their carotid arteries to measure intima-media thickness (CIMT) and atherosclerotic plaques. Additionally, 24-h personal exposures to particulate matter (PM), carbon monoxide (CO), and black carbon (BC) were assessed.
Mean 24-h PM exposure was 119 μg/m (range 10-803), BC was 13 μg/m (range 1.1-72), and CO was 2.3 ppm (range 0-39). Mean and maximal unadjusted CIMT measurements were 0.64 ± 0.13 mm and 0.75 ± 0.14 mm, respectively. Prevalence of atherosclerotic plaques was 7.1 % (range: 0.8 %-11.6 % by country). In adjusted linear models, each 10 μg/m increase in PM was associated with a 0.001 mm increase in mean CIMT (95 % CI: 0 to 0.002) and a 0.002 mm increase in maximal CIMT (95 % CI: 0 to 0.003). For CO, each 10 ppm increase was associated with a 0.04 mm increase in maximal CIMT (95 % CI: 0 to 0.08), with the highest quartile of CO exposure having 0.036 mm and 0.05 mm greater mean and maximal CIMT (95 % CI: 0.002 to 0.07; 0.01, 0.09), respectively, than the lowest quartile. No significant associations were found between BC and CIMT or between any exposures and carotid atherosclerotic plaque.
In this cross-sectional study, higher personal exposures to PM and CO were associated with greater mean and maximal CIMT, a well-established biomarker of atherosclerosis, further supporting the association between HAP and cardiovascular disease.
心血管疾病是全球发病和死亡的主要原因，对低收入和中等收入国家（LMICs）的人群影响尤为严重。LMICs中用于烹饪的生物质燃料是家庭空气污染（HAP）的重要来源，而HAP与炎症、氧化应激以及其他与动脉粥样硬化相关的途径有关。我们通过颈动脉超声评估HAP暴露与动脉粥样硬化之间的关联。
利用来自危地马拉、印度、秘鲁和卢旺达的家庭空气污染干预网络（HAPIN）试验中397名40 - 79岁女性的横断面基线数据进行暴露 - 反应分析。参与者接受颈动脉超声评估，以测量内膜中层厚度（CIMT）和动脉粥样硬化斑块。此外，还评估了24小时个人对颗粒物（PM）、一氧化碳（CO）和黑碳（BC）的暴露情况。
24小时平均PM暴露为119μg/m（范围10 - 803），BC为13μg/m（范围1.1 - 72），CO为2.3ppm（范围0 - 39）。平均和最大未调整CIMT测量值分别为0.64±0.13mm和0.75±0.14mm。动脉粥样硬化斑块的患病率为7.1%（各国范围：0.8% - 11.6%）。在调整后的线性模型中，PM每增加10μg/m，平均CIMT增加0.001mm（95%CI：0至0.002），最大CIMT增加0.002mm（95%CI：0至0.003）。对于CO，每增加10ppm，最大CIMT增加0.04mm（95%CI：0至0.08），CO暴露最高四分位数的平均和最大CIMT分别比最低四分位数高0.036mm和0.05mm（95%CI：0.002至0.07；0.01，0.09）。未发现BC与CIMT之间或任何暴露与颈动脉粥样硬化斑块之间存在显著关联。
在这项横断面研究中，个人对PM和CO的较高暴露与更大的平均和最大CIMT相关，CIMT是动脉粥样硬化的一个公认生物标志物，进一步支持了HAP与心血管疾病之间的关联。
