Household Air Pollution and Blood Pressure, Vascular Damage, and Subclinical Indicators of Cardiovascular Disease in Older Chinese Adults

Abstract

Background: Limited data suggest that household air pollution from cooking and heating with solid fuel (i.e., coal and biomass) stoves may contribute to the development of hypertension and vascular damage.

Methods: Using mixed-effects regression models, we investigated the associations of household air pollution with blood pressure (BP) and vascular function in 753 adults (ages 40-79 years) from 3 diverse provinces in China. We conducted repeated measures of participants' household fuel use, personal exposure to fine particulate air pollution (PM2.5), BP, brachial-femoral pulse wave velocity (bfPWV), and augmentation index. Ultrasound images of the carotid arteries were obtained to assess intima-media thickness (CIMT) and plaques. Covariate information on sociodemographics, health behaviors, 24-h urinary sodium, and blood lipids was also obtained.

Results: Average estimated yearly personal exposure to PM2.5 was 97.5 µg/m3 (SD: 79.2; range: 3.5-1241), and 65% of participants cooked with solid fuel. In multivariable models, current solid fuel use was associated with higher systolic (2.4 mm Hg, 95% CI: -0.4, 4.9) and diastolic BP (1.4 mm Hg, 95% CI: -0.1, 3.0) and greater total area of plaques (1.7 mm2, 95% CI: -6.5, 9.8) compared with exclusive use of electricity or gas stoves. A 1 - ln(µg/m3) increase in PM2.5 exposure was associated with higher systolic (1.5 mm Hg, 95% CI: 0.2, 2.7) and diastolic BP (1.0 mm Hg, 95% CI: 0.4, 1.7) and with greater CIMT (0.02 mm, 95% CI: 0.00, 0.04) and total area of plaques (4.7 mm2, 95% CI: -2.0, 11.5). We did not find associations with arterial stiffness, except for a lower bfPWV (-1.5 m/s, 95% CI: -3.0, -0.0) among users of solid fuel heaters.

Conclusions: These findings add to limited evidence that household air pollution is associated with higher BP and with greater CIMT and total plaque area.

Keywords: arterial stiffness; atherosclerosis; blood pressure; fine particulate matter; hypertension; plaques; solid fuel.