The Cardiovascular Impact of Household Air Pollution in Semi-Urban and Rural Communities in Puno, Peru

Abstract

Background: The Global Burden of Disease Study estimated the global cardiovascular disease burden attributed to household air pollution from biomass fuel combustion based on data from ambient air pollution exposure. The effect of biomass fuel use on cardiac geometry and function has not been well described. Our objective was to determine the association between air pollution from biomass fuel use with cardiac structure and function by transthoracic echocardiography.Methods: We identified a random sample of residents living in the high-altitude region of Puno, Peru. Daily biomass fuel use was self-reported in a questionnaire. Each participant underwent transthoracic echocardiography. Multivariable linear regression analyses were used to examine the relationship between biomass fuel use with each echocardiographic variable, adjusting for age, sex, height, body mass index, diabetes, physical activity, and tobacco use.Results: 187 participants were included in this analysis; 80 biomass fuel users and 107 nonusers. Fifty-eight percent of the participants were women. After adjusting for multiple variables, daily exposure to biomass fuel smoke was associated with increased left ventricular internal diastolic diameter, left atrial diameter, left atrial area (4-chamber and 2-chamber), septal E', and lateral E'. There was no relationship between biomass fuel use with left ventricular systolic function or right ventricular size or function.Conclusion: Daily biomass fuel use was associated with increased left ventricular and left atrial size in a population-based sample of individuals living at high-altitude in Puno, Peru. This difference in cardiac structure potentially increases the risk for multiple adverse cardiovascular outcomes in biomass fuel users. Additional studies are needed to better describe the association between household air pollution from biomass fuel use and cardiovascular outcomes.