Associations of household solid fuel suspension with blood pressure and markers of arterial stiffness and atherosclerosis in a multi-provincial cohort of Chinese adults

Abstract

OPS 35: Health effects of indoor air pollution in LMIC countries, Room 411, Floor 4, August 27, 2019, 1:30 PM - 3:00 PM Background. Household air pollution from solid fuel stoves is a pervasive exposure affecting over 2 billion people. Transition to clean fuels like gas and electricity can reduce household air pollution. We evaluated the associations between current and long-term exclusive use of clean fuel stoves with blood pressure and markers of arterial stiffness and atherosclerosis in rural men and women living in Beijing, Shanxi, and Guangxi provinces. Methods. Among 784 Chinese adults (40-79y) enrolled in the INTERMAP-China Prospective Study, we obtained detailed information on household fuel and stove use between 1996 and 2016 and measured systolic (SBP) and diastolic blood pressure (DBP), brachial-femoral pulse wave velocity (bfPWV), and potential socio-demographic, dietary, and behavioral confounders in winter and summer. Ultrasound images of participants’ carotid arteries were evaluated for plaque area and stability using grayscale analysis. Mixed-effects regression models were used to investigate associations between fuel use and cardiovascular biomarkers. Results. All participants used solid fuel stoves in 1996; 35.3% and 12% suspended use of solid fuel for cooking and heating, respectively, by 2016. In multivariable models, exclusive use of clean cooking fuel was associated with lower SBP (Difference±StErr: -2.8mmHg±1.2) and DBP (-1.6mmHg±0.7) and less grayscale (-3.2±2.5) and total plaque area (-1.5mm2±0.5). Years since suspension of solid fuel cooking were associated with lower SBP [1-5y: -2.1mmHg±1.4; 6-10y: -3.4mmHg±1.6) and DBP (1-5y: -1.3mmHg±1.0; 6-10y: -1.5mmHg±0.9) compared with adults not suspending. Years since suspension of solid fuel heating was associated only with less grayscale (1-5y: -6.8±3.4). These associations were larger in men, older age, and anti-hypertensive medication users. Fuel use was not associated with bfPWV. Conclusions. In this first study of exclusive clean fuel use and cardiovascular outcomes in men and women, exclusive use of clean fuel and years since suspension of solid fuel were associated with lower BP and less plaque vulnerability and severity.