Evaluation of the effects of chronic biomass fuel smoke exposure on peripheral endothelial functions: an observational study

Abstract

ÖZETAmaç: Hayvansal biyokütle yakıtı (tezek) dumanı inhalasyon ürünlerine kronik olarak maruz kalan bireylerde endoteliyal fonksiyonların değer-lendirilmesi. Yöntemler: Doğumlarından itibaren tezek dumanı inhalasyon ürünleri maruziyeti olan 47 sağlıklı birey (ortalama yaş 31.6±6.8 yıl, 21 erkek) enine kesitli gözlemsel çalışmaya dahil edildi. Kontrol grubu ise 32 sağlıklı kişiden (ortalama yaş 27.9±4.4 yıl, 11 erkek) oluşturuldu. Tüm bireylerde, karotis intima media kalınlığı (CIMT), akım ile ilişkili dilatasyon (FAD %) ve endotel-bağımlı olmayan vazodilatasyon (GTN %) değerlendirildi. CIMT, lümen-intima ile media-adventisya yüzeylerinin önde gelen kenarları arasındaki mesafe olarak hesaplandı. FAD %, reaktif hiperemi sıra-sında brakiyal arter lümen çapının başlangıç düzeyine göre yüzde değişimi olarak tanımlanırken, GTN % ise, 400 µg gliseriltrinitrat uygulandıktan dört dakika sonra ölçülen brakiyal arter lümen çapının başlangıç düzeyine göre yüzde değişimi olarak tanımlanmıştır. İstatistiksel analiz Student t-testi, Ki-kare testi ve Spearman korelasyon katsayısı analizi ile yapıldı. Bulgular: Her iki grubun CIMT değerleri arasında istatistiksel açıdan anlamlı farklılık yoktur (0.47±0.09'a karşın 0.49±0.06 mm, p=0.138). Ancak, kontrol grubu ile karşılaştırıldığında, çalışma grubundaki kişilerin FAD % değerleri belirgin azalmış olarak saptanmıştır (5.06±4.95'e karşın 10.70±4.64, p<0.001). Buna ilaveten, tezek maruziyeti olan kimselerin GTN % değerleri de kontrol grubuna göre düşük düzeylerde bulunmuştur (14.41±8.47'ye karşın21.85±7.87, p<0.001). ABSTRACTObjective: To evaluate the effect of chronic biomass fuel (BMF) smoke exposure on peripheral endothelial functions. Methods: Forty-seven healthy subjects who have been exposed to BMF smoke since birth (mean age 31.6±6.8 years, 21 male) were enrolled in the present cross-sectional observational study. The control group consisted of 32 healthy subjects (mean age 27.9±4.4 years, 11 male). The carotid intima media thickness (CIMT), flow associated dilatation (FAD %) and endothelium independent vasodilatation (GTN %) were assessed in all subjects. The carotid CIMT was defined as the distance between the leading edge of the lumen-intima and the media-adventitia interfaces. FAD % was defined as the percentage change in the internal diameter of the brachial artery during reactive hyperemia related to the baseline. GTN % was defined as the change in diameter in response to the application of 400 µg of glyceril trinitrate relative to the baseline scan at the end of the fourth minute. Statistical analysis was performed using Student's t-test, Chi-square test and Spearman rank order correlation analysis. Results: The average exposure time of the subjects to biomass fuel smoke was 31.7±6.6 years. They have been exposed to dung inhalation products meanly 8.3±1.8 months in a year seasonally. The average daily exposure time was 15.7±3.3 hours. CIMT values of the two groups were not statistically different from each other (0.47±0.09 vs. 0.49±0.06 mm, p=0.138). However, a markedly...

Coronary heart disease and household air pollution from use of solid fuel: a systematic review

“…Two showed significant associations with higher carotid intima media thickness (CIMT),14,30 and one also with the prevalence of carotid plaque ascertained by ultrasound (OR 2.55, 95%CI 1.08-5.98) 30. Against this, a third study found no association with CIMT, although exposure was significantly related to reduced flow-associated dilatation and lower endothelium-independent vasodilatation of the brachial artery 15. In the fourth study, reported only as an abstract, flow-mediated dilatation of the brachial artery again tended to be lower in people using biomass fuels, especially if there was no chimney in the kitchen 32.…”

Chronic exposure to biomass fuel smoke and markers of endothelial inflammation

“…Few studies, however, have examined the relationship between household air pollution from burning biomass fuels and endothelial function markers. One recent study by Buturak et al found that flow mediated dilation and endothelial-independent vasodilation were reduced in individuals with biomass fuel exposure (Butarak et al 2011). …”

“…Specifically, observational studies have found higher blood pressure (Baumgartner et al 2011; Burroughs Peña et al 2015; McCracken et al 2007); a thicker carotid intima-media complex (Painschab et al 2013), and an increased prevalence of self-reported coronary heart disease, stroke and diabetes in populations chronically exposed to biomass fuel smoke (Lee et al 2012). The mechanisms proposed include lung-mediated inflammation with a systemic release of cytokines (Barregard et al 2006), oxidative stress (Banerjee et al 2012), endothelial dysfunction (Allen et al 2011; Butarak et al 2011) and thrombogenesis (Ray et al 2006), all of which could lead to atherosclerosis and adverse health outcomes (Brevetti et al 2006; Fichtlscherer et al 2004; Verma et al 2002). …”

Solid fuel use is a major risk factor for acute coronary syndromes among rural women: a matched case control study

“…11-13 Exposure from solid fuel smoke induces oxidative stress and systemic inflammation, which can lead to high blood pressure and tachycardia. 5 Smoke from solid fuels impairs endothelial and smooth muscle function in blood vessels, increases coagulation tendency and promotes platelet activation , 5,14 thus predisposing to atherosclerosis, which can lead to coronary heart disease and stroke. Furthermore, long-term exposure to smoke from solid fuel has been linked with impaired systolic and diastolic function of the heart.…”