Acute Effects on Blood Pressure Following Controlled Exposure to Cookstove Air Pollution in the STOVES Study

Background: Exposure to air pollution from solid fuel used in residential cookstoves is considered a leading environmental risk factor for disease globally, but evidence for this relationship is largely extrapolated from literature on smoking, secondhand smoke, and ambient fine particulate matter (PM_2.5). Methods and Results: We conducted a controlled human-exposure study (STOVES [the Subclinical Tests on Volunteers Exposed to Smoke] Study) to investigate acute responses in blood pressure following exposure to air pollution emissions from cookstove technologies. Forty-eight healthy adults received 2-hour exposures to 5 cookstove treatments (three stone fire, rocket elbow, fan rocket elbow, gasifier, and liquefied petroleum gas), spanning PM_2.5 concentrations from 10 to 500 μg/m³, and a filtered air control (0 μg/m³). Thirty minutes after exposure, systolic pressure was lower for the three stone fire treatment (500 μg/m³ PM_2.5) compared with the control (−2.3 mm Hg; 95% CI, −4.5 to −0.1) and suggestively lower for the gasifier (35 μg/m³ PM_2.5; −1.8 mm Hg; 95% CI, −4.0 to 0.4). No differences were observed at 3 hours after exposure; however, at 24 hours after exposure, mean systolic pressure was 2 to 3 mm Hg higher for all treatments compared with control except for the rocket elbow stove. No differences were observed in diastolic pressure for any time point or treatment. Conclusions: Short-term exposure to air pollution from cookstoves can elicit an increase in systolic pressure within 24 hours. This response occurred across a range of stove types and PM_2.5 concentrations, raising concern that even low-level exposures to cookstove air pollution may pose adverse cardiovascular effects.