Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study

Tom Cole-Hunter; Radhika Dhingra; Kristen M. Fedak; Nicholas Good; Christian L'Orange; Gary Luckasen; John Mehaffy; Ethan Walker; Ander Wilson; John Balmes; Robert D. Brook; Maggie L. Clark; Robert B. Devlin; John Volckens; Jennifer L. Peel

doi:10.1016/j.envint.2020.106254

Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study

Tom Cole-Hunter
, Radhika Dhingra
, Kristen M. Fedak
, Nicholas Good
, Christian L'Orange
, Gary Luckasen
, John Mehaffy
, Ethan Walker
, Ander Wilson
, John Balmes
, Robert D. Brook
, Maggie L. Clark
, Robert B. Devlin
, John Volckens
, Jennifer L. Peel

School of Public and Community Health Sciences

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

Abstract

Background: Exposure to household air pollution from solid fuel combustion for cooking and heating is an important risk factor for premature death and disability worldwide. Current evidence supports an association of ambient air pollution with cardiovascular disease but is limited for household air pollution and for cardiac function. Controlled exposure studies can complement evidence provided by field studies. Objectives: To investigate effects of short-term, controlled exposures to emissions from five cookstoves on measures of cardiac function. Methods: Forty-eight healthy adults (46% female; 20–36 years) participated in six, 2-h exposures (‘treatments’), including emissions from five cookstoves and a filtered-air control. Target fine particulate matter (PM_2.5) exposure-concentrations per treatment were: control, 0 µg/m³; liquefied petroleum gas, 10 µg/m³; gasifier, 35 µg/m³; fan rocket, 100 µg/m³; rocket elbow, 250 µg/m³; and three stone fire, 500 µg/m³. Participants were treated in a set (pre-randomized) sequence as groups of 4 to minimize order bias and time-varying confounders. Heart rate variability (HRV) and cardiac repolarization metrics were calculated as 5-min means immediately and at 3 h following treatment, for analysis in linear mixed-effects models comparing cookstove to control. Results: Short-term differences in SDNN (standard deviation of duration of all NN intervals) and VLF (very-low frequency power) existed for several cookstoves compared to control. While all cookstoves compared to control followed a similar trend for SDNN, the greatest effect was seen immediately following three stone fire (β = −0.13 ms {%}; 95% confidence interval = −0.22, −0.03%), which reversed in direction at 3 h (0.03%; −0.06, 0.13%). VLF results were similar in direction and timing to SDNN; however, other HRV or cardiac repolarization results were not similar to those for SDNN. Discussion: We observed some evidence of short-term, effects on HRV immediately following cookstove treatments compared to control. Our results suggest that cookstoves with lower PM_2.5 emissions are potentially capable of affecting cardiac function, similar to stoves emitting higher PM_2.5 emissions.

Original language	English
Article number	106254
Journal	Environment International
Volume	146
DOIs	https://doi.org/10.1016/j.envint.2020.106254
State	Published - Jan 2021

Funding

We acknowledge that this study would not be possible without our volunteer participants, the supervisory medical staff (study nurses and doctors) from Heart Center of the Rockies, and students of Colorado State University who helped to run our controlled exposure facility (in alphabetical order of surname: Evan Guiderra, Kate Gutekunst, Danny Stringer, and Lizette VanZyl). Research reported in this publication was supported by the National Institute of Environmental Health Sciences of the National Institutes of Health (NIH) under award number ES023688. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. At the time of submission, Tom Cole-Hunter receives funding in the form of a postdoctoral research fellowship from the Centre for Air pollution, energy, and health Research (CAR), a National Health and Medical Research Council (NHMRC) Centre for Research Excellence, under award number APP1116412. The authors certify that their freedom to design, conduct, interpret, and publish research is not compromised by any controlling sponsor, including CAR and NHMRC. That is, the funding sources had no involvement: in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The research described in this article has been reviewed by the Environmental Protection Agency and approved for publication. The contents of this article do not necessarily represent Agency policy nor does mention of trade names or commercial products constitute endorsement or recommendation for use. The authors declare they have no actual or potential competing financial interests. Research reported in this publication was supported by the National Institute of Environmental Health Sciences of the National Institutes of Health (NIH) under award number ES023688. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. At the time of submission, Tom Cole-Hunter receives funding in the form of a postdoctoral research fellowship from the Centre for Air pollution, energy, and health Research (CAR), a National Health and Medical Research Council (NHMRC) Centre for Research Excellence, under award number APP1116412. The authors certify that their freedom to design, conduct, interpret, and publish research is not compromised by any controlling sponsor, including CAR and NHMRC. That is, the funding sources had no involvement: in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Funders	Funder number
Heart Center of the Rockies
R01ES023688
Colorado State University Pueblo
APP1116412
Environmental Protection Agency

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Cardiac repolarization
Cookstove
Fine particulate matter
Healthy adult
Heart rate variability
Household air pollution

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10.1016/j.envint.2020.106254

Cite this

Cole-Hunter, T., Dhingra, R., Fedak, K. M., Good, N., L'Orange, C., Luckasen, G., Mehaffy, J., Walker, E., Wilson, A., Balmes, J., Brook, R. D., Clark, M. L., Devlin, R. B., Volckens, J., & Peel, J. L. (2021). Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study. Environment International, 146, Article 106254. https://doi.org/10.1016/j.envint.2020.106254

@article{5c359dfe3c3043f7914ec80873006aeb,

title = "Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study",

abstract = "Background: Exposure to household air pollution from solid fuel combustion for cooking and heating is an important risk factor for premature death and disability worldwide. Current evidence supports an association of ambient air pollution with cardiovascular disease but is limited for household air pollution and for cardiac function. Controlled exposure studies can complement evidence provided by field studies. Objectives: To investigate effects of short-term, controlled exposures to emissions from five cookstoves on measures of cardiac function. Methods: Forty-eight healthy adults (46\% female; 20–36 years) participated in six, 2-h exposures ({\textquoteleft}treatments{\textquoteright}), including emissions from five cookstoves and a filtered-air control. Target fine particulate matter (PM2.5) exposure-concentrations per treatment were: control, 0 µg/m3; liquefied petroleum gas, 10 µg/m3; gasifier, 35 µg/m3; fan rocket, 100 µg/m3; rocket elbow, 250 µg/m3; and three stone fire, 500 µg/m3. Participants were treated in a set (pre-randomized) sequence as groups of 4 to minimize order bias and time-varying confounders. Heart rate variability (HRV) and cardiac repolarization metrics were calculated as 5-min means immediately and at 3 h following treatment, for analysis in linear mixed-effects models comparing cookstove to control. Results: Short-term differences in SDNN (standard deviation of duration of all NN intervals) and VLF (very-low frequency power) existed for several cookstoves compared to control. While all cookstoves compared to control followed a similar trend for SDNN, the greatest effect was seen immediately following three stone fire (β = −0.13 ms \{\%\}; 95\% confidence interval = −0.22, −0.03\%), which reversed in direction at 3 h (0.03\%; −0.06, 0.13\%). VLF results were similar in direction and timing to SDNN; however, other HRV or cardiac repolarization results were not similar to those for SDNN. Discussion: We observed some evidence of short-term, effects on HRV immediately following cookstove treatments compared to control. Our results suggest that cookstoves with lower PM2.5 emissions are potentially capable of affecting cardiac function, similar to stoves emitting higher PM2.5 emissions.",

keywords = "Cardiac repolarization, Cookstove, Fine particulate matter, Healthy adult, Heart rate variability, Household air pollution",

author = "Tom Cole-Hunter and Radhika Dhingra and Fedak, \{Kristen M.\} and Nicholas Good and Christian L'Orange and Gary Luckasen and John Mehaffy and Ethan Walker and Ander Wilson and John Balmes and Brook, \{Robert D.\} and Clark, \{Maggie L.\} and Devlin, \{Robert B.\} and John Volckens and Peel, \{Jennifer L.\}",

note = "Publisher Copyright: {\textcopyright} 2020 The Authors",

year = "2021",

month = jan,

doi = "10.1016/j.envint.2020.106254",

language = "English",

volume = "146",

journal = "Environment International",

issn = "0160-4120",

publisher = "Elsevier Ltd",

}

Cole-Hunter, T, Dhingra, R, Fedak, KM, Good, N, L'Orange, C, Luckasen, G, Mehaffy, J, Walker, E, Wilson, A, Balmes, J, Brook, RD, Clark, ML, Devlin, RB, Volckens, J & Peel, JL 2021, 'Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study', Environment International, vol. 146, 106254. https://doi.org/10.1016/j.envint.2020.106254

TY - JOUR

T1 - Short-term differences in cardiac function following controlled exposure to cookstove air pollution

T2 - The subclinical tests on volunteers exposed to smoke (STOVES) study

AU - Cole-Hunter, Tom

AU - Dhingra, Radhika

AU - Fedak, Kristen M.

AU - Good, Nicholas

AU - L'Orange, Christian

AU - Luckasen, Gary

AU - Mehaffy, John

AU - Walker, Ethan

AU - Wilson, Ander

AU - Balmes, John

AU - Brook, Robert D.

AU - Clark, Maggie L.

AU - Devlin, Robert B.

AU - Volckens, John

AU - Peel, Jennifer L.

PY - 2021/1

Y1 - 2021/1

N2 - Background: Exposure to household air pollution from solid fuel combustion for cooking and heating is an important risk factor for premature death and disability worldwide. Current evidence supports an association of ambient air pollution with cardiovascular disease but is limited for household air pollution and for cardiac function. Controlled exposure studies can complement evidence provided by field studies. Objectives: To investigate effects of short-term, controlled exposures to emissions from five cookstoves on measures of cardiac function. Methods: Forty-eight healthy adults (46% female; 20–36 years) participated in six, 2-h exposures (‘treatments’), including emissions from five cookstoves and a filtered-air control. Target fine particulate matter (PM2.5) exposure-concentrations per treatment were: control, 0 µg/m3; liquefied petroleum gas, 10 µg/m3; gasifier, 35 µg/m3; fan rocket, 100 µg/m3; rocket elbow, 250 µg/m3; and three stone fire, 500 µg/m3. Participants were treated in a set (pre-randomized) sequence as groups of 4 to minimize order bias and time-varying confounders. Heart rate variability (HRV) and cardiac repolarization metrics were calculated as 5-min means immediately and at 3 h following treatment, for analysis in linear mixed-effects models comparing cookstove to control. Results: Short-term differences in SDNN (standard deviation of duration of all NN intervals) and VLF (very-low frequency power) existed for several cookstoves compared to control. While all cookstoves compared to control followed a similar trend for SDNN, the greatest effect was seen immediately following three stone fire (β = −0.13 ms {%}; 95% confidence interval = −0.22, −0.03%), which reversed in direction at 3 h (0.03%; −0.06, 0.13%). VLF results were similar in direction and timing to SDNN; however, other HRV or cardiac repolarization results were not similar to those for SDNN. Discussion: We observed some evidence of short-term, effects on HRV immediately following cookstove treatments compared to control. Our results suggest that cookstoves with lower PM2.5 emissions are potentially capable of affecting cardiac function, similar to stoves emitting higher PM2.5 emissions.

AB - Background: Exposure to household air pollution from solid fuel combustion for cooking and heating is an important risk factor for premature death and disability worldwide. Current evidence supports an association of ambient air pollution with cardiovascular disease but is limited for household air pollution and for cardiac function. Controlled exposure studies can complement evidence provided by field studies. Objectives: To investigate effects of short-term, controlled exposures to emissions from five cookstoves on measures of cardiac function. Methods: Forty-eight healthy adults (46% female; 20–36 years) participated in six, 2-h exposures (‘treatments’), including emissions from five cookstoves and a filtered-air control. Target fine particulate matter (PM2.5) exposure-concentrations per treatment were: control, 0 µg/m3; liquefied petroleum gas, 10 µg/m3; gasifier, 35 µg/m3; fan rocket, 100 µg/m3; rocket elbow, 250 µg/m3; and three stone fire, 500 µg/m3. Participants were treated in a set (pre-randomized) sequence as groups of 4 to minimize order bias and time-varying confounders. Heart rate variability (HRV) and cardiac repolarization metrics were calculated as 5-min means immediately and at 3 h following treatment, for analysis in linear mixed-effects models comparing cookstove to control. Results: Short-term differences in SDNN (standard deviation of duration of all NN intervals) and VLF (very-low frequency power) existed for several cookstoves compared to control. While all cookstoves compared to control followed a similar trend for SDNN, the greatest effect was seen immediately following three stone fire (β = −0.13 ms {%}; 95% confidence interval = −0.22, −0.03%), which reversed in direction at 3 h (0.03%; −0.06, 0.13%). VLF results were similar in direction and timing to SDNN; however, other HRV or cardiac repolarization results were not similar to those for SDNN. Discussion: We observed some evidence of short-term, effects on HRV immediately following cookstove treatments compared to control. Our results suggest that cookstoves with lower PM2.5 emissions are potentially capable of affecting cardiac function, similar to stoves emitting higher PM2.5 emissions.

KW - Cardiac repolarization

KW - Cookstove

KW - Fine particulate matter

KW - Healthy adult

KW - Heart rate variability

KW - Household air pollution

UR - https://www.scopus.com/pages/publications/85096707757

U2 - 10.1016/j.envint.2020.106254

DO - 10.1016/j.envint.2020.106254

M3 - Article

C2 - 33221594

AN - SCOPUS:85096707757

SN - 0160-4120

VL - 146

JO - Environment International

JF - Environment International

M1 - 106254

ER -

Short-term differences in cardiac function following controlled exposure to cookstove air pollution: The subclinical tests on volunteers exposed to smoke (STOVES) study

Abstract

Funding

UN SDGs

Keywords

Access to Document

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