Household air pollution exposure in adult women is associated with increased carotid intima-media thickness: A cross-sectional study of the Household Air Pollution Intervention Network trial

Lindsay J Underhill¹, Lisa de Las Fuentes², Laura Nicolaou³, Shakir Hossen⁴, Anaite Diaz-Artiga⁵, Ajay Pillarisetti⁶, Aris T Papageorghiou⁷, Florien Ndagijimana⁸, Ghislaine Rosa⁹, Gurusamy Thangavel¹⁰, John P McCracken¹¹, Kalpana Balakrishnan¹⁰, Krishnendu Mukhopadhyay¹⁰, Kyle Steenland¹², Lisa M Thompson¹³, Lance A Waller¹⁴, Maggie L Clark¹⁵, Michael A Johnson¹⁶, Sarada Garg¹⁰, Sankar Sambandam¹⁰, Suzanne M Simkovich¹⁷, Vigneswari Aravindalochanan¹⁰, Kendra N Williams³, Wenlu Ye¹⁸, Jennifer L Peel¹⁵, Thomas F Clasen¹², William Checkley³, Victor G Davila-Roman¹⁹; HAPIN Investigators

Affiliations

¹ Cardiovascular Division and Global Health Center, Washington University School of Medicine, St. Louis, MO, USA.
² Cardiovascular Division and Global Health Center, Washington University School of Medicine, St. Louis, MO, USA; Center for Biostatistics and Data Science, Institute for Informatics, Data Science, and Biostatistics (I2BD), Washington University School of Medicine, St. Louis, MO, USA.
³ Division of Pulmonary and Critical Care, School of Medicine and Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
⁵ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁶ Division of Environmental Health Sciences, University of California at Berkeley, Berkeley, California, USA.
⁷ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
⁸ Eagle Research Centre, Kigali, Rwanda.
⁹ Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
¹⁰ Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India.
¹¹ Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA.
¹² Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
¹³ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
¹⁴ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
¹⁵ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA.
¹⁶ Berkeley Air Monitoring Group, Berkeley, CA, USA.
¹⁷ Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, MD, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington, DC, USA.
¹⁸ World Health Organization, Geneva, Switzerland.
¹⁹ Cardiovascular Division and Global Health Center, Washington University School of Medicine, St. Louis, MO, USA; Global Health Innovation Network, WashU School of Public Health, St. Louis, MO, USA. Electronic address: vdavila@wustl.edu.

PMID: 40897110
DOI: 10.1016/j.ijheh.2025.114649

Free article

Household air pollution exposure in adult women is associated with increased carotid intima-media thickness: A cross-sectional study of the Household Air Pollution Intervention Network trial

Lindsay J Underhill et al. Int J Hyg Environ Health. 2025 Sep.

Free article

. 2025 Sep:270:114649.

doi: 10.1016/j.ijheh.2025.114649. Epub 2025 Sep 1.

Authors

Affiliations

¹ Cardiovascular Division and Global Health Center, Washington University School of Medicine, St. Louis, MO, USA.
² Cardiovascular Division and Global Health Center, Washington University School of Medicine, St. Louis, MO, USA; Center for Biostatistics and Data Science, Institute for Informatics, Data Science, and Biostatistics (I2BD), Washington University School of Medicine, St. Louis, MO, USA.
³ Division of Pulmonary and Critical Care, School of Medicine and Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
⁵ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁶ Division of Environmental Health Sciences, University of California at Berkeley, Berkeley, California, USA.
⁷ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
⁸ Eagle Research Centre, Kigali, Rwanda.
⁹ Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
¹⁰ Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India.
¹¹ Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA.
¹² Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
¹³ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
¹⁴ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
¹⁵ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA.
¹⁶ Berkeley Air Monitoring Group, Berkeley, CA, USA.
¹⁷ Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, MD, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington, DC, USA.
¹⁸ World Health Organization, Geneva, Switzerland.
¹⁹ Cardiovascular Division and Global Health Center, Washington University School of Medicine, St. Louis, MO, USA; Global Health Innovation Network, WashU School of Public Health, St. Louis, MO, USA. Electronic address: vdavila@wustl.edu.

PMID: 40897110
DOI: 10.1016/j.ijheh.2025.114649

Abstract

Background: Cardiovascular disease is the leading cause of global morbidity and mortality, disproportionately affecting people in low- and middle-income countries (LMICs). Biomass fuels used for cooking in LMICs contribute significantly to household air pollution (HAP), which has been associated with inflammation, oxidative stress, and other pathways linked to atherosclerosis. We evaluate the association between HAP exposure and atherosclerosis by use of carotid artery ultrasound.

Methods: An exposure-response analysis was conducted using cross-sectional baseline data from 397 women aged 40-79 years from the Household Air Pollution Intervention Network (HAPIN) trial in Guatemala, India, Peru, and Rwanda. Participants underwent ultrasound evaluation of their carotid arteries to measure intima-media thickness (CIMT) and atherosclerotic plaques. Additionally, 24-h personal exposures to particulate matter (PM_2.5), carbon monoxide (CO), and black carbon (BC) were assessed.

Findings: Mean 24-h PM_2.5 exposure was 119 μg/m³ (range 10-803), BC was 13 μg/m³ (range 1.1-72), and CO was 2.3 ppm (range 0-39). Mean and maximal unadjusted CIMT measurements were 0.64 ± 0.13 mm and 0.75 ± 0.14 mm, respectively. Prevalence of atherosclerotic plaques was 7.1 % (range: 0.8 %-11.6 % by country). In adjusted linear models, each 10 μg/m³ increase in PM_2.5 was associated with a 0.001 mm increase in mean CIMT (95 % CI: 0 to 0.002) and a 0.002 mm increase in maximal CIMT (95 % CI: 0 to 0.003). For CO, each 10 ppm increase was associated with a 0.04 mm increase in maximal CIMT (95 % CI: 0 to 0.08), with the highest quartile of CO exposure having 0.036 mm and 0.05 mm greater mean and maximal CIMT (95 % CI: 0.002 to 0.07; 0.01, 0.09), respectively, than the lowest quartile. No significant associations were found between BC and CIMT or between any exposures and carotid atherosclerotic plaque.

Interpretation: In this cross-sectional study, higher personal exposures to PM_2.5 and CO were associated with greater mean and maximal CIMT, a well-established biomarker of atherosclerosis, further supporting the association between HAP and cardiovascular disease.

Keywords: Atherosclerosis; Carotid artery ultrasound; Household air pollution.

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Conflict of interest statement

Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Household air pollution exposure in adult women is associated with increased carotid intima-media thickness: A cross-sectional study of the Household Air Pollution Intervention Network trial

Affiliations

Household air pollution exposure in adult women is associated with increased carotid intima-media thickness: A cross-sectional study of the Household Air Pollution Intervention Network trial

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical