• aortic and arterial disease
• hypertension
• heart disease
• global health

Much of the world’s population relies on use of inefficient biomass and coal stoves for cooking, heating and lighting needs, with a high prevalence of biomass fuel use occurring in low/middle-income countries. The burning of wood, animal/crop residue and charcoal produces high concentrations of particulate matter (PM_2.5) and carbon monoxide. That some 3 billion people are habitually exposed to such toxicants is alarming as there is a causal link between air pollution (both outdoor and indoor) and cardiovascular disease (CVD).1

Morbidity and mortality related to hypertension and subsequent CVD is very high in China and expected to rise. In their Heart paper, Baumgartner and colleagues examined exposure–response associations between personal exposure to air pollution stemming from biomass stoves and novel measures of CVD risk in women living in rural China.2 Members of the research team visited 205 women in their homes throughout 12 villages in Sichuan Province, China. Personal exposure to PM_2.5 and black carbon were measured for 48 hours using waist-worn air pollution monitors. Researchers then measured both conventional brachial blood pressure (BP) and novel measures of central haemodynamic burden including central/aortic stiffness (assessed using carotid-femoral pulse wave velocity considered the gold standard approach), aortic BP, augmentation index (AIx) and pulse pressure (PP) amplification. Results revealed that in older women in the cohort (>50 years of age), levels of PM_2.5 and black carbon were associated with higher BP (brachial and aortic), higher AIx and lower PP amplification. The authors concluded that personal exposure to household air pollution was associated with a higher central haemodynamic burden in older Chinese women. This study provides important empirical data confirming a relation between household air pollution and novel risk factors for cardiovascular morbidity and mortality.

Baumgartner et al chose to assess parameters of central haemodynamic burden that have been recognised as important …