Acute coronary syndrome and use of biomass fuel among women in rural Pakistan: a case–control study

Exploring the links between indoor air pollutants and health outcomes in South Asian countries: a systematic review

Indoor air pollution (IAP) has adverse effects on the health of people, globally. The objective of this systematic review was to present the range of health problems studied in association with indoor air pollutants in South Asian countries. We searched five databases, including PubMed, Web of Science, Scopus, Google Scholar, and CAB Direct for articles published between the years 2000 and 2020. We retrieved 5,810 articles, out of which we included 90 articles in our review. Among South Asian countries, only five countries have published results related to relationship between indoor air pollutants and adverse health conditions. All studies have shown adversity of indoor air pollutants on human's health. We found indoor solid fuel burning as a key source of indoor air pollution in the included studies, while women and children were most affected by their exposure to solid fuel burning. More than half of the studies accounted particulate matter responsible for indoor air pollution bearing negative health effects. In the included studies, eyes and lungs were the most commonly affected body organs, exhibiting common symptoms like cough, breathing difficulty and wheezing. This might have developed into common conditions like respiratory tract infection, chronic obstructive pulmonary diseases and eye cataract. In addition to promote research in South Asian countries, future research should focus on novel digital ways of capturing effects of indoor air pollutants among vulnerable segments of the population. As a result of this new knowledge, public health agencies should develop and test interventions to reduce people's exposure levels and prevent them to develop adverse health outcomes.

The Effect of Chronic Inhouse Biomass Fuel Smoke Exposure on Coronary Slow Flow Phenomenon in Women Living in the Eastern Region of Turkey

Objective:

Biomass fuel (BMF) is still widely used in rural areas for cooking and heating worldwide. BMF smoke inhalation is a prominent cause of respiratory and cardiovascular disease. The slow coronary flow (SCF) phenomenon is known as the delayed opacification of distal coronary arteries on a coronary angiogram. SCF is known to be related to cardiovascular morbidity and mortality. Thus, we aimed to investigate the relationship between exposure to BMF and SCF in women in this study.

Methods:

A total of 457 consecutive women who underwent coronary angiography were retrospectively enrolled in this study. Patients were divided into two groups according to the use of BMF during their lives, from birth to older ages, as biomass exposure group (BEG) and non-exposure group. The presence of SCF was calculated based on thrombolysis in myocardial infarction frame count.

Results:

Two hundred fifty nine patients were in the BEG, whereas 198 patients were in the non-exposure group. The prevalence of SCF was higher in the BEG compared to the non-exposure group (47.9% vs. 13.1%, respectively, p<0.001). The presence of biomass exposure, body mass index, white blood cell count, low-density lipoprotein cholesterol, C-reactive protein, serum creatinine, and hypertension were independent predictors of SCF. The optimal cutoff point of biomass exposure time in years to detect the presence of SCF was 30 years (Area under the curve: 0.71, sensitivity: 0.65, specifity: 0.71).

Conclusions:

Exposure to indoor BMF was associated with a SCF phenomenon in women.

Solid fuel use and cardiovascular events: A systematic review and meta-analysis of observational studies

Although solid fuel use has been increasingly linked to cardiovascular events (CVEs), conclusions have been inconsistent. We systematically searched 3 databases (PubMed, Embase, and Web of Science) up to July 3, 2020, to identify English language reports that assessed the association of solid fuel use with CVEs. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated with a random-effects model. Subgroup analyses and sensitivity analyses were conducted to explore the potential sources of heterogeneity and to test the stability of the results. We finally included 13 observational studies (8 cohort, 3 cross-sectional, and 2 case-control studies comprising 791,220 participants) in the meta-analysis. The risk of CVEs was increased 21% with the highest versus the lowest solid fuel use (highest/lowest, RR_pooled  = 1.21, 95% CI: 1.10-1.34). As for the subgroup analyses on study design, the pooled RR for cohort studies, case-control studies, and cross-sectional studies were 1.11 (95%CI: 1.03-1.19), 4.80 (95%CI: 2.22-10.39), and 1.46 (95%CI: 0.82-2.62), respectively. The results of this study suggested that high solid fuel use was associated with increased CVE risk, and that reducing the use of solid fuel will be important for improving the health of the populations in developing countries.