title: Lack of association between chronic exposure to biomass fuel smoke and markers of right ventricular pressure overload at high altitude.
abstract: BACKGROUND
  Chronic exposure to biomass fuel smoke has been implicated in the development of pulmonary hypertension and right ventricular pressure/volume overload through activation of inflammation, increase in vascular resistance, and endothelial dysfunction. We sought to compare N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and echocardiography-derived pulmonary artery systolic pressure (PASP) levels in a high-altitude population-based study in Peru with and without chronic exposure to biomass fuel smoke.
  
  
  METHODS
  NT-pro-BNP levels were measured in 519 adults (275 with and 244 without chronic exposure to biomass fuel smoke). Participants answered sociodemographics and clinical history questionnaires, underwent a clinical examination and blood testing for cardiopulmonary biomarkers. PASP was measured in a subgroup of 153 (31%) subjects.
  
  
  RESULTS
  The study group consisted of 280 men (54%) and 239 women (46%). Average age was 56 years and average body mass index was 27 kg/m(2). In multivariable analysis, there was no association between chronic exposure to biomass fuel smoke and NT-pro-BNP (P = .31) or PASP (P = .31). In the subgroup in which both NT-pro-BNP levels and PASP were measured, there was strong evidence of an association between these two variables (ρ = 0.24, 95% CI 0.09-0.39; P = .003). We found that age, high sensitivity C-reactive protein, being male, and systolic blood pressure were positively associated with NT-pro-BNP levels whereas body mass index, low-density/high-density lipoprotein ratio, and Homeostasis Model of Assessment-Insulin Resistance were negatively associated (all P ≤ .02).
  
  
  CONCLUSIONS
  In this population-based study in a high-altitude setting, neither NT-pro-BNP levels nor echocardiography-derived PASP were associated with chronic exposure to biomass fuel smoke.
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Caravedo
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Painschab
authors.affiliation: Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO.
authors.forename: Victor G
authors.initials: VG
authors.lastname: Davila-Roman
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Aldo
authors.initials: A
authors.lastname: De Ferrari
authors.affiliation: Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.
authors.forename: Angel D
authors.initials: AD
authors.lastname: Vasquez-Villar
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Pollard
authors.affiliation: CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: wcheckl1@jhmi.edu.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000531:Altitude; D062186:Arterial Pressure; D018533:Biomass; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D004452:Echocardiography; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D007333:Insulin Resistance; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D010568:Peru / Q000453:epidemiology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D012737:Sex Factors; D012906:Smoke; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017725:Ventricular Pressure
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006454:Hemoglobins; D010446:Peptide Fragments; D012906:Smoke; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein