Exposure to wood smoke increases arterial stiffness and decreases heart rate variability in humans

Jon Unosson, Anders Blomberg, Thomas Sandström, Ala Muala, Christoffer Boman, Robin Nyström, Roger Westerholm, Nicholas L Mills, David E Newby, Jeremy P Langrish, Jenny A Bosson, Jon Unosson, Anders Blomberg, Thomas Sandström, Ala Muala, Christoffer Boman, Robin Nyström, Roger Westerholm, Nicholas L Mills, David E Newby, Jeremy P Langrish, Jenny A Bosson

Abstract

Background: Emissions from biomass combustion are a major source of indoor and outdoor air pollution, and are estimated to cause millions of premature deaths worldwide annually. Whilst adverse respiratory health effects of biomass exposure are well established, less is known about its effects on the cardiovascular system. In this study we assessed the effect of exposure to wood smoke on heart rate, blood pressure, central arterial stiffness and heart rate variability in otherwise healthy persons.

Methods: Fourteen healthy non-smoking subjects participated in a randomized, double-blind crossover study. Subjects were exposed to dilute wood smoke (mean particle concentration of 314±38 μg/m3) or filtered air for three hours during intermittent exercise. Heart rate, blood pressure, central arterial stiffness and heart rate variability were measured at baseline and for one hour post-exposure.

Results: Central arterial stiffness, measured as augmentation index, augmentation pressure and pulse wave velocity, was higher after wood smoke exposure as compared to filtered air (p < 0.01 for all), and heart rate was increased (p < 0.01) although there was no effect on blood pressure. Heart rate variability (SDNN, RMSSD and pNN50; p = 0.003, p < 0.001 and p < 0.001 respectively) was decreased one hour following exposure to wood smoke compared to filtered air.

Conclusions: Acute exposure to wood smoke as a model of exposure to biomass combustion is associated with an immediate increase in central arterial stiffness and a simultaneous reduction in heart rate variability. As biomass is used for cooking and heating by a large fraction of the global population and is currently advocated as a sustainable alternative energy source, further studies are required to establish its likely impact on cardiovascular disease.

Trial registration: ClinicalTrials.gov, NCT01488500.

Figures

Figure 1
Figure 1
Vascular parameters 10-60 minutes after exposure. Compared to filtered air, wood smoke exposure increased heart rate (p = 0.008), pulse wave velocity (p = 0.005), augmentation index (p < 0.001) and augmentation pressure (p = 0.004), but no effect was seen on brachial systolic (p = 0.858) or diastolic (p = 0.213) blood pressure. All data expressed as mean ± standard error of the mean and P-values from 2-way ANOVA with repeated measures.
Figure 2
Figure 2
Heart rate variability recordings in 10 min intervals 0-60 minutes post exposure. Compared to filtered air, wood smoke exposure decreased the HF domain (p = 0.009), and a small decrease was seen in the LF domain (p = 0.086). All the time domain recordings were reduced following wood smoke exposure as compared to filtered air; SDNN (p = 0.003), RMSSD (p < 0.001) and pNN50 (p < 0.001). All data expressed as mean ± standard error of the mean and P-values from 2-way ANOVA with repeated measures.

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