Our Work

The Cardiovascular Impact of Household Air Pollution in Semi-urban and Rural Communities in Puno, Peru

Project Overview

Eighty percent of cardiovascular deaths occur in Iow- and middle-income countries (LMIC). In LMIC cardiovascular disease (CVD) and poverty create a positive feedback loop in which poverty places one at increased risk of CVD and CVD contributes to poverty. While traditional CVD risk factors such as hypertension account for much of CVD in resource-poor settings in developing countries, there are environmental risk factors such as household air pollution (HAP) from biomass fuel use. Small studies have shown that cook-stove interventions to reduce exposure to HAP in Guatemala result in decreases in diastolic blood pressure and resolution of ST changes on electrocardiogram [1, 2]. Preliminary data from our research group in Puno, Peru have found that rural households have greater biomass fuel use and greater mean PM2.5 levels than urban households. The objective of this study is to determine the relationship between HAP and cardiovascular diseas in Puno, Peru. I hypothesize that exposure to HAP is associated with increased prevalence of systemic hypertension and coronary atherosclerosis, in turn resulting in left ventricular systolic dysfunction and hypertrophy.

Aim 1: Examine the relationship of HAP exposure to left ventricular systolic dysfunction, left ventricular hypertrophy and left atrial enlargement in Puno, Peru.

Aim 2: Determine the relationship between HAP exposure and carotid intimal-medial thickness in Puno, Peru.
My hypothesis is that increased HAP is associated with atherosclerosis. Carotid intimal-medial thickness is a surrogate end-point for atherosclerosis that can be easily measured. Individuals in rural Puno have greater exposure to HAP and thus are expected to have a greater carotid intimal-medial thickness than individuals living in semi-urban Puno.

My hypothesis is that chronic HAP results in left ventricular systolic dysfunction, left ventricular hypertrophy, and left atrial enlargement. I also hypothesize that the correlation between HAP and left ventricular and atrial abnormalities is mediated by hypertension and atherosclerosis. I expect individuals in rural Puno to have higher blood pressures and greater carotid intimal-medial thickness, which will lead to a greater prevalence of left ventricular and left atrial abnormalities in comparison to individuals living in semi-urban Puno.
This study is innovative because it explores the potential correlation between HAP and left heart dysfunction and also investigates the mechanisms by which HAP causes left heart dysfunction.

This project has implications for policies in reducing exposure to household air pollution.



  • NIH-National Heart, Lung and Blood Institute NIH-Fogarty International Center

Project Collaborators

  • Universidad Cayetano Heredia
  • Washington University
  • Johns Hopkins University
  • Duke Clinical Research Institute

Project Status


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