{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T19:54:50Z","timestamp":1793908490719,"version":"4.8.0"},"reference-count":39,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:00:00Z","timestamp":1659052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Out of over 3 billion people exposed to household air pollution (HAP), approximately 4 million die prematurely, most from cardiorespiratory diseases. Although many recent studies have reported adverse effects of HAP on cardiovascular outcomes, the findings are inconsistent. Objectives: The primary aim of this systematic review is to critically appraise the published studies and report the pooled summary of the findings on the association between HAP and cardiovascular outcomes, particularly in LMICs. Methods: During this systematic review and meta-analysis, six databases were searched systematically, and the protocol was published in PROSPERO (CRD 42021248800). Only peer-reviewed English-language studies published from 1980 to March 2021 were included. We extracted data for the population \u2265 18 years old. Newcastle\u2013Ottawa Criteria were used to assess the quality of evidence. The heterogeneity and publication bias of the studies was evaluated. A meta-analysis was conducted using a random-effect model to pool the findings from published studies. Results: In sixteen studies totaling 547,463 cases, 319,180 were exposed to HAP. The pooled estimate suggested an overall 13% higher risk of CVDs, and a 21% higher risk of CVD mortality in LMICs among those exposed to HAP. Similarly, the increased risk of stroke and cerebrovascular accidents, heart failure, and hypertension was statistically significant among those exposed to HAP but not with myocardial infarction, IHD, eclampsia\/preeclampsia, and carotid intima-media thickness. Conclusions: Our findings suggest exposure to HAP increases the risk of cardiovascular outcomes.<\/jats:p>","DOI":"10.3390\/ijerph19159298","type":"journal-article","created":{"date-parts":[[2022,7,31]],"date-time":"2022-07-31T23:37:29Z","timestamp":1659310649000},"page":"9298","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Effects of Household Air Pollution (HAP) on Cardiovascular Diseases in Low- and Middle-Income Countries (LMICs): A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2435-2934","authenticated-orcid":false,"given":"Akorede","family":"Adekoya","sequence":"first","affiliation":[{"name":"Global Health, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3103-7100","authenticated-orcid":false,"given":"Sudhir K.","family":"Tyagi","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiana N.","family":"Duru","sequence":"additional","affiliation":[{"name":"NES Healthcare, Aylesbury HP20 1SE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Satia","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"},{"name":"Firestone Institute for Respiratory Health, St Joseph\u2019s Healthcare, Hamilton, ON L8S 4L8, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada"},{"name":"McMaster Institute for Research on Ageing, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4173-6490","authenticated-orcid":false,"given":"Vibhu","family":"Paudyal","sequence":"additional","affiliation":[{"name":"School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Birmingham B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-4716","authenticated-orcid":false,"given":"Om P.","family":"Kurmi","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada"},{"name":"Firestone Institute for Respiratory Health, St Joseph\u2019s Healthcare, Hamilton, ON L8S 4L8, Canada"},{"name":"Centre for Intelligent Healthcare, Institute of Health and Wellbeing, Richard Cross Building, Coventry University, Coventry CV1 5FB, UK"},{"name":"Nexus Institute of Research and Innovation, Lalitpur 44700, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2018). Household Air Pollution and Health, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1161\/CIRCULATIONAHA.117.030377","article-title":"Developing a clinical approach to air pollution and cardiovascular health","volume":"137","author":"Hadley","year":"2018","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3389\/fpubh.2020.00014","article-title":"Environmental and health impacts of air pollution: A review","volume":"8","author":"Manisalidis","year":"2020","journal-title":"Front. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.scitotenv.2016.10.233","article-title":"Household air pollution following replacement of traditional open fire with an improved rocket type cookstove","volume":"580","author":"Ochieng","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.envres.2012.09.008","article-title":"Indoor air pollution from solid fuels and risk of upper aerodigestive tract cancers in central and eastern Europe","volume":"120","author":"Sapkota","year":"2013","journal-title":"Environ. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1427","DOI":"10.1016\/S2214-109X(20)30343-0","article-title":"Adverse health effects associated with household air pollution: A systematic review, meta-analysis, and burden estimation study","volume":"8","author":"Lee","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1056\/NEJMoa054409","article-title":"Long-term exposure to air pollution and incidence of cardiovascular events in women","volume":"356","author":"Miller","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1161\/01.CIR.0000108927.80044.7F","article-title":"Cardiovascular mortality and long-term exposure to particulate air pollution: Epidemiological evidence of general pathophysiological pathways of disease","volume":"109","author":"Pope","year":"2004","journal-title":"Circulation"},{"key":"ref_9","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2009). The Newcastle-Ottawa Scale for Assessing the Quality of Non-Randomized Studies in Meta-Analyses, Ottawa Hospital Research Institute."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"Br. Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: A simple funnel-plot\u2013based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref_12","unstructured":"Borenstein, M., Hedges, L., Higgins, J., and Rothstein, H. (2007). Comprehensive Meta-Analysis, version 3, Biostat."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/heartjnl-2012-303440","article-title":"Chronic exposure to biomass fuel is associated with increased carotid artery intima-media thickness and a higher prevalence of atherosclerotic plaque","volume":"99","author":"Painschab","year":"2013","journal-title":"Heart"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/10641955.2015.1046604","article-title":"Association between wood cooking fuel and maternal hypertension at delivery in central East India","volume":"34","author":"Wylie","year":"2015","journal-title":"Hypertens Pregnancy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1177\/1010539517753930","article-title":"Incense smoke and increasing carotid intima media thickness: A cross sectional study on the Thai-Vietnamese community","volume":"30","author":"Kammoolkon","year":"2018","journal-title":"Asia Pac. J. Public Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-020-0878-3","article-title":"Household fuel use and adverse pregnancy outcomes in a Ghanaian cohort study","volume":"17","author":"Weber","year":"2020","journal-title":"Reprod. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1001\/jama.2018.2151","article-title":"Association of solid fuel use with risk of cardiovascular and all-cause mortality in rural China","volume":"319","author":"Yu","year":"2018","journal-title":"J. Amer. Med. Assn."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1289\/EHP236","article-title":"Cooking coal use and all-cause and cause-specific mortality in a prospective cohort study of women in Shanghai, China","volume":"124","author":"Kim","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1161\/CIRCULATIONAHA.115.020288","article-title":"Household fuel use and cardiovascular disease mortality: Golestan Cohort Study","volume":"133","author":"Mitter","year":"2016","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e430","DOI":"10.1016\/S2214-109X(19)30525-X","article-title":"Cooking fuels and risk of all-cuase and cardiopulmonary mortality in urban China: A prospective cohort study","volume":"8","author":"Yu","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1289\/EHP3915","article-title":"Health effects of household solid fuel use: Findings from 11 countries with the prospective urban and rural epidemiology study","volume":"127","author":"Hystad","year":"2019","journal-title":"Environ. Health Perspect."},{"key":"ref_22","first-page":"1","article-title":"Ischeamic heart disease and stroke mortality by specific coal type among non-smoking women with substantial indoor air pollution exposure in China","volume":"49","author":"Bassig","year":"2019","journal-title":"Int. J. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.envres.2020.109851","article-title":"Adverse health impacts of cooking with kerosine: A multi-country analysis within the prospective urban and rural epidemiology study","volume":"188","author":"Arku","year":"2020","journal-title":"Environ. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1476-069X-11-18","article-title":"In-home solid fuel use and cardiovascular disease: A cross sectional analysis of the Shanghai Putuo study","volume":"11","author":"Lee","year":"2012","journal-title":"Environ. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/ina.12144","article-title":"Effect of indoor air pollution from biomass and solid fuel combustion on symptoms of preeclampsia\/eclampsia in India women","volume":"25","author":"Agrawal","year":"2014","journal-title":"Indoor Air"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"James, B.S., Shetty, R.S., Kamath, A., and Shetty, A. (2020). Household cooking fuel use and its health effects among rural women in southern India: A cross sectional study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0231757"},{"key":"ref_27","first-page":"625","article-title":"Household solid fuel use and cardiovascular disease in rural areas in Shanxi, China","volume":"144","author":"Qu","year":"2015","journal-title":"Iran J. Public Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5334\/gh.405","article-title":"Biomass fuel use and cardiac function in Nepali women","volume":"15","author":"Tiwana","year":"2020","journal-title":"Glob. Heart"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wu, Y., Liu, F., Adi, D., Yang, Y.N., Xie, X., Li, X.-M., Ma, X., Fu, Z.-Y., Huang, Y., and Chen, B.-D. (2017). Association between carotid atherosclerosis and different subtypes of hypertension in adult populations: A multiethnic study in Xinjiang, China. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0171791"},{"key":"ref_30","first-page":"492","article-title":"Evaluation of the effects of chronic biomass fuel smoke exposure on peripheral endothelial functions: An observational study","volume":"11","author":"Buturak","year":"2011","journal-title":"Anatol. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s11869-014-0267-6","article-title":"Systolic blood pressure changes in indigenous Bolivian women associated with an improved cookstove intervention","volume":"8","author":"Alexander","year":"2015","journal-title":"Air Qual. Atmos. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.envres.2014.10.031","article-title":"Sustained use of biogas fuel and blood pressure among women in rural Nepal","volume":"136","author":"Neupane","year":"2015","journal-title":"Environ. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1161\/HYPERTENSIONAHA.114.04840","article-title":"Relationship between daily exposure to biomass fuel smoke and blood pressure in high-altitude Peru","volume":"65","author":"Romero","year":"2015","journal-title":"Hypertension"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1289\/ehp.1003371","article-title":"Indoor air pollution and blood pressure in adult women living in rural China","volume":"119","author":"Baumgartner","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"13229","DOI":"10.1073\/pnas.1317176111","article-title":"Highway proximity and black carbon from cookstoves as a risk factor for higher blood pressure in rural China","volume":"111","author":"Baumgartner","year":"2014","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/j.1600-0668.2010.00694.x","article-title":"Hypertension with elevated levels of oxidized low-density lipoprotein and anticardiolipin antibody in the circulation of premenopausal Indian women chronically exposed to biomass smoke during cooking","volume":"21","author":"Dutta","year":"2011","journal-title":"Indoor Air"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1179\/107735211799030942","article-title":"A baseline evaluation of traditional cook stove smoke exposures and cardiovascular and respiratory health indicatorsamong Nicaraguan women","volume":"17","author":"Clark","year":"2011","journal-title":"Int. J. Occup. Environ. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1161\/CIR.0b013e3181dbece1","article-title":"Particulate matter air pollution and cardiovascular diseases","volume":"121","author":"Brook","year":"2010","journal-title":"Circulation"},{"key":"ref_39","first-page":"459","article-title":"Indoor air pollution and the risk of cardiovascular diseases","volume":"2","year":"2020","journal-title":"Eur. J. Med. Health Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9298\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:59:07Z","timestamp":1760140747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,29]]},"references-count":39,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph19159298"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19159298","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,29]]}}}