Abstract
BACKGROUND: Solid fuel use for cooking and heating is a major environmental risk factor, yet its association with new-onset heart disease (HD) remains unclear. The aim of this study was to investigate the relationship between solid fuel exposure and new-onset HD in a large cohort. METHODS: Multivariable logistic regression models assessed associations between cooking/heating fuel types (coal, crop residue/wood, liquefied petroleum gas, natural gas, and others) and new-onset HD. Subgroup analyses explored effect modification by age, sex, education, smoking, alcohol use, and region. RESULTS: A prospective cohort study included 5915 participants, with 781 participants (13.2%) developing new-onset HD. Coal use for cooking showed an initial association with new-onset HD risk (OR = 1.41, 95% CI: 1.06-1.86, P = 0.02), which attenuated after full adjustment (OR = 1.28, 95% CI: 0.96-1.72, P = 0.10). Coal use for heating demonstrated robust associations across all models (OR = 1.86, 95% CI: 1.42-2.43, P < 0.001). Crop residue/wood burning for heating was also significant (Model 2: OR = 1.40, 95% CI: 1.06-1.86, P = 0.02). Subgroup analyses revealed stronger associations among females, non-smokers, non-drinkers, and less-educated participants. Geographic stratification showed significant associations in southern but not northern regions. CONCLUSIONS: Solid fuel use, particularly coal for heating, is associated with increased new-onset HD risk. Reducing solid fuel exposure is crucial for HD prevention in low-resource settings.