INTRODUCTION Household air pollution (HAP) from burning of biomass smoke has been recognised as the third leading risk factor for death worldwide, 1 and it is estimated to affect 3 billion people each year. Exposure to biomass smoke is a major cause of illness and death in developing countries.2 Its exposure has been linked with increased risk of various diseases like acute and chronic pulmonary tract infections in children and adults3 , emphysema, 4 tuberculosis5 and cardiovascular disease (CVD)6 A healthy endothelium is essential for proper functioning of the vasculature. The inflammatory response is a key mechanism in the pathogenesis of atherosclerosis and its progression.7 Neutrophils secrete inflammatory mediators that can cause vascular wall degeneration. Conversely, lymphocytes regulate the inflammatory response and thus have an anti-atherosclerotic role. Therefore, the neutrophil to lymphocyte ratio (NLR) has been proposed as an inflammatory biomarker8 and potential predictor of risk and prognosis in CVD. Different lipoproteins have particular effects on vessel health. In the clinical context high levels of LDL and low levels of HDL are particularly important risk factors for CVD and are considered good for vascular health.9Highly sensitive-C reactive protein (hs-CRP) also has pro atherogenic effects: it facilitates plaque deposition, transmigration of monocytes and macrophages. 10Many studies have proposed a relationship between exposure to particulate matter (PM) and initiation of endothelial inflammation leading to an increased risk of cardiovascular events11 . Specifically, observational studies have found higher blood pressure, a thicker carotid intima–media complex and an increased prevalence of coronary heart disease, stroke and diabetes in populations chronically exposed to biomass fuel smoke. 12The mechanisms proposed include pulmonary inflammation with release of cytokines in systemic circulation, oxidative stress, endothelial dysfunction and thrombogenesis, -------------------------------------------------------------------------------- Received on 07-04-2019 Accepted on 17-07-2019 all of which could lead to atherosclerosis and adverse health outcomes13 . Recent research has focused on identifying markers of early endothelial inflammation which could help assess CVD risk earlier in the exposed population. MATERIALS AND METHODS Seventy two females in the age range of 20-40 years were included in this study from Tejgarh Yadgar Shaheedan. It is a small village near Manawa, Lahore. There is no natural gas supply in this village. Poor class use cow dunk cake or grass as a source of energy And affording class use LPG cylinder for cooking and heating purpose. The study protocol was approved by the Ethics committee of the University of Health Sciences, Lahore. Inclusion Criteria: The inclusion criteria were (i) Apparently healthy women, (ii) non-smokers, nonconsumption of alcohol and non-chewers of tobacco and (iii) cook regularly with either biomass or LPG at least 2 h/day, 5 days/week for greater than or equal to 10 years. These women were divided into two groups. Group 1: women who cook exclusively with biomass fuel. Group 2: women who cook exclusively with LPG fuel. Exclusion criteria: Mixed fuel user (biomass + LPG + Kerosene), (ii) pregnant, (iii) currently under medication, (iv) family history of Tuberculosis or complicated cardiovascular disease and (v) History of chronic respiratory diseases like asthma, Chronic Obstructive Pulmonary Disease. After taking informed consent from the subject. Following sampling was done. Blood Sampling: Six cc venous blood sample was drawn from antecubital vein of each subject. Four ml was added in serum tube i.e. red top vacutainer and other 2ml was added in EDTA added purple coloured top vacutainer. Blood in red vacutainer was centrifuged (1600g for 15 minutes), serum was separated, divided into aliquots and frozen at -80 °C to be used later for analysis. Complete Blood Count Analysis: For complete blood count, 2cc blood taken in purple top vacutainer (containing ethylene Nabiha Saeed, Hamdah Saeed, Mehr-Un-Nisa Fatima Gondal et al P J M H S Vol. 13, NO. 3, JUL – SEP 2019 694 diamine tetra acetic acid) was used, mixed for 5 minutes on rotator and used for complete blood analysis. Estimation of lipid profile: Serum cholesterol levels and serum high density lipoprotein (HDL) were estimated by total enzymatic colorimetric method endpoint. Results were read by calorimetric analyser micro lab 300 (USA) at 500 nm Serum triglyceride levels were estimated by the use of enzyme lipoprotein lipase. Serum Low density lipoprotein (LDL) was estimated by the formula Low density lipoprotein (LDL) = Total cholesterol – HDL – (Triglyceride/5).14 Estimation of serum hs-CRP Serum hs-CRP estimation was done by High Sensitivity C - reactive protein (hs-CRP) ELISA Kit Results were analysed by stipreader, USA. Data analysis was carried out through computer software IBM SPSS version 21.Quantitative variables were compared by Mann Whitney U test which were non-normally distributed normally distributed were compared by independent t-test as they were normally distributed and presented in the form of mean ± SD. Correlation between years of cooking wth bomass fuel and markers of endothelial inflammation was checked by Spearman’s rank correlation. p≤ 0.05 was considered statistically significant. RESULTS Median (IQR) of neutrophil count, lymphocyte count, neutrophil lymphocyte ratio NLR and platelet count was higher in group 1 biomass users as compared to LPG users as shown in table-4. When compared by Mann Whitney U test both groups show statistically significant different neutrophil, lymphocyte count, NLR and Platelet count as shown in Table 1. Mean ± SD total leukocyte count of Biomass user was higher than LPG user but didn’t show statistically significant difference when compared by independent t-test. Lipid profile of study population: Table-2 both groups had significant difference in lipid profile. Levels of triglycerides (pvalue < 0.001) and Cholesterol (p-value < 0.001) showed significant difference when compared by Mann Whitney U test. Serum LDL (p-value= 0.007) and serum HDL (p-value< 0.001) also showed significant difference when compared by Independent t-test. Levels of serum triglyceride, serum cholesterol, serum LDL were significantly higher n biomass users and serum HDL levels were significantly lower in biomass user when compared with LPG users (Fig.1) Correlation between years of cooking with biomass fuel and markers of endothelial inflammation: When markers of inflammation were correlated with years of cooking. All markers showed positive correlation except serum HDL which showed negative correlation as shown in table 3. Comparison of serum hs-CRP in both groups: Levels of hsCRP (inflammatory marker) was significantly different among two groups as compared by Mann Whitney U test (p-value