1. Low to moderate chronic arsenic exposure (<100i µg/L) in food and water is associated with increased risk of coronary heart disease, stroke, non-fatal cardiovascular disease and fatal cardiovascular disease.
Evidence Rating Level: 2 (Good)
Study Rundown: Prior studies have suggested that arsenic in water and food increases the risk of peripheral artery disease, heart disease, stroke, and carotid atherosclerosis. This represents a global health risk and is an issue that predominately affects rural areas. Although past studies have provided evidence for high levels of arsenic (>100µg/L) as a cardiovascular risk factors, few studies have been performed studying this relationship for low to moderate levels of chronic arsenic exposure. This study evaluated the association of chronic exposure of arsenic (levels less than <100µg/L) with cardiovascular disease and mortality American Indian populations living in small rural communities within Oklahoma, Dakota and Arizona. Comparing the highest to lowest quartiles of urine arsenic levels in the study population, the results of this study showed significantly higher hazard ratios for cardiovascular disease, coronary heart disease and stroke mortality. Limitations of this study include possible confounding bias. Adjustment for known risk factors of cardiovascular disease (e.g. diabetes, hypertension and kidney disease) attenuated the results compared to the values reported.
Relevant Reading: Arsenic and Cardiovascular Disease
In-Depth [prospective Study]: This prospective study aimed to evaluate the effect low to moderate levels of chronic arsenic exposure on cardiovascular disease utilizing an American Indian population. 4549 participants were initially recruited with 3575 being analyzed. Study population included American Indian men and women aged 45-75 years old living in Arizona, Oklahoma and North and South Dakota. The study began in 1989-1991, with subsequent follow up through until 2008. Arsenic exposure was measured using the sum of inorganic and methylated arsenic species in the urine at baseline. Statistical analysis was adjusted for sociodemographic status, smoking, body mass index, and lipid levels. When comparing the highest to lowest quartile arsenic concentrations, the fully adjusted hazard ratios (95% confidence interval) of cardiovascular disease, coronary heart disease, and stroke mortality were 1.65 (1.20 – 2.27; p <0.001), 1.71 (1.19 – 2.44; p<0.001), and 3.03 (1.08 – 8.50; p = 0.061), respectively. Likewise, hazard ratios for incident cardiovascular disease, coronary heart disease and stroke were 1.32 (1.09 – 1.59; p = 0.002), 1.30 (1.04 – 1.62; p=0.006), and 1.47 (0.97 – 2.21; p-0.032), respectively. Significance persisted following adjustment for sex, education, smoking status, body mass index and LDL cholesterol. However, results were attenuated after adjustment for hypertension, diabetes, estimated glomerular filtration rate and albuminuria. There was a significant dose-response relationship between arsenic exposure and cardiovascular disease as well as coronary heart disease incidence, but not for stroke incidence and mortality.
By Adam Whittington and Aimee Li, MD
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