TY - JOUR
T1 - Association between exposure to low to moderate arsenic levels and incident cardiovascular disease
AU - Moon, Katherine A.
AU - Guallar Dr., Eliseo
AU - Umans Dr., Jason G.
AU - Devereux Dr., Richard B.
AU - Best Dr., Lyle G.
AU - Francesconi Dr., Kevin A.
AU - Goessler Dr., Walter
AU - Pollak, Jonathan
AU - Silbergeld Dr., Ellen K.
AU - Howard Dr., Barbara V.
AU - Navas-Acien Dr., Ana
PY - 2013/11/19
Y1 - 2013/11/19
N2 - Background: Long-term exposure to high levels of arsenic is associated with increased risk for cardiovascular disease, whereas risk from long-term exposure to low to moderate arsenic levels (<100 μg/L in drinking water) is unclear. Objective: To evaluate the association between long-term exposure to low to moderate arsenic levels and incident cardiovascular disease. Design: Prospective cohort study. Setting: The Strong Heart Study baseline visit between 1989 and 1991, with follow-up through 2008. Patients: 3575 American Indian men and women aged 45 to 74 years living in Arizona, Oklahoma, and North and South Dakota. Measurements: The sum of inorganic and methylated arsenic species in urine at baseline was used as a biomarker of long-term arsenic exposure. Outcomes were incident fatal and nonfatal cardiovascular disease. Results: A total of 1184 participants developed fatal and nonfatal cardiovascular disease. When the highest and lowest quartiles of arsenic concentrations (>15.7 vs. <5.8 μg/g creatinine) were compared, the hazard ratios for cardiovascular disease, coronary heart disease, and stroke mortality after adjustment for sociodemographic factors, smoking, body mass index, and lipid levels were 1.65 (95% CI, 1.20 to 2.27; P for trend < 0.001), 1.71 (CI, 1.19 to 2.44; P for trend < 0.001), and 3.03 (CI, 1.08 to 8.50; P for trend = 0.061), respectively. The corresponding hazard ratios for incident cardiovascular disease, coronary heart disease, and stroke were 1.32 (CI, 1.09 to 1.59; P for trend = 0.002), 1.30 (CI, 1.04 to 1.62; P for trend = 0.006), and 1.47 (CI, 0.97 to 2.21; P for trend = 0.032). These associations varied by study region and were attenuated after further adjustment for diabetes, hypertension, and kidney disease measures. Limitation: Direct measurement of individual arsenic levels in drinking water was unavailable. Conclusion: Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality. Primary Funding Source: National Heart, Lung, and Blood Institute and National Institute of Environmental Health Sciences.
AB - Background: Long-term exposure to high levels of arsenic is associated with increased risk for cardiovascular disease, whereas risk from long-term exposure to low to moderate arsenic levels (<100 μg/L in drinking water) is unclear. Objective: To evaluate the association between long-term exposure to low to moderate arsenic levels and incident cardiovascular disease. Design: Prospective cohort study. Setting: The Strong Heart Study baseline visit between 1989 and 1991, with follow-up through 2008. Patients: 3575 American Indian men and women aged 45 to 74 years living in Arizona, Oklahoma, and North and South Dakota. Measurements: The sum of inorganic and methylated arsenic species in urine at baseline was used as a biomarker of long-term arsenic exposure. Outcomes were incident fatal and nonfatal cardiovascular disease. Results: A total of 1184 participants developed fatal and nonfatal cardiovascular disease. When the highest and lowest quartiles of arsenic concentrations (>15.7 vs. <5.8 μg/g creatinine) were compared, the hazard ratios for cardiovascular disease, coronary heart disease, and stroke mortality after adjustment for sociodemographic factors, smoking, body mass index, and lipid levels were 1.65 (95% CI, 1.20 to 2.27; P for trend < 0.001), 1.71 (CI, 1.19 to 2.44; P for trend < 0.001), and 3.03 (CI, 1.08 to 8.50; P for trend = 0.061), respectively. The corresponding hazard ratios for incident cardiovascular disease, coronary heart disease, and stroke were 1.32 (CI, 1.09 to 1.59; P for trend = 0.002), 1.30 (CI, 1.04 to 1.62; P for trend = 0.006), and 1.47 (CI, 0.97 to 2.21; P for trend = 0.032). These associations varied by study region and were attenuated after further adjustment for diabetes, hypertension, and kidney disease measures. Limitation: Direct measurement of individual arsenic levels in drinking water was unavailable. Conclusion: Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality. Primary Funding Source: National Heart, Lung, and Blood Institute and National Institute of Environmental Health Sciences.
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U2 - 10.7326/0003-4819-159-10-201311190-00719
DO - 10.7326/0003-4819-159-10-201311190-00719
M3 - Article
C2 - 24061511
AN - SCOPUS:84888256296
SN - 0003-4819
VL - 159
SP - 649
EP - 659
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 10
ER -