Is foundry work a risk for cardiovascular disease? A systematic review.
Aims Foundry work has been associated with an increased risk of adverse cardiovascular events. The objective of this review was systematically and qualitatively to review the published literature to determine whether foundry work is significantly associated with cardiac disease.


METHODS
MEDLINE and Cochrane databases were systematically searched to identify relevant English-language publications between 1966 and October 2002. Articles were rated as 'good', 'fair' or 'poor', using published quality review criteria. Additionally, variables suggesting causality were extracted. A qualitative summation of the literature was presented for two scenarios: all studies, or using only studies rated 'fair' and above.


RESULTS
Fourteen studies were analysed. Four were found to be of 'fair' quality, the remainder 'poor'. No 'good' quality studies were found. Nine studies show increased cardiac mortality among foundry worker groups and four studies also show a decreased risk. When only 'fair' quality studies are taken into consideration, two support increased risk of cardiac disease, one supports a protective effect of foundry work on cardiac disease and one revealed both increased and decreased risk for different cardiac outcomes.


CONCLUSIONS
The exploration of foundry workers' risks of cardiac events reveals conflicting findings, which can only be partly attributed to confounders. Further prospective research to establish the independent contribution of foundry work to cardiac disease is needed.
Department of Medicine, University of Toronto, Toronto, Canada. va.palda@utoronto.ca
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D015982:Bias; D002248:Carbon Monoxide / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008669:Metallurgy; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors
D002248:Carbon Monoxide