title: Dioxins and cardiovascular disease mortality.
abstract: OBJECTIVE
  In this systematic review we evaluated the evidence on the association between dioxin exposure and cardiovascular disease (CVD) mortality in humans.
  
  
  METHODS
  We conducted a PubMed search in December 2007 and considered all English-language epidemiologic studies and their citations regarding dioxin exposure and CVD mortality. To focus on dioxins, we excluded cohorts that were either primarily exposed to polychlorinated biphenyls or from the leather and perfume industries, which include other cardiotoxic coexposures.
  
  
  RESULTS
  We included results from 12 cohorts in the review. Ten cohorts were occupationally exposed. We divided analyses according to two well-recognized criteria of epidemiologic study quality: the accuracy of the exposure assessment, and whether the exposed population was compared with an internal or an external (e.g., general population) reference group. Analyses using internal comparisons with accurate exposure assessments are the highest quality because they minimize both exposure misclassification and confounding due to workers being healthier than the general population ("healthy worker effect"). The studies in the highest-quality group found consistent and significant dose-related increases in ischemic heart disease (IHD) mortality and more modest associations with all-CVD mortality. Their primary limitation was a lack of adjustment for potential confounding by the major risk factors for CVD.
  
  
  CONCLUSIONS
  The results of this systematic review suggest that dioxin exposure is associated with mortality from both IHD and all CVD, although more strongly with the former. However, it is not possible to determine the potential bias, if any, from confounding by other risk factors for CVD.
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Olivier
authors.initials: O
authors.lastname: Humblet
authors.forename: Linda
authors.initials: L
authors.lastname: Birnbaum
authors.forename: Eric
authors.initials: E
authors.lastname: Rimm
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: Russ
authors.initials: R
authors.lastname: Hauser
mesh_terms: D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000401:mortality*; D015331:Cohort Studies; D004147:Dioxins / Q000633:toxicity*; D006801:Humans
chemical_list: D004147:Dioxins