Association between exposure to low to moderate arsenic levels and incident cardiovascular disease. A prospective cohort study.
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 (< 100μg/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.


METHODS
Prospective cohort study.


METHODS
The Strong Heart Study baseline visit between 1989 and 1991, with follow-up through 2008.


METHODS
3575 American Indian men and women aged 45 to 74 years living in Arizona, Oklahoma, and North and South Dakota.


METHODS
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.


CONCLUSIONS
Direct measurement of individual arsenic levels in drinking water was unavailable.


CONCLUSIONS
Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality.
Katherine A
KA
Moon
Eliseo
E
Guallar
Jason G
JG
Umans
Richard B
RB
Devereux
Lyle G
LG
Best
Kevin A
KA
Francesconi
Walter
W
Goessler
Jonathan
J
Pollak
Ellen K
EK
Silbergeld
Barbara V
BV
Howard
Ana
A
Navas-Acien
D000368:Aged; D001151:Arsenic / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology; D060766:Drinking Water; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005506:Food Contamination; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D015415:Biomarkers; D060766:Drinking Water; D001151:Arsenic