The Long-Term Effects of Organophosphates Poisoning as a Risk Factor of CVDs: A Nationwide Population-Based Cohort Study.
BACKGROUND
Organophosphorus pesticides are widely used throughout the world. Because of their ease of availability, organophosphorus compounds are commonly used for self-poisoning in developing countries. The acute effects of exposure to organophosphorus pesticides are well known, but the chronic effects are unclear. Recent studies suggest that abnormalities of the central and peripheral nervous systems persisted for up to 5 years after acute poisoning due to a single large dose of organophosphates (OPs). However, the long-term effects on cardiovascular diseases are poorly understood.


RESULTS
An OPs-exposed cohort (N = 7,561) and an age- and gender-matched control cohort (N = 30,244), both identified from the National Health Insurance Research Database, were compared. We utilized the multivariable Cox proportional model to estimate the risks of developing arrhythmia, coronary artery disease (CAD) and congestive heart failure (CHF). The patients with acute poisoning from OPs had higher incidence rates of arrhythmia (5.89 vs. 3.61 per 1,000 person-years), CAD (9.10 vs. 6.88 per 1,000 person-years), and CHF (3.89 vs. 2.98 per 1,000 person-years) compared with that of the non-OPs poisoning cohort, with a crude subhazard ratio (SHR) of 1.40, 1.13, and 1.12, respectively. Additionally, a significantly higher risk of arrhythmia was observed in the OPs poisoning cohort (adjusted SHR = 1.25) compared with the non-OPs poisoning cohort, particularly in male patients (adjusted SHR = 1.33) and those under 49 years of age (adjusted SHR = 3.16). After accounting for the competing risks of death, there was a higher risk of arrhythmia and CAD during a three year follow-up period (adjusted SHR = 1.50 for arrhythmia; adjusted SHR = 1.10 for CAD). We also found an adjusted SHR of 1.36 associated with developing CHF after 6 years of follow-up for OPs poisoning cohort.


CONCLUSIONS
Acute OPs poisoning may continuously impact human health through mechanisms that are unclear. Any supportive measurements that could contribute to a reduction in the risk of heart disease may be beneficial in cases of OPs poisoning survivors.
Department of Emergency, Toxicology Center, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
Dong-Zong
DZ
Hung
School of Public Health, Chung Shan Medical University, Taichung, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Hao-Jan
HJ
Yang
Institute of Biostatistics, China Medical University, Taichung, Taiwan.
Yu-Fen
YF
Li
College of Medicine, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Cheng-Li
CL
Lin
School of Public Health, Chung Shan Medical University, Taichung, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Shih-Yu
SY
Chang
Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Fung-Chang
FC
Sung
Department of Emergency, Toxicology Center, China Medical University Hospital, Taichung, Taiwan.
Sally C W
SC
Tai
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000209:etiology* / Q000473:pathology; D004781:Environmental Exposure; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007306:Insecticides / Q000506:poisoning; D008297:Male; D008875:Middle Aged; D062025:Organophosphate Poisoning / Q000150:complications* / Q000473:pathology; D009943:Organophosphorus Compounds / Q000633:toxicity*; D010575:Pesticides / Q000506:poisoning; D016016:Proportional Hazards Models; D012306:Risk; D013997:Time Factors
D007306:Insecticides; D009943:Organophosphorus Compounds; D010575:Pesticides