title: Increased intima-media thickness in rayon workers after long-term exposure to carbon disulfide.
abstract: BACKGROUND
  Long-term exposure to carbon disulfide (CS2) is associated with increased cardiovascular mortality. However, previous studies on actual vascular changes showed heterogeneous results. Intima-media thickness of the carotid arteries (IMT) represents an established marker of atherosclerosis and a reasonable surrogate marker for cardiovascular risk. IMT was examined in a large cohort of CS2 exposed workers and the association with cumulative CS2 exposure analysed.
  
  
  METHODS
  In a cross-sectional examination, 290 exposed and 137 non-exposed workers in a German rayon-manufacturing plant were assessed. Individual cumulative exposure was calculated from this assessment combined with the results of two cross-sectional studies in 1992 and 1999 and department-specific annual means of ambient (CECS2) and individual biological (CETTCA) monitoring results obtained 1992-2009. Furthermore, cumulative duration of working in CS2-exposed departments (CEYEARS) was calculated. Examination included assessment of a broad set of known cardiovascular risk factors and IMT measurement of the carotid arteries on both sides. Multiple linear regression analyses were performed with IMT as outcome and three variants of cumulative exposure (duration of exposure, cumulative CS2, and cumulative TTCA) as well as categorised maximum CS2 exposure, all adjusted for cardiovascular risk factors.
  
  
  RESULTS
  All models of cumulative exposure showed a significant increase in IMT in the group with the highest level of exposure: CEYEARS > 20 years, β = 0.045 mm; CECS2 > 270 ppm × years, β = 0.052 mm; CETTCA > 33 mg/g creatinine × years, β = 0.038 mm. Alternatively, addressing maximum exposure, workers with CS2 exposure of >10 ppm in at least 3 years exhibited a significant IMT increase (β = 0.068 mm).
  
  
  CONCLUSIONS
  Long-term CS2 exposure is an independent risk factor concerning IMT changes. The amount of IMT increase, in a similar range as that associated with other cardiovascular risk factors, might be clinically relevant.
authors.affiliation: Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany. axel.schramm@uk-erlangen.de.
authors.forename: Axel
authors.initials: A
authors.lastname: Schramm
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Uter
authors.affiliation: Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Brandt
authors.affiliation: Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Göen
authors.affiliation: Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.affiliation: Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Baumeister
authors.affiliation: Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Drexler
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002246:Carbon Disulfide / Q000633:toxicity*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D059168:Carotid Intima-Media Thickness; D002482:Cellulose; D002617:Chemical Industry; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002482:Cellulose; C012024:rayon, purified; D002246:Carbon Disulfide
keywords: Atherosclerosis; Carbon disulfide; Cardiovascular diseases; Intima-media thickness