Association between exposure to low to moderate arsenic levels and incident cardiovascular disease

Katherine A. Moon, Eliseo Guallar Dr., Jason G. Umans Dr., Richard B. Devereux Dr., Lyle G. Best Dr., Kevin A. Francesconi Dr., Walter Goessler Dr., Jonathan Pollak, Ellen K. Silbergeld Dr., Barbara V. Howard Dr., Ana Navas-Acien Dr.

Research output: Contribution to journalArticle

Abstract

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 (<100 μg/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. Design: Prospective cohort study. Setting: The Strong Heart Study baseline visit between 1989 and 1991, with follow-up through 2008. Patients: 3575 American Indian men and women aged 45 to 74 years living in Arizona, Oklahoma, and North and South Dakota. Measurements: 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. Limitation: Direct measurement of individual arsenic levels in drinking water was unavailable. Conclusion: Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality. Primary Funding Source: National Heart, Lung, and Blood Institute and National Institute of Environmental Health Sciences.

Original languageEnglish (US)
Pages (from-to)649-659
Number of pages11
JournalAnnals of internal medicine
Volume159
Issue number10
DOIs
StatePublished - Nov 19 2013

ASJC Scopus subject areas

  • Internal Medicine

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  • Cite this

    Moon, K. A., Guallar Dr., E., Umans Dr., J. G., Devereux Dr., R. B., Best Dr., L. G., Francesconi Dr., K. A., Goessler Dr., W., Pollak, J., Silbergeld Dr., E. K., Howard Dr., B. V., & Navas-Acien Dr., A. (2013). Association between exposure to low to moderate arsenic levels and incident cardiovascular disease. Annals of internal medicine, 159(10), 649-659. https://doi.org/10.7326/0003-4819-159-10-201311190-00719