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Exposure to Even Small Amounts of Arsenic Raises Heart Disease Risk

Summary and Comment |
October 9, 2013

Exposure to Even Small Amounts of Arsenic Raises Heart Disease Risk

  1. Joel M. Gore, MD

A study in American Indians shows an independent association between low-to-moderate urinary arsenic levels and cardiovascular events.

  1. Joel M. Gore, MD

High levels of arsenic in food or water are among the many environmental toxins that increase the risk for heart disease (BMJ 2011; 342:d2431). To evaluate the effects of long-term exposure to low-to-moderate levels of urinary arsenic on cardiovascular disease, investigators performed a prospective cohort study in 3575 American Indian men and women aged 45 to 74 who participated in the Strong Heart Study in Arizona, Oklahoma, and North and South Dakota between 1989 and 1991, with follow-up through 2008.

Over 45,738 person-years of follow-up, 341 participants died of coronary heart disease, and 45 died of stroke. Fatal or nonfatal cardiovascular events occurred in 1184 participants (coronary heart disease, 846; stroke, 264). Urinary arsenic concentrations varied by study region; overall, the median concentration was 9.7 µg/g creatinine. In a comparison of outcomes in the highest and lowest quartiles of arsenic concentration (>15.7 vs. <5.8 µg/g creatinine) adjusted for sociodemographic factors, smoking, body-mass index, and lipids, the hazard ratios for cardiovascular, coronary heart disease, and stroke mortality were 1.65, 1.71, and 3.03, respectively. In subgroup analysis, the association between urinary arsenic and cardiovascular risk was stronger in individuals with diabetes than in those without diabetes.

Comment

According to this study, even low levels of urinary arsenic are associated with increased risk for cardiovascular disease and death. This finding is a valuable addition to our knowledge of cardiovascular risk factors; however, it is important to remember that the absolute level of risk with arsenic is still far lower than with traditional risk factors, including high blood pressure, diabetes, cigarette smoking, and cholesterol elevation.

  • Disclosures for Joel M. Gore, MD at time of publication Grant / research support NIH; NIH-NHLBI; NSF

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