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A REVIEW OF EPIDEMIOOGICAL STUDIES ON DRINKING WATER HARDNESS AND CARDIOVASCULAR DISEASES
Citation:
MONARCA, S., F. DONATO, R. L. CALDERON, AND G. F. CRAUN. A REVIEW OF EPIDEMIOOGICAL STUDIES ON DRINKING WATER HARDNESS AND CARDIOVASCULAR DISEASES. The Journal of Cardiovascular Prevention & Rehabilitation. Lippincott Williams & Wilkins, Philadelphia, PA, 13(4):495-506, (2006).
Impact/Purpose:
To review epidemiological studies published on drinking water hardness, calcium and magnesium levels, and cardiovascular disease.
Description:
Major risk factors do not entirely explain the worldwide variability of morbidity and mortality due to
cardiovascular disease. Several environmental factors, including the hardness of drinking water may
affect cardiovascular disease risks. We conducted a qualitative review of the epidemiological studies
published on drinking water hardness, calcium and magnesium levels, and cardiovascular disease.
Many of the more than 50 ecological studies published from 1957 to 1978 reported an inverse or
protective association between hardness and cardiovascular disease mortality, but the results are not
consistent. After 1978, a total of 18 ecological, 7 case-control and 2 cohort studies were published.
Although the more recent studies provide little or no evidence for an association between drinking
water hardness or calcium levels and cardiovascular disease, most of the studies found a reduction in
cardiovascular disease risk with increasing magnesium levels in drinking water. Additional evidence
from toxicological, dietary, and other epidemiological studies supports the hypothesis that a low intake
of magnesium is a condition that increases the risk of dying from, and possibly developing,
cardiovascular disease or stroke. However, the association is likely to be weak compared to the major
risk factors for cardiovascular disease. There is some evidence available about the benefits of
magnesium intake, especially in drinking water, and cardiovascular disease. Thus, not removing
magnesium from or, in certain situations, increasing the magnesium intake from drinking water may be
beneficial, especially for populations with an insufficient dietary intake of the mineral.