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A Dose-Response Meta-Analysis of Chronic Arsenic Exposure and Incident Cardiovascular Disease
Citation:
Moon, K., S. Oberoi, A. Barchowsky, Y. Chen, E. Guallar, K. Nachman, M. Rahman, N. Sohel, D. D'Ippoliti, Tim Wade, K. James, S. Farzan, M. Karagas, H. Ahsan, AND A. Navas-Acien. A Dose-Response Meta-Analysis of Chronic Arsenic Exposure and Incident Cardiovascular Disease. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. Oxford University Press, Cary, NC, 47(3):1013, (2018). https://doi.org/10.1093/ije/dyy073
Impact/Purpose:
The authors conducted a meta analysis of arsenic exposure and cardiovascular disease and developed dose-response associations.
Description:
Introduction: High levels of arsenic in drinking water (≥100 µg/L) have consistently been associated with cardiovascular disease (CVD). Growing evidence supports a link with arsenic at low-moderate levels (<100 µg/L). Our objective was to examine the dose-response relationship between arsenic and CVD across studies conducted in populations exposed to a wide range of arsenic levels in drinking water. Methods: We identified epidemiologic studies of arsenic and incident CVD (all CVD, coronary heart disease (CHD) and stroke) in the general population using a systematic review, excluding ecological studies and studies with fewer than three arsenic exposure categories. For studies with urine or toenail arsenic, we estimated water arsenic concentrations. We calculated pooled relative risks (RR) for incident CVD (fatal and nonfatal) and fatal CVD endpoints using a dose-response random effects meta-analysis of categorical RR. We evaluated arsenic as log-transformed concentrations (per doubling of water arsenic) and with restricted cubic splines. Results: Twelve studies met our inclusion criteria (CVD, N=8; CHD, N=10, stroke, N=8), including studies conducted at high (N=7) and low-moderate (N=8) levels of arsenic in drinking water. For a doubling of water arsenic, the pooled RR for non-fatal and fatal CVD, CHD, and stroke were 1.09 (95% CI: 1.03, 1.14), 1.11 (95% CI: 1.05, 1.17), and 1.08 (95% CI: 0.99, 1.17), respectively. We found no evidence of non-linearity, although these tests had low statistical power.Conclusions: Although limited by the small number of studies, this analysis strengthens the evidence of a positive association between low-moderate arsenic exposure and CVD and provides support for CVD endpoints in risk assessments for inorganic arsenic.
URLs/Downloads:
DOI: A Dose-Response Meta-Analysis of Chronic Arsenic Exposure and Incident Cardiovascular Disease
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