Yu Chen, PhD; Margaret R. Karagas, PhD
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2154.
Requests for Single Reprints: Yu Chen, PhD, New York University School of Medicine, 650 First Avenue, Room 510, New York, NY 10016; e-mail, email@example.com.
This article was published online first at www.annals.org on 24 September 2013.
Current Author Addresses: Dr. Chen: New York University School of Medicine, 650 First Avenue, Room 510, New York, NY 10016.
Dr. Karagas: Geisel School of Medicine at Dartmouth, One Medical Center Drive, Rubin Building 7927, Lebanon, NH 03756.
Chen Y., Karagas M.; Arsenic and Cardiovascular Disease: New Evidence From the United States. Ann Intern Med. 2013;159:713-714. doi: 10.7326/0003-4819-159-10-201311190-00720
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Published: Ann Intern Med. 2013;159(10):713-714.
Mounting evidence suggests that exposure to chemicals and other environmental substances, such as ambient urban air particles, cadmium, lead, and inorganic arsenic, could have a profound effect on cardiovascular disease (CVD) risk. Inorganic arsenic, a known carcinogen, occurs naturally in groundwater, exposing millions of people in the United States and worldwide. Epidemiologic studies in villages of southwestern Taiwan with high levels of arsenic in groundwater (median, 780 µg/L) provided early evidence of a dose–response relationship of water arsenic concentrations at less than 300 µg/L, 300 to 590 µg/L, and greater than 590 µg/L with CVD mortality (1). Arsenic exposure has also been related to increased mortality from acute myocardial infarction in Chile, where arsenic concentrations in drinking water increased from 90 to 870 µg/L between 1958 and 1970 (2). Recent prospective studies from Bangladesh reported a dose–response relationship between arsenic exposure and CVD mortality at well water arsenic concentration of 10 to 300 µg/L (3, 4) or urinary creatinine–adjusted arsenic concentration of 106 to 641 µg/g creatinine (3), although estimates for lower exposure levels were less precise. In this issue, Moon and colleagues (5) report results from a U.S. study of American Indians from the Strong Heart Study. Study participants with a urinary arsenic concentration greater than 15.7 µg/g creatinine were 1.65, 1.71, and 3.03 times more likely to die of CVD, coronary heart disease, and stroke, respectively, than their counterparts with urinary arsenic levels less than 5.8 µg/g creatinine (5). The risk for incident CVD associated with urinary arsenic, although lower than that for CVD mortality, was also elevated.
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