Association between Arsenic Exposure from Drinking Water and Longitudinal Change in Blood Pressure among HEALS Cohort Participants

Jiang, Junyan; Liu, Mengling; Parvez, Faruque; Wang, Binhuan; Wu, Fen; Eunus, Mahbubul; Bangalore, Sripal; Newman, Jonathan; Ahmed, Alauddin; Islam, Tariqul; Rakibuz-Zaman, Muhammad; Hasan, Rabiul; Sarwar, Golam; Levy, Diane; Slavkovich, Vesna; Argos, Maria; Bryan, Molly Scannell; Farzan, Shohreh F.; Hayes, Richard B.; Graziano, Joseph H.; Ahsan, Habibul; Chen, Yu

doi:10.1289/ehp.1409004

Cited by 50 publications

(48 citation statements)

References 36 publications

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“…Arsenic has been associated with hypertension and increased blood pressure levels in several studies, although the number of studies is relatively small, especially at low-moderate exposure levels. 37, 38 A critical threshold may exist for arsenic to etiologically affect both atherosclerosis and thickening of the carotid artery wall. Gene-arsenic interactions may also increase the risk of blood pressure in certain individuals.…”

Section: Discussionmentioning

confidence: 99%

Chronic arsenic exposure and risk of carotid artery disease: The Strong Heart Study

Mateen

Grau-Pérez

Pollak

et al. 2017

Environmental Research

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Background Inorganic arsenic exposure from naturally contaminated groundwater is related to vascular disease. No prospective studies have evaluated the association between arsenic and carotid atherosclerosis at low-moderate levels. We examined the association of long-term, low-to-moderate inorganic arsenic exposure with carotid arterial disease. Methods American Indians, 45 to 74 years old, in Arizona, Oklahoma, and North and South Dakota had arsenic concentrations (sum of inorganic and methylated species, μg/g urine creatinine) measured from baseline urine samples (1989-1991). Carotid artery ultrasound was performed in 1998-1999. Vascular disease was assessed by the carotid intima media thickness (CIMT), the presence of atherosclerotic plaque in the carotid, and by the number of segments containing plaque (plaque score). Results 2402 participants (mean age 55.3 years, 63.1% female, mean body mass index 31.0kg/m2, diabetes 45.7%, hypertension 34.2%) had a median (interquintile range) urine arsenic concentration of 9.2 (5.00, 17.06) μg/g creatinine. The mean CIMT was 0.75 mm. 64.7% had carotid artery plaque (3% with >50% stenosis). In fully adjusted models comparing participants in the 80th vs. 20th percentile in arsenic concentrations, the mean difference in CIMT was 0.01 (95% confidence interval (95%CI): 0.00, 0.02) mm, the relative risk of plaque presence was 1.04 (95%CI: 0.99, 1.09), and the geometric mean ratio of plaque score was 1.05 (95%CI: 1.01, 1.09). Conclusions Urine arsenic was positively associated with CIMT and increased plaque score later in life although the association was small. The relationship between urinary arsenic and the presence of plaque was not statistically significant when adjusted for other risk factors. Arsenic exposure may play a role in increasing the severity of carotid vascular disease.

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Section: Discussionmentioning

confidence: 99%

Chronic arsenic exposure and risk of carotid artery disease: The Strong Heart Study

Mateen

Grau-Pérez

Pollak

et al. 2017

Environmental Research

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“…In the Strong Heart Study urinary arsenic levels were associated with increased risk of both fatal and nonfatal CVD, coronary heart disease and stroke among American Indian men and women [17]. The potential effects of arsenic on CVD occurrence is further supported by a growing body of literature indicating that arsenic may affect subclinical indicators of CVD, such as carotid intima media thickness and elevated blood pressure [32–37]. Additional studies suggest that arsenic impacts endothelial function, reactive oxygen signaling and levels of inflammatory mediators [38–41].…”

Section: Discussionmentioning

confidence: 99%

Risk of death from cardiovascular disease associated with low-level arsenic exposure among long-term smokers in a US population-based study

Farzan

Chen

Rees

et al. 2015

Toxicology and Applied Pharmacology

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High levels of arsenic exposure have been associated with increases in cardiovascular disease risk. However, studies of arsenic’s effects at lower exposure levels are limited and few prospective studies exist in the United States using long-term arsenic exposure biomarkers. We conducted a prospective analysis of the association between toenail arsenic and cardiovascular disease mortality using longitudinal data collected on 3939 participants in the New Hampshire Skin Cancer Study. Using Cox proportional hazard models adjusted for potential confounders, we estimated hazard ratios and 95% confidence intervals associated with the risk of death from any cardiovascular disease, ischemic heart disease, and stroke, in relation to natural-log transformed toenail arsenic concentrations. In this US population, although we observed no overall association, arsenic exposure measured from toenail clipping samples was related to an increased risk of ischemic heart disease mortality among long-term smokers (as reported at baseline), with increased hazard ratios among individuals with ≥ 31 total smoking years (HR: 1.52, 95% CI: 1.02, 2.27), ≥ 30 pack-years (HR: 1.66, 95% CI: 1.12, 2.45), and among current smokers (HR: 1.69, 95% CI: 1.04, 2.75). These results are consistent with evidence from more highly exposed populations suggesting a synergistic relationship between arsenic exposure and smoking on health outcomes and support a role for lower-level arsenic exposure in ischemic heart disease mortality.

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“…A small number of epidemiologic studies have assessed the relationship between arsenic exposure and hypertension, and several, though not all, have identified positive associations [5–12]. One recent prospective study found significantly greater year-to-year increases in blood pressure (BP) among participants with higher drinking water arsenic exposure compared to those in the lowest exposure group [13]. …”

Section: Introductionmentioning

confidence: 99%

Hypertension among adults exposed to drinking water arsenic in Northern Chile

Hall

Acevedo

López

et al. 2017

Environmental Research

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Background A growing number of studies have identified an association between exposure to inorganic arsenic and hypertension. However, results have not been consistent across studies. Additional studies are warranted, given the global prevalence of both arsenic exposure and morbidity attributable to hypertension. Methods We analyzed data collected from October 2007–December 2010 for a population-based cancer case-control study in northern Chile. Data included lifetime individual arsenic exposure estimates and information on potential confounders for a total of 1266 subjects. Those self-reporting either a physician diagnosis of hypertension or use of an anti-hypertensive medication were classified as having hypertension (n=612). The association between hypertension and drinking water arsenic exposure was analyzed using logistic regression models. Results Compared to those in the lowest category for lifetime highest 5-year average arsenic exposure (<60 µg/L), those in the middle (60–623 µg/L) and upper (>623 µg/L) exposure categories had adjusted hypertension ORs of 1.49 (95% CI: 1.09, 2.05) and 1.65 (95% CI: 1.18, 2.32), respectively. Similar results were observed in analyses of lifetime cumulative exposures and analyses restricted to exposures from the distant past. Conclusions We identified evidence of increased odds of hypertension with exposure to arsenic in drinking water among study participants. Our findings add to the growing body of research supporting this association, which could have important public health implications.

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Association between Arsenic Exposure from Drinking Water and Longitudinal Change in Blood Pressure among HEALS Cohort Participants

Cited by 50 publications

References 36 publications

Chronic arsenic exposure and risk of carotid artery disease: The Strong Heart Study

Chronic arsenic exposure and risk of carotid artery disease: The Strong Heart Study

Risk of death from cardiovascular disease associated with low-level arsenic exposure among long-term smokers in a US population-based study

Hypertension among adults exposed to drinking water arsenic in Northern Chile

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