Correlations Between Water Hardness and Cardiovascular Deaths in Oklahoma Counties

Lindeman, Robert D.; Assenzo, Joseph R.

doi:10.2105/ajph.54.7.1071

Cited by 43 publications

(12 citation statements)

References 10 publications

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“…Various studies linked water softness to ischemic heart disease (2), to hypertension (3), to atherosclerosis (4), and to stroke (4). However, other studies do not confirm these observations (5,6).…”

mentioning

confidence: 83%

Atherosclerosis and hypertension induction by lead and cadmium ions: an effect prevented by calcium ion.

Revis¹,

Zinsmeister²,

Bull³

1981

Proc. Natl. Acad. Sci. U.S.A.

142

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In epidemiological studies, both positive and negative correlations have been found between cardiovascular disease and mortality and the presence of several inorganic ions in the drinking water. In an attempt to resolve this apparent disagreement, we exposed White Carneau pigeons to drinking water containing calcium (100 ppm), magnesium (30 ppm), lead (0.8 ppm), or cadmium (0.6 ppm) and used a 24-factorial design to measure the effects of these elements in atherosclerosis and hypertension. The results indicate that (i) lead and cadmium induced aortic atherosclerosis and hypertension, and (ii) calcium protects against the cardiovascular effects of cadmium. Furthermore, the effects of lead and cadmium were promoted by magnesium, and there were indications that magnesium antagonized the atherosclerotic protective effect ofcalcium. We suggest that, if these results with the pigeon can be applied to humans, the incidence of aortic atherosclerosis and hypertension should be significantly higher in areas where the drinking water contains magnesium, lead, and cadmium with a relatively low calcium concentration. Furthermore, if hard and soft water produce similar levels of lead and cadmium uptakes, the level of magnesium may be an additional factor in aortic atherosclerosis.Over the past 20 years, epidemiological and clinical evidence on the relationship between the quality of drinking water and the death rate from cardiovascular disease has been conflicting and inconclusive. Earlier studies correlated soft water with a higher cardiovascular death rate (1). Later studies showed a similar relationship but did not agree on the type of cardiovascular disease related to soft water. Various studies linked water softness to ischemic heart disease (2), to hypertension (3), to atherosclerosis (4), and to stroke (4). However, other studies do not confirm these observations (5, 6).Several specific elements in drinking water have been implicated in epidemiological studies of cardiovascular mortality.Noting that the relative concentration ofcalcium is lower in soft water than in hard water, several investigators studied the relationship between drinking-water calcium concentration and cardiovascular mortality and observed an increase in mortality when the relative concentration of calcium was lower (7). Furthermore, some studies have shown a higher incidence of cardiovascular mortality associated with consumption of soft water with relatively high concentrations of lead and cadmium (8). Again, however, other studies fail to confirm these correlations (9).The objective of the present studies was to determine the effects of calcium, magnesium, lead, and cadmium on the induction and progression of atherosclerosis and hypertension. We chose the male White Carneau pigeon (3 months ofage) for these studies because, unlike many other experimental models, it develops spontaneous atherosclerotic lesions ofboth the aorta and coronary arteries (10). METHODSMale pigeons 3 months ofage were housed indoors (in climatecontrolled, uncrowde...

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mentioning

confidence: 83%

Atherosclerosis and hypertension induction by lead and cadmium ions: an effect prevented by calcium ion.

Revis¹,

Zinsmeister²,

Bull³

1981

Proc. Natl. Acad. Sci. U.S.A.

142

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“…Some studies carried out in the United States (84,85,94) and in England and Wales (79) showed an inverse correlation between death rates from hypertensive and arteriosclerotic heart disease and calcium and magnesium levels in drinking water. Other investigations in the United States (78) and Canada (90) showed inverse but statistically nonsignificant correlations between magnesium concentrations in water and IHD mortality.…”

Section: Correlation-based Ecologic Studiesmentioning

confidence: 82%

“…Extensive reviews by Punsar (68), Neri et al (69), Comstock (70), and Sharrett (57) failed to find conclusive relations between calcium and magnesium in water and heart disease. Table 2 and figure 1 provide an overview of correlational studies which relate the calcium and magnesium content of drinking water to cardiovascular disease mortality (69,(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88).…”

Section: Studies Of Water Hardness and The Population Incidence Of Camentioning

confidence: 99%

Magnesium in Drinking Water and Ischemic Heart Disease

Marx

Neutra

1997

Epidemiologic Reviews

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The associations found in the general populations of a number of different countries are suggestive and warrant an integrated program of laboratory and epidemiologic research to reject or confirm the magnesium-IHD hypothesis. Singling out this particular risk factor has two justifications. First, as would be the case with any epidemiologic risk factor for IHD whose attributable risk was large enough to be detectable through epidemiology, applying that attributable risk to the vast annual morbidity and mortality from IHD would translate into tens of thousands of lives benefited and millions of dollars in hospital costs avoided per year. Second, this particular risk factor could conceivably be eliminated by an inexpensive supplementation program. For example, a low-sodium, higher-magnesium and -potassium table salt has been recommended and used in Finland for many years, during a period when the prevalence of hypertension in population surveys was said to decrease (117). Interventions which do not require behavioral change have always been the most cost-effective in public health. We therefore urge funding agencies to give priority to studies determining whether there are unforeseen adverse effects of magnesium for some population subgroups and whether the apparent benefit derived from low doses of magnesium in the development of IHD or IHD death is real. Furthermore, researchers should determine which chemical form of magnesium is best absorbed and most effective. We need to better understand the interrelation of various water and food constituents, as well as individual risk factors, in the pathogenesis of IHD. Susceptible individuals who are at higher risk of being depleted of magnesium need to be identified, and potential untoward effects of magnesium should be studied. Future research must provide better answers about low level waterborne magnesium before recommendations to the public can be made.

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“…For example, in North Carolina (where mortality from cardiovascular and particularly cerebrovascular causes is high even for the United States) the lowest rates were found in the areas with the softest water.8 Neither were significant correlations found between hardness and cardiovascular mortality in rural counties of Oklahoma, in which geographic, environmental, and social variables would have been more uniform than in the larger national studies. 9 Nor was a relation found in three communities in Los Angeles which were similar for age, sex, race, income, socioeconomic status, and stability but different in water hardness.10 In a careful study in Maryland no difference was found between the hardness of the home tap-water of men aged 45-64 who had died from arteriosclerotic or degenerative heart disease and that of controls." In studies in Ireland'2 and England and Wales,13 1 too, negative or inconsistent results have been obtained.…”

Section: Hard Water Story: No Recommendationsmentioning

confidence: 98%

Editorial: Hard water story: no recommendations.

1976

BMJ

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Correlations Between Water Hardness and Cardiovascular Deaths in Oklahoma Counties

Cited by 43 publications

References 10 publications

Atherosclerosis and hypertension induction by lead and cadmium ions: an effect prevented by calcium ion.

Atherosclerosis and hypertension induction by lead and cadmium ions: an effect prevented by calcium ion.

Magnesium in Drinking Water and Ischemic Heart Disease

Editorial: Hard water story: no recommendations.

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