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American Journal of Epidemiology Advance Access originally published online on August 21, 2009
American Journal of Epidemiology 2009 170(6):739-746; doi:10.1093/aje/kwp191
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Association Between Low-Level Environmental Arsenic Exposure and QT Interval Duration in a General Population Study

Irina Mordukhovich, Robert O. Wright, Chitra Amarasiriwardena, Emmanuel Baja, Andrea Baccarelli, Helen Suh, David Sparrow, Pantel Vokonas and Joel Schwartz

Correspondence to Irina Mordukhovich, Department of Epidemiology, Campus Box 7435, McGavran-Greenberg Hall, University of North Carolina, Chapel Hill, NC 27599-7435 (e-mail: irinam{at}email.unc.edu).

Received for publication October 29, 2008. Accepted for publication June 8, 2009.

High-level arsenic exposure is consistently associated with QT prolongation, a risk factor for arrhythmia and sudden cardiac death. Arsenic may act on QT by increasing cardiac calcium currents. The authors hypothesized that low-level arsenic exposure would be associated with QT duration and that this effect would be stronger among persons not using calcium channel blockers. They performed a cross-sectional analysis in elderly men from the Normative Aging Study to analyze associations between toenail arsenic and QT and heart rate-corrected QT (QTc) durations and to examine effect modification by calcium channel blocker use, using linear regression and adjusting for potential confounders. Participants were examined in Boston, Massachusetts, between 2000 and 2002 or in 2006. An interquartile range increase in arsenic concentration was associated with a 3.8-millisecond increase in QT (95% confidence interval: 0.82, 6.8) and a 2.5-millisecond increase in QTc (95% confidence interval: 0.11, 4.9). There was no evidence of effect modification by medication use for either QT (P = 0.93) or QTc (P = 0.58). The authors observed positive associations between a biomarker of arsenic exposure and QT duration but found no evidence of effect modification by calcium channel blocker use, possibly because of modest power.

antioxidants; arrhythmias, cardiac; arsenic; calcium channel blockers; cardiovascular diseases; environmental health; long QT syndrome

Abbreviations: hERG, human ether-a go-go related gene product protein; QTc, heart rate-corrected QT


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