American Journal of Epidemiology Advance Access published online on November 3, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi330
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1 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD; Johns Hopkins Center for Excellence in Environmental Public Health Tracking, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
* To whom correspondence should be addressed. Arsenic exposure is a likely cause of blackfoot disease and a potential risk factor for atherosclerosis. The authors performed a systematic review of the epidemiologic evidence on the association between arsenic and cardiovascular outcomes. The search period was January 1966 through April 2005. Thirteen studies conducted in general populations (eight in high-arsenic areas in Taiwan, five in other countries) and 16 studies conducted in occupational populations were identified. Exposure was assessed ecologically in most studies. In Taiwan, relative risks comparing the highest arsenic exposure category with the lowest ranged from 1.59 to 4.90 for coronary disease, from 1.19 to 2.69 for stroke, and from 1.66 to 4.28 for peripheral arterial disease. In other general populations, relative risks ranged from 0.84 to 1.54 for coronary disease, from 0.69 to 1.53 for stroke, and from 0.61 to 1.58 for peripheral arterial disease. In occupational populations, relative risks ranged from 0.40 to 2.14 for coronary disease mortality and from 0.30 to 1.33 for stroke mortality. Methodologic limitations, however, limited interpretation of the moderate-to-strong associations between high arsenic exposure and cardiovascular outcomes in Taiwan. In other populations or in occupational settings, the evidence was inconclusive. Because of the high prevalence of arsenic exposure, carefully performed studies of arsenic and cardiovascular outcomes should be a research priority.
Received May 13, 2005
Accepted July 8, 2005
REVIEW
Arsenic Exposure and Cardiovascular Disease: A Systematic Review of the Epidemiologic Evidence
2 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
3 Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
4 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
5 Johns Hopkins Center for Excellence in Environmental Public Health Tracking, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Ana Navas-Acien, E-mail: anavas{at}jhsph.edu
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