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American Journal of Epidemiology Advance Access published online on December 12, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwk037
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

ORIGINAL CONTRIBUTION

Arsenic Exposure from Drinking Water, Dietary Intakes of B Vitamins and Folate, and Risk of High Blood Pressure in Bangladesh: A Population-based, Cross-sectional Study

Yu Chen1,2,3, Pam Factor-Litvak1,4, Geoffrey R. Howe1, Joseph H. Graziano4, Paul Brandt-Rauf4, Faruque Parvez4, Alexander van Geen5 and Habibul Ahsan1,6

1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
2 Department of Environmental Medicine, New York University School of Medicine, New York, NY
3 New York University Cancer Institute, New York, NY
4 Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
5 Lamont-Doherty Earth Observatory, Columbia University, New York, NY
6 Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY

Correspondence to Dr. Yu Chen, Department of Environmental Medicine, New York University School of Medicine, 650 First Avenue, Room 510, New York, NY 10016 (e-mail: Y.Chen{at}med.nyu.edu).

The authors performed a cross-sectional analysis to evaluate the association between arsenic exposure from drinking water and blood pressure using baseline data of 10,910 participants in the Health Effects of Arsenic Longitudinal Study in Bangladesh (October 2000–May 2002). A time-weighted well arsenic concentration (TWA) based on current and past use of drinking wells was derived. Odds ratios for high pulse pressure (≥55 mmHg) by increasing TWA quintiles (≤8, 8.1–40.8, 40.9–91.0, 91.1–176.0, and 176.1–864.0 µg/liter) were 1.00 (referent), 1.39 (95% confidence interval (CI): 1.14, 1.71), 1.21 (95% CI: 0.99, 1.49), 1.19 (95% CI: 0.97, 1.45), and 1.19 (95% CI: 0.97, 1.46). Among participants with a lower than average dietary intake level of B vitamins and folate, the odds ratios for high pulse pressure by increasing TWA quintiles were 1.00 (referent), 1.84 (95% CI: 1.07, 3.16), 1.89 (95% CI: 1.11, 3.20), 1.83 (95% CI: 1.09, 3.07), and 1.89 (95% CI: 1.12, 3.20). The odds ratios for systolic hypertension suggest a similar but weaker association. No apparent associations were observed between TWA and general or diastolic hypertension. These findings indicate that the effect of low-level arsenic exposure on blood pressure is nonlinear and may be more pronounced in persons with lower intake of nutrients related to arsenic metabolism and cardiovascular health. Future research is needed to evaluate the effect of low-level arsenic exposure on specific cardiovascular outcomes.

arsenic; Bangladesh; blood pressure; cross-sectional studies; hypertension

Abbreviations: CI, confidence interval; DBP, diastolic blood pressure; SBP, systolic blood pressure; TWA, time-weighted well arsenic concentration


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