A Systematic Review of Epidemiological Associations between Low and Moderate Doses of Ionizing Radiation and Late Cardiovascular Effects, and Their Possible Mechanisms

Little, Mark P.; Tawn, E. Janet; Tzoulaki, Ioanna; Wakeford, Richard; Hildebrandt, Guido; Pâris, François; Tapio, Soile; Elliott, Paul

doi:10.1667/rr1070.1

Cited by 170 publications

(156 citation statements)

References 70 publications

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“…Several authors and committees have reviewed evidence for excess risk of circulatory disease in groups exposed to low and moderate doses of radiation (mean dose < 0.5 Gy) [8,9,28]. For example, a recent systematic review and metaanalysis [8] documented statistically significant excess risk for three of the four major subtypes of circulatory disease.…”

Section: Discussionmentioning

confidence: 99%

“…The candidate biological mechanisms for the circulatory disease effects of radiation have been recently reviewed [9,28,29]. At high radiotherapeutic doses (>5 Gy), the cell-killing effect on capillaries and endothelial cells plausibly explains effects on the heart and other parts of the circulatory system [29].…”

Section: Discussionmentioning

confidence: 99%

“…At high radiotherapeutic doses (>5 Gy), the cell-killing effect on capillaries and endothelial cells plausibly explains effects on the heart and other parts of the circulatory system [29]. At lower doses (0.5-5 Gy), in humans and in in vivo and in vitro experiments, many inflammatory markers are upregulated long after exposure to radiation, although for exposures less than about 0.5 Gy, the balance shifts toward anti-inflammatory effects [9,28,30], implying that the initiating mechanisms for adverse effects in this dose range would not directly result from inflammation. A recent analysis of death from renal failure in the Life Span Study suggests that radiation-induced renal dysfunction may be a factor in increasing the risk of circulatory disease [31], and some experimental data support this suggestion [32].…”

Section: Discussionmentioning

confidence: 99%

“…There is biological data suggesting radiation-associated senescence of monocytes [39], and a some-what similar mechanism based on monocyte cell killing in the arterial intima suggests that the arterial intima may be causally associated with initiating atheroma in the arterial wall [40] (although there are many other stages between that point and plaque rupture [41,42]), so that mean arterial dose might be the most relevant organ or tissue dose for studying circulatory disease. Several recent reviews [8,9,28,43] describe the abundant radiobiological reasons for considering the studies of moderate and low doses separately from studies of high doses. The mechanisms relevant for lower doses are likely to differ from those relevant at higher (e.g., radiotherapeutic) doses.…”

Section: Discussionmentioning

confidence: 99%

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Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

et al. 2015

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High-dose ionizing radiation is associated with circulatory disease. Risks from lower-dose fractionated exposures, such as from diagnostic radiation procedures, remain unclear. In this study we aimed to ascertain the relationship between fractionated low-to-medium dose radiation exposure and circulatory disease mortality in a cohort of 13,568 tuberculosis patients in Massachusetts, some with fluoroscopy screenings, between 1916 and 1961 and follow-up until the end of 2002. Analysis of mortality was in relation to cumulative thyroid (cerebrovascular) or lung (all other circulatory disease) radiation dose via Poisson regression. Over the full dose range, there was no overall radiation-related excess risk of death from circulatory disease (n = 3221; excess relative risk/Gy -0.023; 95 % CI -0.067, 0.028; p = 0.3574). Risk was somewhat elevated in hypertensive heart disease (n = 89; excess relative risk/Gy 0.357; 95 % CI -0.043, 1.030, p = 0.0907) and slightly decreased in ischemic heart dis-ease (n = 1950; excess relative risk/Gy -0.077; 95 % CI -0.130, -0.012; p = 0.0211). However, under 0.5 Gy, there was a borderline significant increasing trend for all circulatory disease (excess relative risk/Gy 0.345; 95 % CI -0.032, 0.764; p = 0.0743) and for ischemic heart disease (excess relative risk/Gy 0.465; 95 % CI, -0.032, 1.034, p = 0.0682). Pneumolobectomy increased radiation-associated risk (excess relative risk/Gy 0.252; 95 % CI 0.024, 0.579). Fractionation of dose did not modify excess risk. In summary, we found no evidence of radiation-associated excess circulatory death risk overall, but there are indications of excess circulatory death risk at lower doses (<0.5 Gy). Although consistent with other radiation-exposed groups, the indications of higher risk at lower doses are unusual and should be confirmed against other data.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

et al. 2015

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“…Radiotherapy treatment for breast cancer is associated with an increased risk of cardiovascular disease (45), and for Hodgkin's lymphoma it is associated with an increased risk of myocardial infarction (87). In these clinical studies, nonthoracic organs were the specific target of the treatment, and yet cardiovascular disease was a significant cause of long-term morbidity or mortality (59). In a radiological terrorism or nuclear accident event, children would account for a significant portion of the population affected and thus studies are needed to determine whether a single exposure to 10 Gy TBI in the child might increase the risk factor for development of cardiovascular disease and damage to heart morphology and ventricular function.…”

Section: Radiological Terrorismmentioning

confidence: 99%

Radiation as a Risk Factor for Cardiovascular Disease

Baker

Moulder

Hopewell

2011

Antioxidants & Redox Signaling

108

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Humans are continually exposed to ionizing radiation from terrestrial sources. The two major contributors to radiation exposure of the U.S. population are ubiquitous background radiation and medical exposure of patients. From the early 1980s to 2006, the average dose per individual in the United States for all sources of radiation increased by a factor of 1.7-6.2 mSv, with this increase due to the growth of medical imaging procedures. Radiation can place individuals at an increased risk of developing cardiovascular disease. Excess risk of cardiovascular disease occurs a long time after exposure to lower doses of radiation as demonstrated in Japanese atomic bomb survivors. This review examines sources of radiation (atomic bombs, radiation accidents, radiological terrorism, cancer treatment, space exploration, radiosurgery for cardiac arrhythmia, and computed tomography) and the risk for developing cardiovascular disease. The evidence presented suggests an association between cardiovascular disease and exposure to low-to-moderate levels of radiation, as well as the well-known association at high doses. Studies are needed to define the extent that diagnostic and therapeutic radiation results in increased risk factors for cardiovascular disease, to understand the mechanisms involved, and to develop strategies to mitigate or treat radiation-induced cardiovascular disease. Antioxid. Redox Signal. 15, 1945Signal. 15, -1956

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Effects of Space Radiation on Humans in Space Flight

Townsend

2021

Space Weather Effects and Applications

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A Systematic Review of Epidemiological Associations between Low and Moderate Doses of Ionizing Radiation and Late Cardiovascular Effects, and Their Possible Mechanisms

Cited by 170 publications

References 70 publications

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

Radiation as a Risk Factor for Cardiovascular Disease

Effects of Space Radiation on Humans in Space Flight

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