Arsenic Exposure and Predicted 10-Year Atherosclerotic Cardiovascular Risk Using the Pooled Cohort Equations in U.S. Hypertensive Adults

Abstract

This study was to evaluate the association of urine arsenic with predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk in U.S. adults with hypertension. Cross-sectional analysis was conducted in 1570 hypertensive adults aged 40–79 years in the 2003–2012 National Health and Nutrition Examination Survey (NHANES) with determinations of urine arsenic. Predicted 10-year ASCVD risk was estimated by the Pooled Cohort Equations, developed by the American College of Cardiology/American Heart Association in 2013. For men, after adjustment for sociodemographic factors, urine dilution, ASCVD risk factors and organic arsenic intake from seafood, participants in the highest quartiles of urine arsenic had higher 10-year predicted ASCVD risk than in the lowest quartiles; the increases were 24% (95% confidence interval (CI): 2%, 53%) for total arsenic, 13% (95% CI: 2%, 25%) for dimethylarsinate and 22% (95% CI: 5%, 40%) for total arsenic minus arsenobetaine separately. For women, the corresponding increases were 5% (95% CI: −15%, 29%), 10% (95% CI: −8%, 30%) and 0% (95% CI: −15%, 19%), respectively. Arsenic exposure, even at low levels, may contribute to increased ASCVD risk in men with hypertension. Furthermore, our findings suggest that particular circumstances need urgently to be considered while elucidating cardiovascular effects of low inorganic arsenic levels.

Positive Association of Cardiovascular Disease (CVD) with Chronic Exposure to Drinking Water Arsenic (As) at Concentrations below the WHO Provisional Guideline Value: A Systematic Review and Meta-analysis

“…The full text of studies which was regarded as potentially eligible was then assessed and further excluded if they were (a) not related with dietary As exposure or not for the general population; (b) no available relative risk (risk ratios, odds ratios) and measures of variability of different types of CVD were mentioned; or c) no categorical As exposure (at least three categories) was used ( Figure S1). The methodological quality of the studies was also assessed and those with missing data on, or incomplete definitions of, the study design, population, exposure condition, or outcome variables were excluded [42][43][44][45][46][47][48][49]. Furthermore, as it is difficult to convert plasma As to water As, we excluded two studies which could only provide plasma As concentration to lower the bias of exposure assessment [50,51].…”

Association of Arsenic Exposure With Cardiac Geometry and Left Ventricular Function in Young Adults

“…Stratification according to BP status is important to gain insight into the cardiovascular risk profile of hypertensive patients, which is directly related to arsenic exposure. 64 However, the rates of overweight and obesity, conditions independently related to cardiac growth, 65 were high (27.9% and 46.3%, respectively); nevertheless, interaction analysis showed no effect modification by BMI status. Circadian variation of BP levels, as well as changes in BP treatment and compliance, could have an impact on measures of cardiac geometry but were not available for the present study.…”

Development and application of an evidence-based directed acyclic graph to evaluate the associations between metal mixtures and cardiometabolic outcomes

“…For example, several papers in our literature review discussed the use of urinary metal exposures as a limitation (notably one that is also present in our pilot analysis) because urinary exposures do not necessarily reflect total lifetime exposure, or even average exposure over an extended time period depending on the metal of interest and renal functioning. 29,39,40 Our systematic literature review suggested several mechanisms through which exposure to individual metals could potentially affect cardiometabolic health outcomes; however, future work is needed to understand how metals may interact physically and/or chemically to affect health. For individual metals, much of the literature focuses on how arsenic may be associated with cardiometabolic health through mechanisms mediated by epigenetic changes, 29 and through associations with immune function, endothelial dysfunction, and oxidative stress.…”

“…For example, several papers in our literature review discussed the use of urinary metal exposures as a limitation (notably one that is also present in our pilot analysis) because urinary exposures do not necessarily reflect total lifetime exposure, or even average exposure over an extended time period depending on the metal of interest and renal functioning. 29, 39, 40…”

“…27 Each arrow from an exposure to an outcome represented a relationship mentioned in at least one articles from the literature review ( Figure 2). 1,3,5,6,9,10,[12][13][14][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Each arrow mapping a covariate to either the exposure or the outcome was verified from either an article in the literature review or an alternate source found searching in PubMed (Appendix A). The primary DAG is shown in Figure 2, and the metal specific DAGs are presented in the supplement (Supplemental Figures 1-5).…”