Atherogenicity and carcinogenicity of high-arsenic artesian well water. Multiple risk factors and related malignant neoplasms of blackfoot disease.

Abstract

The objective of this study was to examine multiple risk factors and correlated malignant neoplasms of blackfoot disease (BFD), a unique peripheral vascular disease related to continuous exposure to high-arsenic artesian well water. A total of 241 BFD cases, Including 169 with spontaneous or surgical amputations of affected extremities, and 759 age-sex-resldence-matched healthy community controls were studied to explore the risk factors of BFD. Multiple logistic regression analysis showed that artesian well water consumption, arsenic poisoning, familial history of BFD, and undernourishment were significantly associated with the development of BFD. The life-table method used to analyze cancer mortality of 789 BFD patients followed for 15 years showed a significantly higher mortality from cardiovascular diseases, peripheral vascular diseases, and cancers of bladder, skin, lung, and liver among BFD patients as compared with the general population In Taiwan 1 Clinically the disease starts with numbness or coldness of one or more extremities and intermittent claudication which progress to black discoloration, ulceration, and gangrene. In trie end stages of the disease, spontaneous or surgical amputations of distal parts of affected extremities are common.2 Extensive pathological study showed that 30% of BFD patients had histological lesions compatible with thromboangiitis obliterans and 70% showed changes of arteriosclerosis obliterans.3 BFD has long been related to the drinking water derived from artesian wells in the endemic area; 4 -7 however, the etiology of this disease still remains unclear. While artesian well water was commonly used in the BFD-endemic area, the prevalence of the disease was only 8.9 per 1000 at most. 7 The lifetime cumulative incidence rate of BFD was estimated to be less than 10% among those who drank artesian well water.8 It is important to explore the reason why most residents who consumed artesian well water were free of the disease. Both fishermen and salt-field workers had significantly higher

Prevalence of non-insulin-dependent diabetes mellitus and related vascular diseases in southwestern arseniasis-endemic and nonendemic areas in Taiwan.

“…The finding of a strikingly increased prevalence of macrovascular diseases observed in the arseniasis-endemic area compared with the nonendemic area is consistent with our previous findings of arsenic-induced atherosclerosis (Chen et al 1988bChiou et al 1997b;Tseng et al 1996;Wang et al 2002;Wu et al 1989). There have been few studies comparing the prevalence of specific vascular diseases in relation to arsenic exposure in diabetics and nondiabetics.…”

“…The water from a large proportion of artesian wells in these four townships had arsenic concentrations > 0.35 mg/L according to a national survey of more than 90% of wells in Taiwan (Chang et al 1991). This arseniasis-endemic area has been described in detail in a previous report (Chen et al 1988b). A total of 66,667 residents ≥ 25 years of age in the arseniasis-endemic area were included in this study.…”

“…Other chronic health effects induced by arsenic have also drawn global attention, especially cardiovascular, neurologic, reproductive, and developmental hazards (Chen et al 1997a(Chen et al , 1999. Mortality and morbidity of vascular diseases, including peripheral vascular disease, cerebral infarction, and ischemic heart disease, have been documented to be associated with arsenic levels in drinking water in the arseniasisendemic area (Chen et al 1988bChiou et al 1997b;Tseng et al 1996;Wang et al 2002;Wu et al 1989). The associations between long-term exposure to arsenic and microvascular diseases, including renal disease, retinopathy, and neuropathy, remain to be elucidated.…”

Family correlations of arsenic methylation patterns in children and parents exposed to high concentrations of arsenic in drinking water.

“…Few studies have investigated familial patterns and genetic factors in development of arsenic health effects and metabolism. In Taiwan, a population-based study found that patients with blackfoot disease, an arsenic-induced peripheral vascular disease, were three times more likely to have a family history of blackfoot disease than community controls (23). However, exposure variation could account for this pattern.…”

Arsenic drinking water regulations in developing countries with extensive exposure

“…In contrast, the lung cancer risk of smokers without arsenic in their water was about six times that of non-smokers. This, along with the vascular effects of both arsenic and smoking (Tseng et al, 1996;Engel et al, 1994;Chen et al, 1996Chen et al, , 1988Hertz-Picciotto et al, 2000) might suggest that those who have been exposed to arsenic in water should be advised not to smoke. However, since smoking kills nearly one in two persons without arsenic in their water, it hardly seems pertinent to point out that smokers who have arsenic in their water have even greater risks.…”