Epidemiology of stroke and transient ischemic attacks in the population of the territories adjacent to the former Semipalatinsk Nuclear Test Site, Kazakhstan

Semenova, Yuliya; Rakhimova, Idaliya; Nurpeissov, Tair; Alikeyeva, Galiya; Хайбуллин, Т Н; Ковальчук, В. В.; Ainabekova, Yelena; Yurkovskaya, Oksana; Glushkova, Natalya; Pivina, Lyudmila; Sarría‐Santamera, Antonio; Абдрахманова, З Б; Abdrakhmanov, Ayan

doi:10.1007/s00411-021-00955-1

Cited by 11 publications

(5 citation statements)

References 44 publications

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“…However, information was more limited in the lower dose occupational or environmental studies (supplement table S3.5). In the lower dose studies of the Japanese atomic bomb survivors,20 Mayak workers,646566 and a few other occupationally9091929394 and environmentally exposed9596 groups, substantial information was available on lifestyle factors (supplement S3 table S3.5). In most groups that were exposed to radiation, lifestyle risk factors had little or no evidence of interacting with cardiovascular disease risk related to radiation 13192054565759606162636790919395979899.…”

Section: Discussionmentioning

confidence: 99%

Ionising radiation and cardiovascular disease: systematic review and meta-analysis

Little

Азизова

Richardson

et al. 2023

BMJ

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ObjectiveTo systematically review and perform a meta-analysis of radiation associated risks of cardiovascular disease in all groups exposed to radiation with individual radiation dose estimates.DesignSystematic review and meta-analysis.Main outcome measuresExcess relative risk per unit dose (Gy), estimated by restricted maximum likelihood methods.Data sourcesPubMed and Medline, Embase, Scopus, Web of Science Core collection databases.Eligibility criteria for selecting studiesDatabases were searched on 6 October 2022, with no limits on date of publication or language. Animal studies and studies without an abstract were excluded.ResultsThe meta-analysis yielded 93 relevant studies. Relative risk per Gy increased for all cardiovascular disease (excess relative risk per Gy of 0.11 (95% confidence interval 0.08 to 0.14)) and for the four major subtypes of cardiovascular disease (ischaemic heart disease, other heart disease, cerebrovascular disease, all other cardiovascular disease). However, interstudy heterogeneity was noted (P<0.05 for all endpoints except for other heart disease), possibly resulting from interstudy variation in unmeasured confounders or effect modifiers, which is markedly reduced if attention is restricted to higher quality studies or those at moderate doses (<0.5 Gy) or low dose rates (<5 mGy/h). For ischaemic heart disease and all cardiovascular disease, risks were larger per unit dose for lower dose (inverse dose effect) and for fractionated exposures (inverse dose fractionation effect). Population based excess absolute risks are estimated for a number of national populations (Canada, England and Wales, France, Germany, Japan, USA) and range from 2.33% per Gy (95% confidence interval 1.69% to 2.98%) for England and Wales to 3.66% per Gy (2.65% to 4.68%) for Germany, largely reflecting the underlying rates of cardiovascular disease mortality in these populations. Estimated risk of mortality from cardiovascular disease are generally dominated by cerebrovascular disease (around 0.94-1.26% per Gy), with the next largest contribution from ischaemic heart disease (around 0.30-1.20% per Gy).ConclusionsResults provide evidence supporting a causal association between radiation exposure and cardiovascular disease at high dose, and to a lesser extent at low dose, with some indications of differences in risk between acute and chronic exposures, which require further investigation. The observed heterogeneity complicates a causal interpretation of these findings, although this heterogeneity is much reduced if only higher quality studies or those at moderate doses or low dose rates are considered. Studies are needed to assess in more detail modifications of radiation effect by lifestyle and medical risk factors.Systematic review registrationPROSPERO CRD42020202036

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Section: Discussionmentioning

confidence: 99%

Ionising radiation and cardiovascular disease: systematic review and meta-analysis

Little

Азизова

Richardson

et al. 2023

BMJ

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“…The Danish study of Lorenzen et al [ 82 ] was omitted as it is largely subsumed by the Nordic study of Darby et al [ 19 ]. There was a similar situation for the lower dose studies (of the type shown in Table 2 ), which in some cases had rich lifestyle information but only presented a single type of analysis [ 83 – 88 ] although in many instances the lower dose studies that were omitted had little or no information, apart from crude markers of socioeconomic status [ 54 , 89 – 111 ]. Of the final selected studies, 22 were of groups exposed to substantial doses of medical radiation for therapy or diagnosis (Table 1 ).…”

Section: Resultsmentioning

confidence: 92%

Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease

Little,

Boerma,

Bernier

et al. 2024

BMC Public Health

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Background Cardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors and latent period. Methods We assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose–response, using data assembled for a recent systematic review. Results There are 43 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of medical radiation for therapy or diagnosis. The remaining 21 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect. Conclusions There are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.

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“…The Danish study of Lorenzen et al [40] was omitted as it is largely subsumed by the Nordic study of Darby et al [41]. There was a similar situation for the lower dose studies (of the type shown in Table 2), which in some cases had rich lifestyle information but only presented a single type of analysis [42][43][44][45][46][47] although in many instances the lower dose studies that were omitted had little or no information, apart from crude markers of socioeconomic status . Of the nal selected studies, 22 were of groups exposed to substantial doses of medical radiation for therapy or diagnosis (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease

Little,

Boerma,

Bernier

et al. 2023

Preprint

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Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors. Methods: We assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose-response, using data assembled for a recent systematic review. Results: There are 42 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of radiation for therapy or diagnosis. The remaining 20 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect. Conclusions: There are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.

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Epidemiology of stroke and transient ischemic attacks in the population of the territories adjacent to the former Semipalatinsk Nuclear Test Site, Kazakhstan

Cited by 11 publications

References 44 publications

Ionising radiation and cardiovascular disease: systematic review and meta-analysis

Ionising radiation and cardiovascular disease: systematic review and meta-analysis

Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease

Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease

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