High Urinary Tungsten Concentration Is Associated with Stroke in the National Health and Nutrition Examination Survey 1999–2010

Abstract

BackgroundIn recent years there has been an exponential increase in tungsten demand, potentially increasing human exposure to the metal. Currently, the toxicology of tungsten is poorly understood, but mounting evidence suggests that both the elemental metal and its alloys have cytotoxic effects. Here, we investigate the association between tungsten and cardiovascular disease (CVD) or stroke using six waves of the National Health and Nutrition Examination Survey (NHANES).MethodsWe investigated associations using crude and adjusted logistic regression models in a cohort of 8614 adults (18–74 years) with 193 reported stroke diagnoses and 428 reported diagnoses of CVD. We also stratified our data to characterize associations in a subset of younger individuals (18–50 years).ResultsElevated tungsten concentrations were strongly associated with an increase in the prevalence of stroke, independent of typical risk factors (Odds Ratio (OR): 1.66, 95% Confidence Interval (95% CI): 1.17, 2.34). The association between tungsten and stroke in the young age category was still evident (OR: 2.17, 95% CI: 1.33, 3.53).ConclusionThis study represents the most comprehensive analysis of the human health effects of tungsten to date. Individuals with higher urinary tungsten concentrations have double the odds of reported stroke. We hypothesize that the pathological pathway resulting from tungsten exposure may involve oxidative stress.

Environmental Metals and Cardiovascular Disease in Adults: A Systematic Review Beyond Lead and Cadmium

“…Among the four retrieved studies, one cardiovascular endpoint was based on examination (peripheral arterial disease) [58], while other endpoints were based on self-report of composite cardiovascular disease [57, 121•], coronary heart failure, coronary heart disease, heart attack and stroke [57, 121•]. The association of elevated tungsten levels and composite cardiovascular disease [57, 121•], peripheral arterial disease [58], and stroke [121•] were statistically significant. The associations of tungsten with heart failure, coronary heart disease, heart attack, and stroke in one study [20] were in the positive direction but non-significant.…”

“…All three studies took into account urine dilution by adjusting the regression models by urine creatinine. Two studies adjusted for molybdenum and cobalt [20, 121•]. Only one study also adjusted for cadmium and lead [20]…”

Environmental factors in cardiovascular disease

“…142 Limited evidence also implicates other toxic metals (such as mercury, tungsten, and antimony) in the risk of CVD. 143,144 High levels of exposure to essential metals (including iron, cobalt, copper, zinc, and selenium) could be involved in development of CVD, but research on the roles of these metals in humans is challenging, as levels of essential metals in the body are generally tightly regulated, which limits the usefulness of biomarkers. In this Review we focus on arsenic, cadmium, and lead, which are consistently associated with increased risk of CVD, and which are included in the top 10 environmental chemicals of concern compiled by the WHO and the Agency for Toxic Substances and Disease Registry (ATSDR).…”

Tungsten-induced carcinogenesis in human bronchial epithelial cells

“…There has been recent discussion concerning tungsten as an emerging chemical toxicant of environmental health concerns. In vitro and animal studies point to tungsten toxicity leading to pulmonary inflammation and the development of cancer [38]. …”