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

Abstract

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

Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions

“…As long as uniform incidence ascertainment is made, incidence data are more reliable and preferable than mortality data, and for this aim, disease assignment plays a pivotal role. The latest systematic review of epidemiological literature published by October 2022 and its meta-analysis (hereafter referred to as the latest meta-analysis) documented that there were indications of a DCS risk for mortality with a metaanalysis ERR (mERR)/Gy of 0.20 (95% CI: 0.13, 0.26) higher than that for incidence with 0.09 (95% CI: 0.05, 0.13) when estimated from all relevant studies: there were similar (but nonsignificant) indications when restricted to high quality studies (120). In the Mayak studies, a difference between incidence and mortality is evident, but in an opposite way, which have shown increased risks for incidence of various DCS subtypes (i.e., IHD, angina pectoris, heart failure and CeVD in both sexes, cardiac arrhythmia and conduction disorder in males, but not acute myocardial infarction and stoke in both sexes, nor cardiac arrhythmia and conduction disorder in females) but for mortality of only ischemic stroke in men within the resident subcohort (123,140).…”

“…Accumulating evidence has supported increased radiation risks for DCS, especially ischemic heart disease (IHD) and CeVD at high dose, and to a lesser extent at low dose, albeit with interstudy heterogeneity (117)(118)(119)(120). At similar levels of cumulative dose posed by protracted exposure, however, increased radiation risks for DCS mortality have been observed in the International Nuclear Workers Study (INWORKS, the joint analysis of cohorts in France, UK and US) (121) cohort, but not in any cohorts of the US Million Person Study (MPS) (122).…”

Salud ocupacional: rol del personal de enfermería en la evaluación y prevención de riesgos

“…La radiación ionizante tiene efectos carcinógenos, y se ha relacionado con mayor riesgo de cánceres ocupacionales como mesotelioma (Visci et al, 2022), cáncer de mama y tiroides (Gonzalez et al, 2020) y cáncer de piel no melanoma (Azizova et al, 2018). La exposición ocupacional afecta las hormonas tiroideas y se relaciona con una mayor probabilidad de desarrollar enfermedades inmunes tiroideas (El-Benhawy et al, 2022) y enfermedad cardiovascular (Little et al, 2023).…”

Increased cardiovascular disease risk after exposure to low dose radiation

“…In a linked BMJ article (doi:10.1136/bmj-2022-072924),1 Little and colleagues report the results of a large meta-analysis of 93 studies evaluating associations between a range of cardiovascular diseases and exposure to radiation in various settings (mostly radiotherapy and occupational exposures, but also diagnostic radiology and environmental exposures). The authors found robust evidence for a dose dependent increase in cardiovascular risks across a broad range of radiation doses.…”

“…Cancer risk is the most important health risk related to low dose radiation because the risk coefficients per dose unit are lower for cardiovascular disease than for cancer (excess relative risk per grey around 0.1-0.2 v 0.4-0.5) 111. Nevertheless, absolute cardiovascular risks attributable to radiation per dose unit are not materially lower than those for cancer risks because of the high baseline risks of cardiovascular disease.…”