Water Quality and Mortality from Coronary Artery Disease in Sardinia: A Geospatial Analysis

Abstract

The role of water hardness on human health is still debated, ranging from beneficial to harmful. Before the rise of drinking bottled water, it was a common habit to obtain supplies of drinking water directly from spring-fed public fountains. According to the geographic location, spring waters are characterized by a variable content of mineral components. In this ecological study, for the first time in Sardinia, Italy, the spatial association between spring water quality/composition and standardized mortality ratio (SMR) for coronary artery disease (CAD) in the decade from 1981 to 1991 was investigated using data retrieved from published databases. In a total of 377 municipalities, 9918 deaths due to CAD, including acute myocardial infarction (AMI), ICD-9 code 410, and ischemic heart disease (IHD), ICD-9 code 411–414, were retrieved. A conditional autoregressive model with spatially structured random effects for each municipality was used. The average SMR for CAD in municipalities with a predominantly “soft” (<30 mg/L) or “hard” (≥30 mg/L) water was, respectively, 121.4 ± 59.1 vs. 104.7 ± 38.2 (p = 0.025). More specifically, an inverse association was found between elevated calcium content in spring water and cardiovascular mortality (AMI: r = −0.123, p = 0.032; IHD: r = −0.146, p = 0.009) and borderline significance for magnesium (AMI: r = −0.131, p = 0.054; IHD: r = −0.138, p = 0.074) and bicarbonate (IHD: r = −0.126, p = 0.058), whereas weak positive correlations were detected for sodium and chloride. The lowest CAD mortality was observed in geographic areas (North-West: SMR 0.92; South-East: SMR 0.88), where calcium- and bicarbonate-rich mineral waters were consumed. Our results, within the limitation of an ecological study, confirm the beneficial role of waters with high content in calcium and bicarbonate against coronary artery disease.

Relationship between Regional Distribution of Centenarians and Drinking Water Hardness in the Amami Islands, Kagoshima Prefecture, Japan

“…Our findings contribute to the accumulating evidence on the longevity-promoting effects of hard water. Recent examples of such research include studies in China [ 18 ] and Costa Rica [ 19 ] on longevity, and in Sardinia on protective effects against cardiovascular mortality [ 20 ]. In those studies, areas were not specifically geologically characterized; however, our study demonstrated how the limestone bedrock occupancy is related to the hardness of drinking water, which is in turn related to the centenarian rate across the 11 constituent municipalities of our four surveyed islands.…”

The Association between Water Consumption and Hyperuricemia and Its Relation with Early Arterial Aging in Middle-Aged Lithuanian Metabolic Patients

“…Despite the lack of evidence, drinking water has shown numerous potential effects on metabolic and CV health. It was confirmed that slightly alkaline drinking water helps to keep blood vessels elastic and maintain blood pressure, which is beneficial for the CV system [ 39 ]. Alkalization of urine may have an effect on removing uric acid from the body [ 40 ].…”

Association between serum calcium level and in-hospital mortality in patients with acute myocardial infarction: a retrospective cohort study

“…However, it is worth noting that research in recent years has shown that calcium intake from the diet can benefit cardiovascular health. A geospatial analysis found an inverse association between high calcium spring water and cardiovascular mortality, citing waters with high calcium content as cardiovascular protective 36 . Multiple studies on drinking water have found the same result 37 , 38 .…”