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Toxic metals increase risk for CVD, CHD
The risk for CVD and CHD increased with exposure to lead, arsenic, copper and cadmium, according to a systematic review and meta-analysis published in The BMJ.
Rajiv Chowdhury, PhD, principal researcher and associate professor in global health in the department of public health and primary care at University of Cambridge School of Clinical Medicine, and colleagues analyzed data from 348,259 patients from 37 studies that assessed the effects of lead, arsenic, mercury, cadmium and copper on the risk for CVD. Across the studies, there were 4,205 stroke events, 13,033 CHD events and 15,274 CVD events.
The primary outcomes were angina, CHD, coronary revascularization, stroke and CVD, defined as CHD and stroke.
An increased risk for CVD was linked to levels of arsenic (RR = 1.3; 95% CI, 1.04-1.63) and lead (RR = 1.43; 95% CI, 1.16-1.76). Arsenic and lead also increased the risk for CHD (arsenic, RR = 1.23; 95% CI, 1.04-1.45; lead, RR = 1.85; 95% CI, 1.27-2.69) and stroke (arsenic, RR = 1.15; 95% CI, 0.92-1.43; lead, RR = 1.63; 95% CI, 1.14-2.34).
The risk for CVD also increased with the exposure to copper (RR = 1.81; 95% CI, 1.05-3.11) and cadmium (RR = 1.33; 95% CI, 1.09-1.64). These two metals also increased the risk for stroke (copper, RR = 1.29; 95% CI, 0.77-2.17; cadmium, RR = 1.72; 95% CI, 1.29-2.28) and CHD (copper, RR = 2.22; 95% CI, 1.31-3.74; cadmium, RR = 1.29; 95% CI, 0.98-1.71).
Levels of mercury did not have an association with the risk for CVD (RR = 0.94; 95% CI, 0.66-1.36). The association between lead, arsenic and cadmium with CVD outcomes had a linear dose-response relation.
“Although circulating levels of lead seem to be in decline in the developed world, owing principally to the concomitant decrease in the usage of leaded gasoline and leaded paint, lead exposure remains considerably high in many areas,” Chowdhury and colleagues wrote. “The strong positive association found in our review between lead and the risk of cardiovascular disease reinforces lead exposure as a major public health concern.”
In a related editorial, Maria Tellez-Plaza, MD, PhD, scientist in the department of chronic diseases epidemiology at the National Center for Epidemiology at National Health Institutes Carlos III in Madrid and at the Biomedical Research Institute Hospital Clinic de Valencia INCLIVA in Spain, and colleagues wrote: “In communities affected by disproportionate environmental and occupational exposure, surveillance systems should monitor metal biomarkers and cardiovascular disease events and implement cardiovascular disease prevention programs. Since metals are associated with cardiovascular disease even at relatively low levels of exposure, population-wide strategies to minimize exposure can further contribute to overall cardiovascular prevention efforts.” – by Darlene Dobkowski
Disclosures: The study and editorial authors report no relevant financial disclosures.