Online Resource 3. Studies of arsenic and cardiovascular disease among general populations (13 studies included in the previous review by Navas-Acien et al. (2005))a

Study,
year / Design / Population / Men
(%) / Age
range / Arsenic
assessment / Exposed
vs. Reference / Endpoint
ascertain-ment / Outcome / No. of
cases /
non-cases / RR / 95% CI / Adjusted for
Taiwan
Lin,
1988 [54] / CC / HAA / NR / NR / Urine
(Hydride AAS) / 75th vs
25th p / NR / Prevalent BFD / 20 / 20 / 1.66 / 0.78, 3.51 / Age, sex
Chen,
1988 [55] / CC / HAA / 49 / <50-60+ / Years of well water consumption / 30 vs
0 y / Clinical exam / Prevalent BFD / 241 / 759 / 3.47 / 1.66,7.23b / Age, sex, diet, family histoy BFD
Tseng,
1996 [25] / CS / HAA / 45 / Mean 53 / CEI from village drinking water / 20 vs
0 mg/L-y / ABI / Prevalent PAD / 69 / 513 / 4.28 / 1.26, 14.5 / Age, sex, smoking, BMI, lipids, HT, DM
Chen,
1996 [56] / CO
(Int.) / HAA / 52 / 40 – 70+ / CEI from village drinking water / 20 vs
0 mg/L-y / Death certificate / Coronary mort. / 39 / 2,517 / 4.90 / 1.36, 17.7 / Age, sex, smoking, BFD, BMI, lipids, HT, DM
Chiou,
1997 [57] / CS / HAA / 50 / 40 – 70+ / CEI from village drinking water / 5 vs <0.1 mg/L-y / Self-report + med. records / Prevalent stroke / 139 / 7,963 / 2.69 / 1.35, 5.38 / Age, sex, smoking, alcohol, HT, DM
Tsai,
1999
[53,58] / CO
(Ext.) / HAA / 35 / All ages / Village drinking water level / HAA vs Gral. Pop. / Death certificate / Coronary mort.
Stroke mort.
PAD mort. / 728 deaths
2,638 deaths
175 deaths / 1.59
1.19
2.88 / 1.32, 1.93
1.10, 1.29
1.88, 4.42 / Age, sex
Wang,
2001[52] / CC / HAA / 67 / Mean 63 / Arterial tissue
(AAS) / 75th vs
25th p / Surgery / Prevalent BFD / 31 / 30 / 2.40 / 2.00, 2.89 / Crude
Tseng,
2003 [23] / CS / HAA / 44 / 30 – 60+ / CEI from village drinking water / 15 vs
0 mg/L-y / ECG / Prev. coronary disease / 78 / 384 / 3.60 / 1.11, 11.7 / Age, sex, smoking, BMI, lipids, HT, DM
Other Countries
Varsanyi,
1991 [49] / CO
(Ext.) / 12 villages
(Hungary) / 49 / All ages / Village drinking water level / >50 vs
<40 µg/L / Death certificate / CV mortality / NR / Men: 1.19
Women: 0.82 / Age
Engel,
1994 [62] / CO
(Ext.) / 30 counties
(US) / 43 / 0 – 65+ / County drinking water level / >20 vs
5-10 µg/L / Death certificate / Coronary mort.
Stroke mort.
PAD mort. / 63,831/~1.7 M
20,963/~1.7 M
7,203/~1.7 M / 0.84
0.91
1.58 / 0.76, 0.93
0.74. 1.10
1.34, 1.88 / Age, sex
Ruiz-
Navarro,
1998 [61] / CC / Hospital based
(Spain) / 39 / NR / Urinary levels / 75th vs
25th p / NR / Prevalent MI / 29 / 49 / 0.97 / 0.50, 1.89 / Crude
Lewis,
1999 [60] / CO
(Int.) / Mormons
(US) / 52 / >1 yr / CEI from community drinking water / 5 vs
<1 mg/L-y / Death certificate / Coronary mort.
Stroke mort.
PAD mort. / 411 / 3,647
176 / 3,882
47 / 4,011 / 0.86
0.69
0.61 / 0.68, 1.10
0.47, 0.99
0.28, 1.31 / Age, sex
Zierold,
2004 [59] / CS / Survey
participants
private wells (US) / NR / Mean 62 / Subject drinking water level / >10 vs
<2 µg/L / Self-report / Prev. coronary
Prev. stroke / 128 / 1,057
31 / 1,154 / 1.54
1.53 / 0.90, 2.68
0.60, 4.07 / Age, Sex, smoking, BMI

AAS: atomic absorption spectrometry; ABI: Ankle-brachial blood pressure index; BFD: black foot disease; CC: case-control; CEI: cumulative exposure index = ∑ arsenic levels in drinking water x time of exposure(i: specific village); CI: confidence interval; CO: cohort; CS: cross-sectional; CV: cardiovascular; ECG: electrocardiogram; Ext.: external comparisons; Int.: internal comparisons; M: millions; MI: myocardial infarction; NR: Not reported; PAD: peripheral arterial disease; Mort.: mortality; p: percentile; Prev.: prevalent; RR: relative risk.

aOriginal source: Navas-Acien A, Sharrett AR, Silbergeld EK, Schwartz BS, Nachman KE, Burke TA, et al. Arsenic exposure and cardiovascular disease: a systematic review of the epidemiologic evidence. Am. J. Epidemiol. 2005 Dec 1;162(11):1037–49.

bThe 95% confidence interval of the relative risk for Chen et al. 1988 [55] has been corrected since the published version.

Current Atherosclerosis Reports

Arsenic and Cardiovascular Disease: An Updated Systematic Review

Katherine Moon, Eliseo Guallar , Ana Navas-Acien*

* Departments of Environmental Health Science and Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health;