Chowdhury, Rajiv; Ramond, Anna; O'Keeffe, Linda M; Shahzad, Sara; Kunutsor, Setor K; Muka, Taulant; Gregson, John; Willeit, Peter; Warnakula, Samantha; Khan, Hassan; Chowdhury, Susmita; Gobin, Reeta; Franco, Oscar H; Di Angelantonio, Emanuele (2018). Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis. BMJ, 362, k3310. BMJ Publishing Group 10.1136/bmj.k3310
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OBJECTIVE
To conduct a systematic review and meta-analysis of epidemiological studies investigating the association of arsenic, lead, cadmium, mercury, and copper with cardiovascular disease.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Embase, and Web of Science searched up to December 2017.
REVIEW METHODS
Studies reporting risk estimates for total cardiovascular disease, coronary heart disease, and stroke for levels of arsenic, lead, cadmium, mercury, or copper were included. Two investigators independently extracted information on study characteristics and outcomes in accordance with PRISMA and MOOSE guidelines. Relative risks were standardised to a common scale and pooled across studies for each marker using random effects meta-analyses.
RESULTS
The review identified 37 unique studies comprising 348 259 non-overlapping participants, with 13 033 coronary heart disease, 4205 stroke, and 15 274 cardiovascular disease outcomes in aggregate. Comparing top versus bottom thirds of baseline levels, pooled relative risks for arsenic and lead were 1.30 (95% confidence interval 1.04 to 1.63) and 1.43 (1.16 to 1.76) for cardiovascular disease, 1.23 (1.04 to 1.45) and 1.85 (1.27 to 2.69) for coronary heart disease, and 1.15 (0.92 to 1.43) and 1.63 (1.14 to 2.34) for stroke. Relative risks for cadmium and copper were 1.33 (1.09 to 1.64) and 1.81 (1.05 to 3.11) for cardiovascular disease, 1.29 (0.98 to 1.71) and 2.22 (1.31 to 3.74) for coronary heart disease, and 1.72 (1.29 to 2.28) and 1.29 (0.77 to 2.17) for stroke. Mercury had no distinctive association with cardiovascular outcomes. There was a linear dose-response relation for arsenic, lead, and cadmium with cardiovascular disease outcomes.
CONCLUSION
Exposure to arsenic, lead, cadmium, and copper is associated with an increased risk of cardiovascular disease and coronary heart disease. Mercury is not associated with cardiovascular risk. These findings reinforce the importance of environmental toxic metals in cardiovascular risk, beyond the roles of conventional behavioural risk factors.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM) |
UniBE Contributor: |
Franco Duran, Oscar Horacio |
Subjects: |
600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services |
ISSN: |
1756-1833 |
Publisher: |
BMJ Publishing Group |
Language: |
English |
Submitter: |
Tanya Karrer |
Date Deposited: |
13 Sep 2018 10:08 |
Last Modified: |
05 Dec 2022 15:17 |
Publisher DOI: |
10.1136/bmj.k3310 |
PubMed ID: |
30158148 |
BORIS DOI: |
10.7892/boris.119862 |
URI: |
https://boris.unibe.ch/id/eprint/119862 |
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