Abstract
To the best of our knowledge, a dose-response meta-analysis of the relationship between cardiovascular disease (CVD) and arsenic (As) exposure at drinking water As concentrations lower than the WHO provisional guideline value (10 µg/L) has not been published yet. We conducted a systematic review and meta-analyses to estimate the pooled association between the relative risk of each CVD endpoint and low-level As concentration in drinking water both linearly and non-linearly using a random effects dose-response model. In this study, a significant positive association was found between the risks of most CVD outcomes and drinking water As concentration for both linear and non-linear models (p-value for trend < 0.05). Using the preferred linear model, we found significant increased risks of coronary heart disease (CHD) mortality and CVD mortality as well as combined fatal and non-fatal CHD, CVD, carotid atherosclerosis disease and hypertension in those exposed to drinking water with an As concentration of 10 µg/L compared to the referent (drinking water As concentration of 1 µg/L) population. Notwithstanding limitations included, the observed significant increased risks of CVD endpoints arising from As concentrations in drinking water between 1 µg/L and the 10 µg/L suggests further lowering of this guideline value should be considered.
Highlights
Originating from either geological or anthropogenic activities, arsenic (As) has been widely recognized since the 1950s as one of the most serious human carcinogens [1,2]
Combined with the estimated I2 statistic, Cochran’s Q-statistic and p-values for heterogeneity as presented in Table 2 and the individual and pooled relative risks of different cardiovascular disease (CVD) endpoints at 10 drinking water As in comparison with 1 μg/L shown in Figure 3, we found evidence of significantly μg/L drinking water As in comparison with 1 μg/L shown in Figure 3, we found evidence of high heterogeneity among the studiesamong combined for the linearfor and analysisanalysis of the mortality significantly high heterogeneity the studies combined thenon-linear linear and non-linear risk of coronary heart disease (CHD), stroke and risk twoofCVD
We found a significant increase of 49.8 % and 17.4% of CHD and CVD mortality risks, as well as 40.5%, 41.1%, 93.6% and 23.1% increased risk for combined fatal and non-fatal CHD, CVD, carotid atherosclerosis disease and hypertension at a drinking water As concentration of 10 μg/L compared to 1 μg/L based on the linear model, which is preferred over the non-linear model
Summary
Originating from either geological or anthropogenic activities, arsenic (As) has been widely recognized since the 1950s as one of the most serious human carcinogens [1,2]. Present in the environment [3,4,5], exposure to As can take place via ingestion (oral), dermal contact, inhalation, and even parenteral routes [6], and can lead to a wide range of carcinogenic and non-carcinogenic end-points [7,8]. Concerning non-carcinogenic endpoints, while skin lesions are considered to be a primary marker of As toxicity [10], it has been reported to be associated with different neurological problems [11], increased risk of immune problems in new-born [12], infant infections [13], some reproductive health problems in pregnant women [14] and, importantly, cardiovascular diseases (CVD). Public Health 2020, 17, 2536; doi:10.3390/ijerph17072536 www.mdpi.com/journal/ijerph
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
