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. 2024 Jun 15;24(1):1601.
doi: 10.1186/s12889-024-18701-9.

Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease

Mark P Little #  1   2 , Marjan Boerma #  3 , Marie-Odile Bernier #  4 , Tamara V Azizova  5 , Lydia B Zablotska  6 , Andrew J Einstein #  7 , Nobuyuki Hamada #  8
Affiliations

Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease

Mark P Little et al. BMC Public Health. .

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors and latent period.

Methods: We assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose-response, using data assembled for a recent systematic review.

Results: There are 43 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of medical radiation for therapy or diagnosis. The remaining 21 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect.

Conclusions: There are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.

Keywords: Cardiovascular disease; Confounding; Coronary heart disease; Heart disease; Ionising radiation; Stroke.

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Conflict of interest statement

Andrew Einstein has received speaker fees from Ionetix; has received consulting fees from WL Gore & Associates; has received authorship fees from Wolters Kluwer Healthcare–UpToDate; and has received grants to his institution from Attralus, Canon Medical Systems, Eidos Therapeutics, GE Healthcare, Pfizer, Roche Medical Systems, WL Gore & Associates, and XyloCor Therapeutics; none of these are related to the present work. No other authors report conflicts of interest.

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