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. 2025 May 9;24(1):29.
doi: 10.1186/s12940-025-01184-5.

"Low-to-moderate arsenic exposure: a global systematic review of cardiovascular disease risks"

Meroona Gopang  1 , Mahdieh Danesh Yazdi  2   3 , Anne Moyer  4 , Dylan M Smith  2   3 , Jaymie R Meliker  2   3
Affiliations

"Low-to-moderate arsenic exposure: a global systematic review of cardiovascular disease risks"

Meroona Gopang et al. Environ Health. .

Abstract

High arsenic (As) exposure (≥ 100 µg/l) is associated with cardiovascular (CVD) outcomes, however, the CVD risk from low-to-moderate As exposure (< 100 µg/l) has been less explored. There is a paucity of systematic reviews that comprehensively evaluate both urine and water As exposure metrics in assessing As-related CVD outcomes within the general population. To fill this gap, this review sought to update and consolidate data regarding the correlation between low-to-moderate As exposure and specific CVD outcomes, including stroke, ischemic heart disease (IHD), acute myocardial infarction (AMI), and heart failure (HF). A search for peer-reviewed articles indexed in PubMed, Embase, CINAHL, the Global Medicos Index, and Web of Science and unpublished dissertations in Prospero until October 31, 2024, was performed. Nineteen studies were included. Relative risks were pooled by contrasting the highest v/s lowest exposure groups across studies. Positive associations were observed between urine As and stroke incidence, and water As with IHD incidence. Associations between water As and IHD and AMI mortality were suggestive and became stronger after excluding ecological studies. Sex-stratified analyses suggested an increased risk for all groups with strongest indication of an increased risk of AMI mortality in men. Increased risk was suggested for HF but only two studies assessed this outcome. These findings underscore potential risk for CVD outcomes in relation to low-to-moderate As exposure, and highlight the necessity for additional rigorous, well-structured studies to more clearly delineate the possible effects of low-to-moderate As exposure on different CVD outcomes.

Keywords: Acute Myocardial Infarction; Arsenic; Cardiovascular disease; Heart Failure; Ischemic Heart Disease; Stroke.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pooled risk ratios for urine As and CVD outcomes
Fig. 2
Fig. 2
Pooled risk ratios for water As and stroke incidence/mortality
Fig. 3
Fig. 3
Pooled risk ratios for water As and IHD incidence/mortality
Fig. 4
Fig. 4
Pooled risk ratio of water As and AMI incidence/mortality
See this image and copyright information in PMC

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References

    1. Chen QY, Costa M. Arsenic: a global environmental challenge. Annu Rev Pharmacol Toxicol. 2021;61:47–63. 10.1146/annurev-pharmtox-030220-013418. - PubMed
    1. Balakumar P, Kaur J. Arsenic exposure and cardiovascular disorders: an overview. Cardiovasc Toxicol. 2009;9(4):169–76. 10.1007/s12012-009-9050-6. - PubMed
    1. Moreira Freire B, Neves Lange C, Pedron T, Lemos Batista B. Chapter two - arsenic in environment: historic, concepts, occurrence and problems. In: Singh VP, Tripathi DK, Fotopoulos V, Lemos Batista B, Tortella Fuentes G, Da Silva Lobato AK, editors. The role of gasotransmitters in the amelioration of arsenic toxicity in plants. Academic Press; 2023. p. 19–36. 10.1016/B978-0-323-98800-1.00004-6.
    1. Nriagu JO. Arsenic poisoning through the ages. Environ Chem Arsen. 2002;1:1–26.
    1. Chen Y, Parvez F, Gamble M, et al. Arsenic exposure at low-to-moderate levels and skin lesions, arsenic metabolism, neurological functions, and biomarkers for respiratory and cardiovascular diseases: review of recent findings from the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh. Toxicol Appl Pharmacol. 2009;239(2):184–92. 10.1016/j.taap.2009.01.010. - PMC - PubMed

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