© 1996 American Heart Association, Inc.
Articles |
Dose-Response Relationship Between Ischemic Heart Disease Mortality and Long-term Arsenic Exposure
From the Institute of Epidemiology, College of Public Health (C.-J.C., H.-Y.C., M.-H.C., L.-J.L.) and the Department of Internal Medicine, College of Medicine (T.-Y.T.), National Taiwan University, Taipei.
Correspondence to Chien-Jen Chen, ScD, Institute of Epidemiology, College of Public Health, National Taiwan University, No. 1 Jen-Ai Rd Section 1, Taipei 10018, Taiwan.
Abstract The cardiovascular effects of
inorganic arsenic have been documented, but the dose-response
relationship between ischemic heart disease (ISHD) and
long-term arsenic exposure remains to be elucidated. Mortality
rates from ISHD among residents in 60 villages of the area in Taiwan
with endemic arseniasis from 1973 through 1986 were analyzed to
examine their association with arsenic concentration in drinking water.
Based on 1 355 915 person-years and 217 ISHD deaths, the
cumulative ISHD mortalities from birth to age 79 years were 3.4%,
3.5%, 4.7%, and 6.6%, respectively, for residents who lived in
villages in which the median arsenic concentrations in drinking water
were <0.1, 0.1 to 0.34, 0.35 to 0.59, and 
0.6 mg/L. A cohort of 263
patients affected with blackfoot disease (BFD), a unique
arsenic-related peripheral vascular disease, and 2293
non-BFD residents in the endemic area of arseniasis were recruited and
followed up for an average period of 5.0 years. There was a monotonous
biological gradient relationship between cumulative arsenic exposure
through drinking artesian well water and ISHD mortality. The relative
risks were 2.5, 4.0, and 6.5, respectively, for those who had a
cumulative arsenic exposure of 0.1 to 9.9, 10.0 to 19.9, and 20.0
mg/L-years compared with those without the arsenic exposure after
adjustment for age, sex, cigarette smoking, body mass index, serum
cholesterol and triglyceride levels, and
disease status for hypertension and diabetes through
proportional-hazards regression analysis. BFD patients were
found to have a significantly higher ISHD mortality than non-BFD
residents, showing a multivariate-adjusted relative
risk of 2.5 (95% CI, 1.1 to 5.4).
Key Words: arsenic • blackfoot disease • ischemic heart disease
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