Arsenic exposure from drinking water and mortality from cardiovascular disease in Bangladesh

Prospective cohort study

Yu Chen, Joseph H. Graziano, Faruque Parvez, Mengling Liu, Vesna Slavkovich, Tara Kalra, Maria Argos, Tariqul Islam, Alauddin Ahmed, Muhammad Rakibuz-Zaman, Rabiul Hasan, Golam Sarwar, Diane Levy, Alexander Van Geen, Habibul Ahsan

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the association between arsenic exposure and mortality from cardiovascular disease and to assess whether cigarette smoking influences the association. Design: Prospective cohort study with arsenic exposure measured in drinking water from wells and urine. Setting: General population in Araihazar, Bangladesh. Participants: 11 746 men and women who provided urine samples in 2000 and were followed up for an average of 6. 6 years. Main outcome measure: Death from cardiovascular disease. Results: 198 people died from diseases of circulatory system, accounting for 43% of total mortality in the population. The mortality rate for cardiovascular disease was 214.3 per 100 000 person years in people drinking water containing <12.0 μg/L arsenic, compared with 271.1 per 100 000 person years in people drinking water with ≥12.0 μg/L arsenic. There was a dose-response relation between exposure to arsenic in well water assessed at baseline and mortality from ischaemic heart disease and other heart disease; the hazard ratios in increasing quarters of arsenic concentration in well water (0.1-12.0, 12.1-62.0, 62.1-148.0, and 148.1-864.0 μg/L) were 1.00 (reference), 1.22 (0.65 to 2.32), 1.35 (0.71 to 2.57), and 1.92 (1.07 to 3.43) (P=0.0019 for trend), respectively, after adjustment for potential confounders including age, sex, smoking status, educational attainment, body mass index (BMI), and changes in urinary arsenic concentration since baseline. Similar associations were observed when baseline total urinary arsenic was used as the exposure variable and for mortality from ischaemic heart disease specifically. The data indicate a significant synergistic interaction between arsenic exposure and cigarette smoking in mortality from ischaemic heart disease and other heart disease. In particular, the hazard ratio for the joint effect of a moderate level of arsenic exposure (middle third of well arsenic concentration 25.3-114.0 μg/L, mean 63.5 μg/L) and cigarette smoking on mortality from heart disease was greater than the sum of the hazard ratios associated with their individual effect (relative excess risk for interaction 1.56, 0.05 to 3.14; P=0.010). Conclusions: Exposure to arsenic in drinking water is adversely associated with mortality from heart disease, especially among smokers.

Original languageEnglish (US)
Article numberd2431
JournalBMJ
Volume342
Issue number7806
DOIs
StatePublished - May 14 2011

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Bangladesh
Arsenic
Drinking Water
Cohort Studies
Cardiovascular Diseases
Prospective Studies
Mortality
Heart Diseases
Smoking
Myocardial Ischemia
Water Wells
Urine
Educational Status
Water
Cardiovascular System
Population
Body Mass Index
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Chen, Y., Graziano, J. H., Parvez, F., Liu, M., Slavkovich, V., Kalra, T., ... Ahsan, H. (2011). Arsenic exposure from drinking water and mortality from cardiovascular disease in Bangladesh: Prospective cohort study. BMJ, 342(7806), [d2431]. https://doi.org/10.1136/bmj.d2431

Arsenic exposure from drinking water and mortality from cardiovascular disease in Bangladesh : Prospective cohort study. / Chen, Yu; Graziano, Joseph H.; Parvez, Faruque; Liu, Mengling; Slavkovich, Vesna; Kalra, Tara; Argos, Maria; Islam, Tariqul; Ahmed, Alauddin; Rakibuz-Zaman, Muhammad; Hasan, Rabiul; Sarwar, Golam; Levy, Diane; Van Geen, Alexander; Ahsan, Habibul.

In: BMJ, Vol. 342, No. 7806, d2431, 14.05.2011.

Research output: Contribution to journalArticle

Chen, Y, Graziano, JH, Parvez, F, Liu, M, Slavkovich, V, Kalra, T, Argos, M, Islam, T, Ahmed, A, Rakibuz-Zaman, M, Hasan, R, Sarwar, G, Levy, D, Van Geen, A & Ahsan, H 2011, 'Arsenic exposure from drinking water and mortality from cardiovascular disease in Bangladesh: Prospective cohort study', BMJ, vol. 342, no. 7806, d2431. https://doi.org/10.1136/bmj.d2431
Chen, Yu ; Graziano, Joseph H. ; Parvez, Faruque ; Liu, Mengling ; Slavkovich, Vesna ; Kalra, Tara ; Argos, Maria ; Islam, Tariqul ; Ahmed, Alauddin ; Rakibuz-Zaman, Muhammad ; Hasan, Rabiul ; Sarwar, Golam ; Levy, Diane ; Van Geen, Alexander ; Ahsan, Habibul. / Arsenic exposure from drinking water and mortality from cardiovascular disease in Bangladesh : Prospective cohort study. In: BMJ. 2011 ; Vol. 342, No. 7806.
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abstract = "Objective: To evaluate the association between arsenic exposure and mortality from cardiovascular disease and to assess whether cigarette smoking influences the association. Design: Prospective cohort study with arsenic exposure measured in drinking water from wells and urine. Setting: General population in Araihazar, Bangladesh. Participants: 11 746 men and women who provided urine samples in 2000 and were followed up for an average of 6. 6 years. Main outcome measure: Death from cardiovascular disease. Results: 198 people died from diseases of circulatory system, accounting for 43{\%} of total mortality in the population. The mortality rate for cardiovascular disease was 214.3 per 100 000 person years in people drinking water containing <12.0 μg/L arsenic, compared with 271.1 per 100 000 person years in people drinking water with ≥12.0 μg/L arsenic. There was a dose-response relation between exposure to arsenic in well water assessed at baseline and mortality from ischaemic heart disease and other heart disease; the hazard ratios in increasing quarters of arsenic concentration in well water (0.1-12.0, 12.1-62.0, 62.1-148.0, and 148.1-864.0 μg/L) were 1.00 (reference), 1.22 (0.65 to 2.32), 1.35 (0.71 to 2.57), and 1.92 (1.07 to 3.43) (P=0.0019 for trend), respectively, after adjustment for potential confounders including age, sex, smoking status, educational attainment, body mass index (BMI), and changes in urinary arsenic concentration since baseline. Similar associations were observed when baseline total urinary arsenic was used as the exposure variable and for mortality from ischaemic heart disease specifically. The data indicate a significant synergistic interaction between arsenic exposure and cigarette smoking in mortality from ischaemic heart disease and other heart disease. In particular, the hazard ratio for the joint effect of a moderate level of arsenic exposure (middle third of well arsenic concentration 25.3-114.0 μg/L, mean 63.5 μg/L) and cigarette smoking on mortality from heart disease was greater than the sum of the hazard ratios associated with their individual effect (relative excess risk for interaction 1.56, 0.05 to 3.14; P=0.010). Conclusions: Exposure to arsenic in drinking water is adversely associated with mortality from heart disease, especially among smokers.",
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AU - Chen, Yu

AU - Graziano, Joseph H.

AU - Parvez, Faruque

AU - Liu, Mengling

AU - Slavkovich, Vesna

AU - Kalra, Tara

AU - Argos, Maria

AU - Islam, Tariqul

AU - Ahmed, Alauddin

AU - Rakibuz-Zaman, Muhammad

AU - Hasan, Rabiul

AU - Sarwar, Golam

AU - Levy, Diane

AU - Van Geen, Alexander

AU - Ahsan, Habibul

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N2 - Objective: To evaluate the association between arsenic exposure and mortality from cardiovascular disease and to assess whether cigarette smoking influences the association. Design: Prospective cohort study with arsenic exposure measured in drinking water from wells and urine. Setting: General population in Araihazar, Bangladesh. Participants: 11 746 men and women who provided urine samples in 2000 and were followed up for an average of 6. 6 years. Main outcome measure: Death from cardiovascular disease. Results: 198 people died from diseases of circulatory system, accounting for 43% of total mortality in the population. The mortality rate for cardiovascular disease was 214.3 per 100 000 person years in people drinking water containing <12.0 μg/L arsenic, compared with 271.1 per 100 000 person years in people drinking water with ≥12.0 μg/L arsenic. There was a dose-response relation between exposure to arsenic in well water assessed at baseline and mortality from ischaemic heart disease and other heart disease; the hazard ratios in increasing quarters of arsenic concentration in well water (0.1-12.0, 12.1-62.0, 62.1-148.0, and 148.1-864.0 μg/L) were 1.00 (reference), 1.22 (0.65 to 2.32), 1.35 (0.71 to 2.57), and 1.92 (1.07 to 3.43) (P=0.0019 for trend), respectively, after adjustment for potential confounders including age, sex, smoking status, educational attainment, body mass index (BMI), and changes in urinary arsenic concentration since baseline. Similar associations were observed when baseline total urinary arsenic was used as the exposure variable and for mortality from ischaemic heart disease specifically. The data indicate a significant synergistic interaction between arsenic exposure and cigarette smoking in mortality from ischaemic heart disease and other heart disease. In particular, the hazard ratio for the joint effect of a moderate level of arsenic exposure (middle third of well arsenic concentration 25.3-114.0 μg/L, mean 63.5 μg/L) and cigarette smoking on mortality from heart disease was greater than the sum of the hazard ratios associated with their individual effect (relative excess risk for interaction 1.56, 0.05 to 3.14; P=0.010). Conclusions: Exposure to arsenic in drinking water is adversely associated with mortality from heart disease, especially among smokers.

AB - Objective: To evaluate the association between arsenic exposure and mortality from cardiovascular disease and to assess whether cigarette smoking influences the association. Design: Prospective cohort study with arsenic exposure measured in drinking water from wells and urine. Setting: General population in Araihazar, Bangladesh. Participants: 11 746 men and women who provided urine samples in 2000 and were followed up for an average of 6. 6 years. Main outcome measure: Death from cardiovascular disease. Results: 198 people died from diseases of circulatory system, accounting for 43% of total mortality in the population. The mortality rate for cardiovascular disease was 214.3 per 100 000 person years in people drinking water containing <12.0 μg/L arsenic, compared with 271.1 per 100 000 person years in people drinking water with ≥12.0 μg/L arsenic. There was a dose-response relation between exposure to arsenic in well water assessed at baseline and mortality from ischaemic heart disease and other heart disease; the hazard ratios in increasing quarters of arsenic concentration in well water (0.1-12.0, 12.1-62.0, 62.1-148.0, and 148.1-864.0 μg/L) were 1.00 (reference), 1.22 (0.65 to 2.32), 1.35 (0.71 to 2.57), and 1.92 (1.07 to 3.43) (P=0.0019 for trend), respectively, after adjustment for potential confounders including age, sex, smoking status, educational attainment, body mass index (BMI), and changes in urinary arsenic concentration since baseline. Similar associations were observed when baseline total urinary arsenic was used as the exposure variable and for mortality from ischaemic heart disease specifically. The data indicate a significant synergistic interaction between arsenic exposure and cigarette smoking in mortality from ischaemic heart disease and other heart disease. In particular, the hazard ratio for the joint effect of a moderate level of arsenic exposure (middle third of well arsenic concentration 25.3-114.0 μg/L, mean 63.5 μg/L) and cigarette smoking on mortality from heart disease was greater than the sum of the hazard ratios associated with their individual effect (relative excess risk for interaction 1.56, 0.05 to 3.14; P=0.010). Conclusions: Exposure to arsenic in drinking water is adversely associated with mortality from heart disease, especially among smokers.

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