The association of arsenic exposure and arsenic metabolism with all-cause, cardiovascular and cancer mortality in the Strong Heart Study

• Type of Material: Article
• Authors: Chin-Chi Kuo, China Medical University; Poojitha Balakrishnan, Columbia University; Matthew Gribble, Emory University; Lyle G Best, Missouri Breaks Industries Research, Inc.; Walter Goessler, Karl-Franzens University Graz; Jason G Umans, MedStar Health Research Institute, Hyattsville; Ana Navas-Acien, Johns Hopkins Bloomberg School of Public Health
• Language: English
• Date: 2021-12-07
• Publisher: PERGAMON-ELSEVIER SCIENCE LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 The Authors. Published by Elsevier Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.envint.2021.107029
• Title of Journal or Parent Work: ENVIRONMENT INTERNATIONAL
• Volume: 159
• Start Page: 107029
• End Page: 107029
• Grant/Funding Information: This study was supported by grants from the U.S. National Heart, Lung, and Blood Institute (R01-HL-090863, HL-41642, HL-41652, HL-41654, and HL-65521), the U.S. National Institute of Environmental Health Sciences (R01-ES-021367 and P30-ES-03819), and the China Medical University Hospital, Taiwan (DMR-HHC-110-5).
• Keywords: Arsenic; ACID; Cardiovascular disease; Environmental Sciences; Science & Technology; Cancer; Strong Heart Study; American Indians; Arsenic species; SUPPLEMENTATION; Environmental Sciences & Ecology; LEVEL; Arsenic metabolism; RISK; METAANALYSIS; DRINKING-WATER; Mortality; Arsenic methylation; DISEASE; AMERICAN-INDIANS; DOSE-RESPONSE; METHYLATION; Life Sciences & Biomedicine

Abstract

The effect of low-moderate levels of arsenic exposure and of arsenic metabolism on mortality remains uncertain. We used data from a prospective cohort study in 3600 men and women aged 45 to 75 years living in Arizona, Oklahoma, and North and South Dakota. The biomarker of inorganic arsenic exposure was the sum of urine inorganic (iAs), monomethylated (MMA) and dimethylated (DMA) arsenic compounds (ƩAs) at baseline. The proportions of urine iAs, MMA and DMA over the ƩiAs, expressed as iAs%, MMA%, and DMA%, respectively, were used as biomarkers of arsenic metabolism. Arsenic exposure and arsenic metabolism were associated with all-cause, cardiovascular, and cancer mortality. For each interquartile range (IQR) increase in ƩAs (12.5 μg/L, overall range 0.7–194.1 μg/L), the adjusted hazard ratios (aHRs) were 1.28 (95% CI 1.16–1.41) for all-cause mortality, 1.28 (1.08–1.52) for cardiovascular mortality and 1.15 (0.92–1.44) for cancer mortality. The aHR for mortality for each IQR increase in MMA%, when iAs% is decreasing, was 1.52 (95% CI 1.16–1.99) for cardiovascular disease, 0.73 (0.55–0.98) for cancer, and 1.03 (0.90–1.19) for all-cause mortality. These findings at low-moderate levels of arsenic exposure highlight the need to implement public health measures to protect populations from involuntary arsenic exposure and for research to advance the biological and clinical understanding of arsenic-related health effects in general populations.