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. 2017 Aug:157:127-134.
doi: 10.1016/j.envres.2017.05.020. Epub 2017 May 26.

Chronic arsenic exposure and risk of carotid artery disease: The Strong Heart Study

Farrah J Mateen  1 , Maria Grau-Perez  2 , Jonathan S Pollak  3 , Katherine A Moon  4 , Barbara V Howard  5 , Jason G Umans  5 , Lyle G Best  6 , Kevin A Francesconi  7 , Walter Goessler  7 , Ciprian Crainiceanu  8 , Eliseo Guallar  9 , Richard B Devereux  10 , Mary J Roman  10 , Ana Navas-Acien  11
Affiliations

Chronic arsenic exposure and risk of carotid artery disease: The Strong Heart Study

Farrah J Mateen et al. Environ Res. 2017 Aug.

Abstract

Background: Inorganic arsenic exposure from naturally contaminated groundwater is related to vascular disease. No prospective studies have evaluated the association between arsenic and carotid atherosclerosis at low-moderate levels. We examined the association of long-term, low-moderate inorganic arsenic exposure with carotid arterial disease.

Methods: American Indians, 45-74 years old, in Arizona, Oklahoma, and North and South Dakota had arsenic concentrations (sum of inorganic and methylated species, μg/g urine creatinine) measured from baseline urine samples (1989-1991). Carotid artery ultrasound was performed in 1998-1999. Vascular disease was assessed by the carotid intima media thickness (CIMT), the presence of atherosclerotic plaque in the carotid, and by the number of segments containing plaque (plaque score).

Results: 2402 participants (mean age 55.3 years, 63.1% female, mean body mass index 31.0kg/m2, diabetes 45.7%, hypertension 34.2%) had a median (interquintile range) urine arsenic concentration of 9.2 (5.00, 17.06) µg/g creatinine. The mean CIMT was 0.75mm. 64.7% had carotid artery plaque (3% with >50% stenosis). In fully adjusted models comparing participants in the 80th vs. 20th percentile in arsenic concentrations, the mean difference in CIMT was 0.01 (95% confidence interval (95%CI): 0.00, 0.02) mm, the relative risk of plaque presence was 1.04 (95%CI: 0.99, 1.09), and the geometric mean ratio of plaque score was 1.05 (95%CI: 1.01, 1.09).

Conclusions: Urine arsenic was positively associated with CIMT and increased plaque score later in life although the association was small. The relationship between urinary arsenic and the presence of plaque was not statistically significant when adjusted for other risk factors. Arsenic exposure may play a role in increasing the severity of carotid vascular disease.

Keywords: Arsenic; Atherosclerosis; Carotid stenosis; Risk factors for stroke; Vascular disease.

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Conflict of interest statement

Disclosures: All authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Dose-response relationship of arsenic with CIMT, presence of plaque and plaque score using restricted cubic splines. Solid lines represent adjusted estimates based on restricted quadratic splines for log transformed arsenic with knots at the 5th, 50th, and 95th percentiles. The green shade areas represent the corresponding 95th confidence intervals. The reference is set at the 10th percentile of arsenic distribution (3.76 μg/g). Adjustment factors are the same as in Tables 2 to 4 (Model 4). Vertical bars represent a histogram of urine arsenic distribution among the study participants. Nine participants in the extreme tail of the distribution are not shown in the histogram.
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