TABLE 24

Zierold et al. (2004)

Study in private well households in Wisconsin, USA

Cross‐sectional

Population 1185

Number of cases not presented

w‐As 0–2389 μg/L, median 2 μg/L,16% > 10 μg/L

< 2

2–10

> 10 μg/L

< 2

2–10

> 10 μg/L

ORs in highest stratum:

Bypass surgery:

1.0

1.77 (0.95–3.30)

2.34 (1.12–4.90)

Heart attack:

1.0

1.31 (0.70–2.30)

2.08 (1.10–4.31)

Wade et al. (2009)

study in Ba Men, Inner Mongolia, China

Retrospective cohort

78,251 person‐years follow‐up 1997–2004

161 deaths in heart disease in those exposed since before 1995 (results in this table)

w‐As (μg/L)

0–5

5.1–20

20.1–100

100.1–300

> 300

Heart disease:

Adj. IRR (cases)

1.0 (44)

1.07 (0.6–1.8) (26)

1.22 (0.8–1.8) (72)

1.55 (0.9–2.7) (17)

2.47 (0.5–12) (2)

Adjusted for age, sex, smoking, education, alcohol, farm work.

Cause of death (blinded to w‐As) from proxy interviews and medical records

Medrano et al. (2010)

study in 651 municipalities in Spain

Ecological

Population 14.4 million

Number of cases:

88,566

19,709

4725

w‐As (μg/L) (median)

< 1 (0.7)

1–10 (3.9)

> 10 (23.3)

RR

1

1.05 (1.01–1.10)

1.02 (0.96, 1.08)

RR derived from reported % increase. p value trend 0.091

Adjusted for sex, age and covariates at municipal or provincial level (income, hospital beds, prevalence of smoking, hypertension, high serum cholesterol, diabetes, overweight/obesity, and low physical activity, dietary factors, water hardness, magnesium, pH and temperature)

Chen, Chiou, Hsu, Hsueh, Wu, & Chen (2010)

Bangladesh

(HEALS)

Cohort study

Cases/Pyrs

14/20,064

16/19,109

15/18,699

26/19,380

w‐As (μg/L) (mean)

0.1–12 (3.7)

12.1–62 (35.9)

62.1–148 (102.5)

148.1–864 (265.7)

u‐tiAs (μg/g creatinine) (mean)

6.6–105.9 (68.5)

106–199 (150.6)

199.1–351.8 (264.9)

352–1100 (641.5)

HR

1

1.22 (0.56, 2.65)

1.49 (0.70, 3.19)

1.94 (0.99, 3.84)

HR

1

1.29 (0.66, 2.51)

1.47 (0.72, 3.01)

1.90 (0.91, 3.98)

p trend 0.03 (water)

p trend 0.06 (u‐As)

Adjusted for sex and baseline age, BMI, smoking, education, changes in u‐As over time

u‐tAs was considered a good measure of iAs (AsB and AsC only 3% in a random speciated subsample, and a high correlation between water‐As and u‐t As)

Moon et al. (2013)

USA (SHS)

Cohort study

CHD Incidence

CHD mortality

Cases/Pyrs

202/13,616

206/13,430

197/12,720

241/12,033

Cases/Pyrs

68 13,616

67 13,430

87 12,720

119 12,033

u‐tiAs (μg/g creatinine) (median)

< 5.8 (4.2)

5.8–9.7 (7.5)

9.8–15.7 (12.4)

> 15.7 (21.8)

< 5.8 (4.2)

5.8–9.7 (7.5)

9.8–15.7 (12.4)

> 15.7 (21.8)

HR

1

1.05 (0.86, 1.28)

0.95 (0.77, 1.19)

1.30 (1.04, 1.62)

1

0.99 (0.70, 1.41)

1.18 (0.83, 1.69)

1.71 (1.19, 2.44)

p trend = 0.006 (incidence)

p trend < 0.001 (mortality)

Adjusted for age, sex, education, smoking status, BMI and LDL cholesterol.

As in water the main source in most participants

Chen, Wu, Liu, et al. (2013)

Bangladesh (HEALS)

Case‐cohort

211 cases of heart disease.

Subcohort 1109.

w‐As (μg/L) (n cases)

0.1–25 (61)

25.1–107 (72)

108–864 (75)

Mean total u‐As in subcohort 277 μg/g creatinine

HR

1.0

1.18 (0.75–1.84)

1.54 (1.02–2.31)

Adjusted for sex, age, smoking, BMI, education, hypertension, diabetes.

Associations with u‐iAs and heart disease not reported, but %MMA (median 13%) was positively associated with risk of heart disease.

Same cohort as in Chen et al. (2011a), but more cases.

Wade et al. (2015)

Case control study in Ba Men, Inner Mongolia, China

IHD

Cases/controls

(recruited 2006–2011)

168/137

105/131

11/4

168/305

105/236

11/26

w‐As (μg/L)

< 10

11–39

> 40

t‐As (μg/g) in toenails

0.11–0.28

0.29–1.37

1.38–34.21

OR

1

1.23 (0.78, 1.93)

4.05 (1.10, 14.99)

1

0.67 (0.33, 1.34)

1.91 (0.73, 4.99)

p trend 0.06.

Adj for diet, BMI, occupation, education, smoking, family history of hypertension, diabetes or heart disease

p trend 0.21

D'Ippoliti et al. (2015)

Cohort study, semi‐ecological

Population 165,609

Deaths

Men:

380

310

567

Women:

304

263

447

w‐As (μg/L (median)

(municipality level)

< 10 (7.4)

10–20 (12.9)

> 20 (29.7)

< 10 (7.4)

10–20 (12.9)

> 20 (29.7)

HR

1

1.42 (1.15, 1.75)

1.70 (1.33, 2.16)

1

1.36 (1.06, 1.74)

1.23 (0.92, 1.65)

p trend < 0.001

Also significant for cumulative dose. HRs only reported by sex.

Adj for age, calendar period, occupation in the ceramic industry. Area level: socioeconomic status,

smoking sales and radon exposure.

Farzan et al. (2015)

Cohort study in New Hampshire, USA

IHD mortality

Population 3939

IHD deaths 154

As (μg/g) in toenails range (median)

0.01–3.26 (0.09)

w‐As (μg/L) range (median) 0–158 (0.29)

Cohort based on previous case–control study on skin cancer.

Adjusted for smoking, education, skin cancer (and presumably age and sex, though not mentioned).

James et al. (2015)

Case cohort study in Colorado, USA

(SLVDS)

96 CHD cases, subcohort 533 (74 cases)

Cases/Pyrs

584,806

181,335

16,534

4 98

w‐As (μg/L) estimated lifetime f (median)

1–20 (5.7)

20–30 (25.3)

30–45 (35.1)

45–88 (50.5)

HR

1

1.23 (0.56, 2.18)

2.18 (1.23, 4.02)

3.10 (1.10, 9.11)

Adjusted for LDL cholesterol and family history of CHD.

Full model adjusted also for sex, smoking, BMI, ethnicity, SES, alcohol, other blood lipids, folate and Se showed very similar HRs.

w‐As (μg/L)

range 0–175,

median 0.4

Wu et al. (2015)

Case cohort study in Bangladesh (HEALS)

238 cases of CHD

Subcohort 1375

w‐As (μg/L, (mean; number of cases)

0.1–16 (4.3; 69)

17–85 (47; 86)

86–864 (191; 82)

Adjusted HR

1.0

1.30 (0.83–2.01)

1.40 (0.88–2.23)

Same cohort as Chen, Wu, Liu, et al. (2013), but more cases.

Mean u‐As 119 μg/L (259 μg/g).

Monrad et al. (2017)

Cohort study in Denmark Danish prospective cohort Diet, Cancer and Health (DCH) two cities, Copenhagen and Aarhus.

Cohort 53,856

Incident MI cases 2707, 784 in the Aarhus cohort

w‐As (μg/L 20 years mean). Total cohort median 0.7

0.05–0.57 (0.44)

0.57–0.76 (0.58)

0.76–1.93 (1.18)

1.93–25.3 (2.11)

Aarhus cohort median 2.1

0.08–1.83 (1.30)

1.83–2.11 (2.09)

2.11–2.11 (2.11)

2.21–25.3 (2.11)

Adjusted IRRs

1.0

1.23 (1.11–1.37)

0.98 (0.87–1.10)

1.04 (0.93–1.16)

1.0

0.82 (0.67–1.02)

0.83 (0.68–1.02)

1.44 (1.16–1.78)

Adjusted for age, sex, smoking, BMI, waist, alcohol, physical activity, education, diabetes, hypertension, cholesterol, fruit intake, vegetable intake.

Note low w‐As and low contrast.

Nigra et al. (2021)

Cohort study of NHANES participants 2003–2014

4990 with available u‐As and u‐AsB

77 deaths

u‐tAs (μg/L)

< 2.30

2.31–4.00

4.01–6.50

> 6.50

HR

1.0

1.24 (0.58–2.68)

1.44 (0.65–3.21)

1.21 (0.46–3.14)

Similar results for u‐DMA.

Individuals with u‐AsB ≥ 1.2 μg/L excluded. Overall median (IQR) for u‐tAs 4.42 (2.52–7.20) and for u‐DMA 2.71 (1.35–4.42).

Adjusted for age, sex, ethnicity, u‐creatinine, eGFR, education, BMI, cholesterol and serum cotinine.

Kuo et al. (2022)

Cohort study in USA

(SHS)

3600

484 deaths

HR per IQR of u‐tiAs:

1.28 (1.08–1.52).

Similar HRs for MMA and DMA (per IQR). Larger HRs when MMA% or DMA% were high.

u‐AsB was low (median 0.68, IQR 0.41–1.54 μg/g creatinine).

Adjusted for age, sex, smoking, BMI, WHR, education, alcohol, u‐creatinine, eGFR, LDL, diabetes, hypertension.