DALLAS, March 26 -- Long-term exposure to ingested arsenic -- a contaminant in artesian well water in many parts of the world -- has been linked to heart attacks, strokes and diseased arteries in the body's extremities, according to a study in today's rapid access Circulation: Journal of the American Heart Association.
For the first time, researchers report a strong dose-dependent relationship between arsenic exposure and accelerated development of atherosclerosis in the arteries leading to the brain. The findings strongly point to arsenic, and possibly other pollutants, as risk factors for blood vessel disease throughout the body. "More than 100 million people are exposed to underground water with high concentrations of arsenic," says Chih-Hao Wang, M.D., of the graduate institute of epidemiology in the college of public health at National Taiwan University in Taipei.
"Chronic arsenic poisoning, called arseniasis, is an emerging epidemic in Asia. Our results indicate that long-term arsenic exposure may lead to the progression or acceleration of carotid artery disease and most likely generalized artery disease in humans," Wang says.
The researchers studied 199 men and 264 women, in an area of southwestern Taiwan with a high prevalence of arseniasis and high rates of blackfoot disease (BFD), a unique form of peripheral vascular disease that begins with coldness or numbness in the lower extremities and progresses to blockages of the small blood vessels that nourish the feet, dry gangrene and spontaneous amputation of extremities.
Subjects in the study were recruited from earlier investigations by the BFD Study Group. Scientists have measured the amount of arsenic in well water in the region since the early 1960s.
Based on those measurements and detailed questionnaires given to the subjects, the researchers calculated the duration and amount of arsenic exposure for each individual.
They measured the atherosclerotic plaque in each subject's carotid arteries with a noninvasive ultrasound system. These arteries, located in the neck, carry blood to the brain.
Three indices of long-term exposure to arsenic -- how long someone consumed artesian well water, the average arsenic concentration in that water, and the cumulative arsenic exposure -- were significantly associated with prevalence of carotid atherosclerosis in a dose-dependent relationship (meaning the amount of disease increased as the amount of arsenic increased).
Researchers divided subjects into three groups based on arsenic exposure levels and found that those with the highest exposure had three times the risk of atherosclerosis as people who were not exposed to arsenic. Those in the mid-range of exposure had double the risk of someone who was not exposed.
"From the strong dose-dependent relationship, we conclude that long-term arsenic exposure is an independent risk factor for atherosclerosis and that carotid atherosclerosis is a novel marker for arseniasis," the researchers write.
Co-authors include: Jiann-shing Jeng, M.D.; Ping-Keung Yip, M.D.; Chi-Ling Chen, Ph.D.; Meei-Mann Wu, Ph.D.; and Chien-Jen Chen, Sc.D.
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