Gernot Pichler1,2,3, Maria Grau-Perez1,2,4, Maria Tellez-Plaza2,5,6, Jason Umans7,8, Lyle Best9, Shelley Cole10, Walter Goessler11, Kevin Francesconi11, Jonathan Newman12, Josep Redon2,13, Richard Devereux14, Ana Navas-Acien1. 1. Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, NY (G.P., M.G.-P., A.N.-A.). 2. Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain (G.P., M.G.-P., M.T.-P., J.R.). 3. Division of Cardiology, Department of Internal Medicine, Hospital Hietzing, Vienna, Austria (G.P.). 4. Department of Statistics and Operational Research, University of Valencia, Spain (M.G.-P.). 5. Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.T.-P.). 6. Department of Chronic Diseases Epidemiology, National Center for Epidemiology, National Institutes for Health Carlos III, Madrid, Spain (M.T.-P.). 7. MedStar Health Research Institute, and Georgetown University (J.U.). 8. Georgetown-Howard Universities Center for Clinical and Translational Science, Washington DC (J.U.). 9. Missouri Breaks Industries Research, Inc, Timber Lake (L.B.). 10. Department of Genetics, Texas Biomedical Research Institute, San Antonio (S.C.). 11. Institute of Chemistry-Analytical Chemistry, University of Graz, Austria (W.G., K.F.). 12. Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, NY (J.N.). 13. CIBER 03/06 Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain (J.R.). 14. Weill Cornell Medical College, New York (R.D.).
Abstract
BACKGROUND: Arsenic exposure has been related to numerous adverse cardiovascular outcomes. The aim of this study was to investigate the cross-sectional and prospective association between arsenic exposure with echocardiographic measures of left ventricular (LV) geometry and functioning. METHODS: A total of 1337 young adult participants free of diabetes mellitus and cardiovascular disease were recruited from the SHFS (Strong Heart Family Study). The sum of inorganic and methylated arsenic concentrations in urine (ΣAs) at baseline was used as a biomarker of arsenic exposure. LV geometry and functioning were assessed using transthoracic echocardiography at baseline and follow-up. RESULTS: Mean follow-up was 5.6 years, and median (interquartile range) of ΣAs was 4.2 (2.8-6.9) µg/g creatinine. Increased arsenic exposure was associated with prevalent LV hypertrophy, with an odds ratio (95% CI) per a 2-fold increase in ΣAs of 1.47 (1.05-2.08) in all participants and of 1.58 (1.04-2.41) among prehypertensive or hypertensive individuals. Measures of LV geometry, including LV mass index, left atrial systolic diameter, interventricular septum, and LV posterior wall thickness, were positively and significantly related to arsenic exposure. Among measures of LV functioning, stroke volume, and ejection fraction were associated with arsenic exposure. CONCLUSIONS: Arsenic exposure was related to an increase in LV wall thickness and LV hypertrophy in young American Indians with a low burden of cardiovascular risk factors. The relationship was stronger in participants with prehypertension or hypertension, suggesting that potential cardiotoxic effects of arsenic might be more pronounced in individuals already undergoing cardiovascular adaptive mechanisms following elevated systemic blood pressure.
BACKGROUND:Arsenic exposure has been related to numerous adverse cardiovascular outcomes. The aim of this study was to investigate the cross-sectional and prospective association between arsenic exposure with echocardiographic measures of left ventricular (LV) geometry and functioning. METHODS: A total of 1337 young adult participantsfree of diabetes mellitus and cardiovascular disease were recruited from the SHFS (Strong Heart Family Study). The sum of inorganic and methylated arsenic concentrations in urine (ΣAs) at baseline was used as a biomarker of arsenic exposure. LV geometry and functioning were assessed using transthoracic echocardiography at baseline and follow-up. RESULTS: Mean follow-up was 5.6 years, and median (interquartile range) of ΣAs was 4.2 (2.8-6.9) µg/g creatinine. Increased arsenic exposure was associated with prevalent LV hypertrophy, with an odds ratio (95% CI) per a 2-fold increase in ΣAs of 1.47 (1.05-2.08) in all participants and of 1.58 (1.04-2.41) among prehypertensive or hypertensive individuals. Measures of LV geometry, including LV mass index, left atrial systolic diameter, interventricular septum, and LV posterior wall thickness, were positively and significantly related to arsenic exposure. Among measures of LV functioning, stroke volume, and ejection fraction were associated with arsenic exposure. CONCLUSIONS:Arsenic exposure was related to an increase in LV wall thickness and LV hypertrophy in young American Indians with a low burden of cardiovascular risk factors. The relationship was stronger in participants with prehypertension or hypertension, suggesting that potential cardiotoxic effects of arsenic might be more pronounced in individuals already undergoing cardiovascular adaptive mechanisms following elevated systemic blood pressure.
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