Peripheral Arterial Disease and Its Association With Arsenic Exposure and
Metabolism in the Strong Heart Study.
Authors Newman JD, Navas-Acien A, Kuo CC, Guallar E, Howard BV, Fabsitz RR, Devereux RB,
Umans JG, Francesconi KA, Goessler W, Best LT, Tellez-Plaza M
Submitted By Jonathan Newman on 12/7/2016
Status Published
Journal American journal of epidemiology
Year 2016
Date Published 12/1/2016
Volume : Pages 184 : 806 - 817
PubMed Reference 27810857
Abstract At high levels, inorganic arsenic exposure is linked to peripheral arterial
disease (PAD) and cardiovascular disease. To our knowledge, no prior study has
evaluated the association between low-to-moderate arsenic exposure and incident
PAD by ankle brachial index (ABI). We evaluated this relationship in the Strong
Heart Study, a large population-based cohort study of American Indian
communities. A total of 2,977 and 2,966 PAD-free participants who were aged
45-74 years in 1989-1991 were reexamined in 1993-1995 and 1997-1999,
respectively, for incident PAD defined as either ABI <0.9 or ABI >1.4. A total
of 286 and 206 incident PAD cases were identified for ABI <0.9 and ABI >1.4,
respectively. The sum of inorganic and methylated urinary arsenic species (?As)
at baseline was used as a biomarker of long-term exposure. Comparing the highest
tertile of ?As with the lowest, the adjusted hazard ratios were 0.57 (95%
confidence interval (CI): 0.32, 1.01) for ABI <0.9 and 2.24 (95% CI: 1.01, 4.32)
for ABI >1.4. Increased arsenic methylation (as percent dimethylarsinate) was
associated with a 2-fold increased risk of ABI >1.4 (hazard ratio = 2.04, 95%
CI: 1.02, 3.41). Long-term low-to-moderate ?As and increased arsenic methylation
were associated with ABI >1.4 but not with ABI <0.9. Further studies are needed
to clarify whether diabetes and enhanced arsenic metabolism increase
susceptibility to the vasculotoxic effects of arsenic exposure.