DOSE-RESPONSE RELATIONSHIP BETWEEN ISCHEMIC-HEART-DISEASE MORTALITY AND LONG-TERM ARSENIC EXPOSURE

The cardiovascular effects of inorganic arsenic have been documented, but the dose-response relationship between ischemic heart disease (ISH D) and long-term arsenic exposure remains to be elucidated. Mortality rates from ISHD among residents in 60 villages of the area in Taiwan w ith endemic arseniasis from 1973 through 1986 were analyzed to examine their association with arsenic concentration in drinking water. Based on 1.355 915 person-years and 217 ISHD deaths, the cumulative ISHD mo rtalities from birth to age 79 years were 3.4%, 3.5%, 4.7%, and 6.6%, respectively, for residents who lived in villages in which the median arsenic concentrations in drinking water were <0.1, 0.1 to 0.34, 0.35 to 0.59, and greater than or equal to 0.6 mg/L. A cohort of 263 patien ts affected with blackfoot disease (BFD), a unique arsenic-related per ipheral vascular disease, and 2293 non-BFD residents in the endemic ar ea of arseniasis were recruited and followed up for an average period of 5.0 years. There was a monotonous biological gradient relationship between cumulative arsenic exposure through drinking artesian well wat er and ISHD mortality. The relative risks were 2.5, 4.0, and 6.5, resp ectively, for those who had a cumulative arsenic exposure of 0.1 to 9. 9, 10.0 to 19.9, and greater than or equal to 20.0 mg/L-years compared with those without the arsenic exposure after adjustment for age, sex , cigarette smoking, body mass index, serum cholesterol and triglyceri de levels, and disease status for hypertension and diabetes through pr opertional-hazards regression analysis. BFD patients were found to hav e a significantly higher ISHD mortality than non-BFD residents, showin g a multivariate-adjusted relative risk of 2.5 (95% CI, 1.1 to 5.4).