ArticleToxicology and applied pharmacology2015
Risk of death from cardiovascular disease associated with low-level arsenic exposure among long-term smokers in a US population-based study.
Article in Toxicology and applied pharmacology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 7 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- "Low-to-moderate arsenic exposure: a global systematic review of cardiovascular disease risks".Environmental health : a global access science source · 2025Pooled it
- Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis.Environmental science and pollution research international · 2022Pooled it
- Urinary arsenic and heart disease mortality in NHANES 2003-2014.Environmental research · 2021Pooled it
- Toenails as a biomarker of exposure to arsenic: A review.Environmental research · 2021Pooled it
- Positive Association of Cardiovascular Disease (CVD) with Chronic Exposure to Drinking Water Arsenic (As) at Concentrations below the WHO Provisional Guideline Value: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2020Pooled it
- Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2018Pooled it
- A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease.International journal of epidemiology · 2017Pooled it
- Long-Term Exposure to Arsenic in Community Water Supplies and Risk of Cardiovascular Disease among Women in the California Teachers Study.Environmental health perspectives · 2024Article
- Update of the risk assessment of inorganic arsenic in food.EFSA journal. European Food Safety Authority · 2024Article
- A Clinical Perspective on Arsenic Exposure and Development of Atherosclerotic Cardiovascular Disease.Cardiovascular drugs and therapy · 2023Review
- Comparative Biomonitoring of Arsenic Exposure in Mothers and Their Neonates in Comarca Lagunera, Mexico.International journal of environmental research and public health · 2022Article
- Metal Exposures in Residents Living Near an Urban Oil Drilling Site in Los Angeles, California.Environmental science & technology · 2022Article
- Overview of the cardiovascular effects of environmental metals: New preclinical and clinical insights.Toxicology and applied pharmacology · 2022Article
- The association of arsenic exposure and arsenic metabolism with all-cause, cardiovascular and cancer mortality in the Strong Heart Study.Environment international · 2022Article
- Synergy of arsenic with smoking in causing cardiovascular disease mortality: A cohort study with 27 follow-up years in China.Frontiers in public health · 2022Article
- Environmental and economics-related factors of smoking among Iranian adults aged 35-70: a PERSIAN cohort-based cross-sectional study.Environmental science and pollution research international · 2021Article
- Association of low-moderate urine arsenic and QT interval: Cross-sectional and longitudinal evidence from the Strong Heart Study.Environmental pollution (Barking, Essex : 1987) · 2018Article
- Ethnic, Geographic, and Genetic Differences in Arsenic Metabolism at Low Arsenic Exposure: A Preliminary Analysis in the Multi-Ethnic Study of Atherosclerosis (MESA).International journal of environmental research and public health · 2018Article
- Evaluating Geologic Sources of Arsenic in Well Water in Virginia (USA).International journal of environmental research and public health · 2018Article
- Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
High levels of arsenic exposure have been associated with increases in cardiovascular disease risk. However, studies of arsenic's effects at lower exposure levels are limited and few prospective studies exist in the United States using long-term arsenic exposure biomarkers. We conducted a prospective analysis of the association between toenail arsenic and cardiovascular disease mortality using longitudinal data collected on 3939 participants in the New Hampshire Skin Cancer Study. Using Cox proportional hazard models adjusted for potential confounders, we estimated hazard ratios and 95% confidence intervals associated with the risk of death from any cardiovascular disease, ischemic heart disease, and stroke, in relation to natural-log transformed toenail arsenic concentrations. In this US population, although we observed no overall association, arsenic exposure measured from toenail clipping samples was related to an increased risk of ischemic heart disease mortality among long-term smokers (as reported at baseline), with increased hazard ratios among individuals with ≥ 31 total smoking years (HR: 1.52, 95% CI: 1.02, 2.27), ≥ 30 pack-years (HR: 1.66, 95% CI: 1.12, 2.45), and among current smokers (HR: 1.69, 95% CI: 1.04, 2.75). These results are consistent with evidence from more highly exposed populations suggesting a synergistic relationship between arsenic exposure and smoking on health outcomes and support a role for lower-level arsenic exposure in ischemic heart disease mortality.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.