Evidence map›Paper›PMID 29212736›Full record

Trial reportStroke2018

Arsenic Exposure in Relation to Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study.

Cari L Tsinovoi, Pengcheng Xun, Leslie A McClure, Vivian M O Carioni, John D Brockman, Jianwen Cai, Eliseo Guallar, Mary Cushman, Frederick W Unverzagt, Virginia J Howard and 1 more

Open access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 3 pooled it
1.7field-weighted citation impact, top 18% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 3 syntheses or guidelines pooled it, 30 citations in OpenAlex.

  1. Pooled it
  2. Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis.Environmental science and pollution research international · 2022
    Pooled it
  3. Pooled it
  4. Article
  5. Article
  6. Article
  7. Update of the risk assessment of inorganic arsenic in food.EFSA journal. European Food Safety Authority · 2024
    Article
  8. Article
  9. Review
  10. Article
  11. Metals in Alzheimer's Disease.Biomedicines · 2023
    Review
  12. Article
  13. Article
  14. Article
  15. Review
  16. Positive association between soil arsenic concentration and mortality from alzheimer's disease in mainland China.Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS) · 2020
    Article
  17. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 1 country.

Cari L TsinovoiFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Pengcheng XunFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Leslie A McClureFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Vivian M O CarioniFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
John D BrockmanFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Jianwen CaiFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Eliseo GuallarFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Mary CushmanFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Frederick W UnverzagtFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Virginia J HowardFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.).
Ka HeFrom the Departments of Epidemiology and Biostatistics (C.L.T., P.X., K.H.) and Psychiatry (F.W.U.), Indiana University, Bloomington; Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.); University of Missouri Research Reactor Center, University of Missouri, Columbia (V.M.O.C., J.D.B.); Department of Biostatistics, University of North Carolina at Chapel Hill (J.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, MD (E.G.); Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Alabama at Birmingham (V.J.H.). kahe@indiana.edu.
University of Vermont · USDrexel University · USUniversity of Missouri · USUniversity of North Carolina at Chapel Hill · USJohns Hopkins University · US

Funding

VCID and Stroke in a Bi-racial National CohortU01NS041588 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI CUSHMAN, MARY, HOWARD, GEORGE · 2002 to 2022
$96.0M
Trace element levels and risk of strokeR01ES021735 · NIEHS · TRUSTEES OF INDIANA UNIVERSITY · PI KAHE, KA, MCCLURE, LESLIE AIN · 2012 to 2016
$2.3M
NIEHS NIH HHS R01 ES021735NINDS NIH HHS U01 NS041588
6 · The paper itself

Abstract

background and purposeThe purpose of this case-cohort study was to examine urinary arsenic levels in relation to incident ischemic stroke in the United States.

methodsWe performed a case-cohort study nested within the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort. A subcohort (n=2486) of controls was randomly sampled within region-race-sex strata while all incident ischemic stroke cases from the full REGARDS cohort (n=671) were included. Baseline urinary arsenic was measured by inductively coupled plasma-mass spectrometry. Arsenic species, including urinary inorganic arsenic and its metabolites monomethylarsonic acid and dimethylarsinic acid, were measured in a random subset (n=199). Weighted Cox's proportional hazards models were used to calculate hazard ratios and 95% confidence intervals of ischemic stroke by arsenic and its species.

resultsThe average follow-up was 6.7 years. Although incident ischemic stroke showed no association with total arsenic or total inorganic arsenic, for each unit higher level of urinary monomethylarsonic acid on a log-scale, after adjustment for potential confounders, ischemic stroke risk increased ≈2-fold (hazard ratio=1.98; 95% confidence interval: 1.12-3.50). Effect modification by age, race, sex, or geographic region was not evident.

conclusionsA metabolite of arsenic was positively associated with incident ischemic stroke in this case-cohort study of the US general population, a low-to-moderate exposure area. Overall, these findings suggest a potential role for arsenic methylation in the pathogenesis of stroke, having important implications for future cerebrovascular research.

Indexed as

Brain IschemiaStrokeAgedAged, 80 and overArsenicArsenicalsFemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedUnited StatesArsenicArsenicalsmonomethylarsonic acidarsenicenvironment exposuresmineralsmonomethylarsonic acidriskstroketrace elements

Identifiers

PMID29212736
PMCPMC5742041
OpenAlexW2771322461

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.