Evidence map›Paper›PMID 30158148›Full record

SynthesisBMJ (Clinical research ed.)2018

Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis.

Rajiv Chowdhury, Anna Ramond, Linda M O'Keeffe, Sara Shahzad, Setor K Kunutsor, Taulant Muka, John Gregson, Peter Willeit, Samantha Warnakula, Hassan Khan and 4 more

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 263 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
263citing papers in PubMed, 12 pooled it
22.8field-weighted citation impact, top 1% 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

263 citing papers in PubMed, 12 syntheses or guidelines pooled it, 613 citations in OpenAlex.

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203 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 8 institutions in 5 countries.

Rajiv ChowdhuryDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
Anna RamondDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
Linda M O'KeeffeMRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Sara ShahzadDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
Setor K KunutsorNational Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK.
Taulant MukaInstitute of Social and Preventive Medicine, Bern, Switzerland.
John GregsonDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Peter WilleitDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
Samantha WarnakulaDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
Hassan KhanEmory University, Atlanta, Georgia, USA.
Susmita ChowdhuryDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
Reeta GobinUniversity of Guyana, Georgetown, Guyana.
Oscar H FrancoInstitute of Social and Preventive Medicine, Bern, Switzerland.
Emanuele Di AngelantonioDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK.
University of Cambridge · GBInstitute of Social and Preventive Medicine · CHAt Bristol · GBEmory University · USLondon School of Hygiene & Tropical Medicine · GBNational Institute for Health Research · GBUniversität Innsbruck · ATUniversity of Guyana · GY

Funding

ARACHIDONATE METABOLISM IN GLOMERULONEPHRITIS/VASCULITISK08HL001313 · NHLBI · WASHINGTON UNIVERSITY · PI LEFKOWITH, JAMES B · 1985 to 1988
–
British Heart Foundation RG/13/13/30194Medical Research Council MR/L003120/1Medical Research Council MR/N015959/1
6 · The paper itself

Abstract

objectiveTo conduct a systematic review and meta-analysis of epidemiological studies investigating the association of arsenic, lead, cadmium, mercury, and copper with cardiovascular disease.

designSystematic review and meta-analysis. DATA SOURCES: PubMed, Embase, and Web of Science searched up to December 2017. REVIEW

methodsStudies reporting risk estimates for total cardiovascular disease, coronary heart disease, and stroke for levels of arsenic, lead, cadmium, mercury, or copper were included. Two investigators independently extracted information on study characteristics and outcomes in accordance with PRISMA and MOOSE guidelines. Relative risks were standardised to a common scale and pooled across studies for each marker using random effects meta-analyses.

resultsThe review identified 37 unique studies comprising 348 259 non-overlapping participants, with 13 033 coronary heart disease, 4205 stroke, and 15 274 cardiovascular disease outcomes in aggregate. Comparing top versus bottom thirds of baseline levels, pooled relative risks for arsenic and lead were 1.30 (95% confidence interval 1.04 to 1.63) and 1.43 (1.16 to 1.76) for cardiovascular disease, 1.23 (1.04 to 1.45) and 1.85 (1.27 to 2.69) for coronary heart disease, and 1.15 (0.92 to 1.43) and 1.63 (1.14 to 2.34) for stroke. Relative risks for cadmium and copper were 1.33 (1.09 to 1.64) and 1.81 (1.05 to 3.11) for cardiovascular disease, 1.29 (0.98 to 1.71) and 2.22 (1.31 to 3.74) for coronary heart disease, and 1.72 (1.29 to 2.28) and 1.29 (0.77 to 2.17) for stroke. Mercury had no distinctive association with cardiovascular outcomes. There was a linear dose-response relation for arsenic, lead, and cadmium with cardiovascular disease outcomes.

conclusionExposure to arsenic, lead, cadmium, and copper is associated with an increased risk of cardiovascular disease and coronary heart disease. Mercury is not associated with cardiovascular risk. These findings reinforce the importance of environmental toxic metals in cardiovascular risk, beyond the roles of conventional behavioural risk factors.

Indexed as

Environmental MonitoringCardiovascular DiseasesEnvironmental ExposureEnvironmental PollutantsEnvironmental PollutionHumansMetals, HeavyRisk AssessmentRisk FactorsEnvironmental PollutantsMetals, Heavy

Identifiers

PMID30158148
PMCPMC6113772
OpenAlexW2888857894

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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.