Evidence map›Paper›PMID 38879521›Full record

SynthesisBMC public health2024

Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease.

Mark P Little, Marjan Boerma, Marie-Odile Bernier, Tamara V Azizova, Lydia B Zablotska, Andrew J Einstein, Nobuyuki Hamada

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 3 pooled it
–field-weighted citation impact
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

5 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Biological effects of high-LET irradiation on the circulatory system.International journal of radiation biology · 2025
    Pooled it
  4. Article
  5. Adverse Outcome Pathways Applied to Space Radiation Research.Environmental and molecular mutagenesis · 2025
    Review
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

7 authors.

Mark P Little *Radiation Epidemiology Branch, National Cancer Institute, Room 7E546, 9609 Medical Center Drive MSC 9778, Bethesda, MD, 20892-9778, USA. mark.little@nih.gov.ORCID 0000-0003-0980-7567
Marjan Boerma *Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.ORCID 0000-0003-2249-5203
Marie-Odile Bernier *Institut de Radioprotection et de Sureté Nucléaire, Fontenay Aux Roses, France.ORCID 0000-0001-5807-4596
Tamara V AzizovaClinical Department, Southern Urals Biophysics Institute, Chelyabinsk Region, Ozyorskoe Shosse 19, Ozyorsk, 456780, Russia.ORCID 0000-0001-6954-2674
Lydia B ZablotskaDepartment of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94143, USA.ORCID 0000-0002-0778-1108
Andrew J Einstein *Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA.ORCID 0000-0003-2583-9278
Nobuyuki Hamada *Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan.ORCID 0000-0003-2518-6131

Funding

Studies of Populations Exposed to Environmental Sources of RadiationZIACP010132 · NCI · DIVISION OF CANCER EPIDEMIOLOGY AND GENETICS · PI CAHOON, ELIZABETH · 2009 to 2025
$35.2M
6 · The paper itself

Abstract

backgroundCardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors and latent period.

methodsWe assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose-response, using data assembled for a recent systematic review.

resultsThere are 43 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of medical radiation for therapy or diagnosis. The remaining 21 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect.

conclusionsThere are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.

Indexed as

Cardiovascular DiseasesLife StyleConfounding Factors, EpidemiologicEnvironmental ExposureHumansRisk FactorsCardiovascular diseaseConfoundingCoronary heart diseaseHeart diseaseIonising radiationStroke

Identifiers

PMID38879521
PMCPMC11179258

What OpenQuestion holds

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Registered trials

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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.