Academic journal article Environmental Health Perspectives

Chronic Exposure to Arsenic and Markers of Cardiometabolic Risk: A Cross-Sectional Study in Chihuahua, Mexico

Academic journal article Environmental Health Perspectives

Chronic Exposure to Arsenic and Markers of Cardiometabolic Risk: A Cross-Sectional Study in Chihuahua, Mexico

Article excerpt


There is growing evidence that chronic exposure to inorganic As (iAs) may increase the risk of cardiometabolic (CM) disorders, including diabetes mellitus (DM) and cardiovascular diseases (CVD) (Kuo et al. 2013; Maull et al. 2012; Moon et al. 2012). Experimental studies report adverse effects of iAs and its metabolites on mechanisms associated with CM disorders, such as insulin secretion and signaling, lipid metabolism, systemic inflammation, and atherosclerosis (Cheng et al. 2011; Douillet et al. 2013; Druwe et al. 2012; Fu et al. 2010; Lemaire et al. 2011; Muthumani and Prabu 2014; Paul et al. 2007). Recent reviews of the epidemiological literature suggest that exposure to levels of iAs in drinking water > 150 [micro]g As/L may increase the risk of diabetes (Maull et al. 2012) and CVD outcomes (Abhyankar et al. 2012; Moon et al. 2012; Navas-Acien et al. 2005). Evidence of relationships at low to moderate levels of exposure is more limited and equivocal.

To date, few epidemiologic studies have examined associations between moderate iAs exposure and markers of CM risk. Such studies may help to provide insight into the potential role of iAs exposure in the development and progression of CVD and diabetes. A few studies in industrially contaminated areas, or in settings with mean water As concentrations > 150 [micro]g/L, have reported As exposure to be associated with CM markers such as elevated blood pressure and elevated fasting glucose, triglyceride, and low-density lipoprotein (LDL) cholesterol levels (Chen et al. 2012; Karim et al. 2013; Wang et al. 2007). However, there are limited and inconsistent data on associations with CM risk markers, most notably dyslipidemias, at lower As exposures (Abhyankar et al. 2012; Gribble et al. 2012; Jones et al. 2011).

Evidence is also limited regarding the role of iAs metabolism in determining health risks associated with iAs exposure. In humans, iAs is enzymatically methylated to yield methylarsenic (MAs) and subsequently dimethylarsenic (DMAs) metabolites that are, along with residual iAs, excreted mainly in urine (Thomas et al. 2007). Urinary As profiles characterized by low percentages of DMAs and high percentages of MAs are thought to indicate a low capacity to methylate iAs. These indicators have been linked to an increased risk of cancer and precancerous skin lesions (Ahsan et al. 2007; Chen et al. 2003a, 2003b; Pierce et al. 2013; Yu et al. 2000). However, the relationship between urinary profiles of iAs metabolites and non-cancerous outcomes remains unclear (Chen et al. 2013b; Del Razo et al. 2011; Huang et al. 2007; Kim et al. 2013; Nizam et al. 2013).

This cross-sectional study explored associations between CM risk and chronic exposure to iAs in a recently established cohort of adult residents of Chihuahua (Mexico) who consume water with a wide range of iAs concentrations. We examined the relationship between iAs in drinking water and urine; we also investigated the relationship between urinary indicators of iAs metabolism and CM risk based on measurements of dysglycemia, including diabetes, dyslipidemia, and blood pressure levels.

Materials and Methods

The Chihuahua cohort. All procedures involving human subjects were approved by institutional review boards at the University of North Carolina at Chapel Hill and Cinvestav-IPN (Centro de Investigacion y de Estudios Avanzados del Instituto Politecnico Nacional, Mexico City, Mexico). All participants provided signed informed consent. A total of 1,160 adults (> 18 years old) with a minimum 5-year uninterrupted residency in the study area were recruited in household visits between 2008 and 2012. The participation rate was 67%. Other exclusion criteria were pregnancy, self-reported kidney or urinary tract infection (both conditions that affect profiles of iAs metabolites in urine), and potential occupational exposure to As (e.g., working with pesticides or in mines or smelters). …

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