Wang Chih-Hao, Hsiao Chuhsing Kate, Chen Chi-Ling, Hsu Lin-I, Chiou Hung-Yi, Chen Shu-Yuan, Hsueh Yu-Mei, Wu Meei-Maan, Chen Chien-Jen
Department of Cardiology, Cardinal Tien Hospital and College of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
Toxicol Appl Pharmacol. 2007 Aug 1;222(3):315-26. doi: 10.1016/j.taap.2006.12.022. Epub 2006 Dec 30.
Cardiovascular disease is the leading cause of mortality worldwide. Arsenic is a ubiquitous metalloid in the crust of the earth. Chronic arsenic poisoning is becoming an emerging epidemic in Asia. Epidemiological studies have shown that chronic arsenic poisoning through ingestion of arsenic-contaminated water is associated with various cardiovascular diseases in dose-response relationships. These cardiovascular disorders include carotid atherosclerosis detected by ultrasonography, impaired microcirculation, prolonged QT interval and increased QT dispersion in electrocardiography, and clinical outcomes such as hypertension, blackfoot disease (a unique peripheral vascular disease endemic in southwestern Taiwan), coronary artery disease and cerebral infarction. Chronic arsenic poisoning is an independent risk factor for cardiovascular disease. The adverse cardiovascular effects of long-term arsenic exposure may be persistent and/or irreversible. Arsenic-induced cardiovascular diseases in human population may result from the interaction among genetic, environment and nutritional factors. The major adverse cardiovascular effect of chronic arsenic poisoning has been established qualitatively and quantitatively in the high arsenic exposure areas, but the low-dose effect of arsenic on cardiovascular diseases remains to be explored. Cardiovascular death is the major cause of mortality worldwide, and a small increased risk may imply a large quantity of excess mortality.
心血管疾病是全球主要死因。砷是地壳中普遍存在的类金属。慢性砷中毒在亚洲正成为一种新出现的流行病。流行病学研究表明，通过摄入受砷污染的水导致的慢性砷中毒与多种心血管疾病存在剂量反应关系。这些心血管疾病包括超声检查发现的颈动脉粥样硬化、微循环受损、心电图中QT间期延长和QT离散度增加，以及诸如高血压、黑脚病（台湾西南部特有的一种外周血管疾病）、冠状动脉疾病和脑梗死等临床结局。慢性砷中毒是心血管疾病的独立危险因素。长期砷暴露对心血管的不良影响可能是持续的和/或不可逆的。人群中砷诱导的心血管疾病可能是遗传、环境和营养因素相互作用的结果。在高砷暴露地区，慢性砷中毒对心血管的主要不良影响已在定性和定量方面得到证实，但砷对心血管疾病的低剂量影响仍有待探索。心血管死亡是全球主要死因，风险的小幅增加可能意味着大量的超额死亡。
