Cardiovascular diseases and the work environment. A critical review of the epidemiologic literature on chemical factors.

This is the second of two articles reviewing the epidemiologic research on cardiovascular diseases (CVD) and the work environment. It deals with chemical factors, i.e., lead, cadmium, cobalt, arsenic, carbon monoxide, passive smoking, organic solvents, carbon disulfide, nitroglycerin, nitroglycol, and others. The epidemiologic literature relating to each is assessed on the basis of a number of methodological criteria, and the need for future research, the methodology of literature reviews, and preventive implications and perspectives are discussed. It is concluded that the causal relationship between two of the chemicals, carbon disulfide and nitroglycerin/nitroglycol, and CVD is very well documented. For lead and passive smoking a causal relation to CVD is likely. More research is needed concerning cobalt, arsenic, antimony, and other chemical compounds. Exposure to carbon monoxide increases the acute risk of CVD but has probably no lasting atherosclerotic effect. Cadmium and organic solvents are probably not causally related to CVD.