Chen C J, Chiou H Y, Chiang M H, Lin L J, Tai T Y
Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei.
Arterioscler Thromb Vasc Biol. 1996 Apr;16(4):504-10. doi: 10.1161/01.atv.16.4.504.
The cardiovascular effects of inorganic arsenic have been documented, but the dose-response relationship between ischemic heart disease (ISHD) and long-term arsenic exposure remains to be elucidated. Mortality rates from ISHD among residents in 60 villages of the area in Taiwan with endemic arseniasis from 1973 through 1986 were analyzed to examine their association with arsenic concentration in drinking water. Based on 1 355 915 person-years and 217 ISHD deaths, the cumulative ISHD mortalities from birth to age 79 years were 3.4%, 3.5%, 4.7%, and 6.6%, respectively, for residents who lived in villages in which the median arsenic concentrations in drinking water were <0.1, 0.1 to 0.34, 0.35 to 0.59, and > or = 0.6 mg/L. A cohort of 263 patients affected with blackfoot disease (BFD), a unique arsenic-related peripheral vascular disease, and 2293 non-BFD residents in the endemic area of arseniasis were recruited and followed up for an average period of 5.0 years. There was a monotonous biological gradient relationship between cumulative arsenic exposure through drinking artesian well water and ISHD mortality. The relative risks were 2.5, 4.0 and 6.5, respectively, for those who had a cumulative arsenic exposure of 0.1 to 9.9, 10.0 to 19.9, and > or = 20.0 mg/L-years compared with those without the arsenic exposure after adjustment for age, sex, cigarette smoking, body mass index, serum cholesterol and triglyceride levels, and disease status for hypertension and diabetes through proportional-hazards regression analysis. BFD patients were found to have a significantly higher ISHD mortality that non-BFD residents, showing a multivariate-adjusted relative risk of 2.5 (95% CI, 1.1 to 5.4).
无机砷对心血管系统的影响已有文献记载，但缺血性心脏病（ISHD）与长期砷暴露之间的剂量反应关系仍有待阐明。分析了1973年至1986年台湾地区60个有地方性砷中毒村庄居民的ISHD死亡率，以研究其与饮用水中砷浓度的关联。基于1355915人年和217例ISHD死亡病例，对于居住在饮用水中砷浓度中位数分别<0.1、0.1至0.34、0.35至0.59以及≥0.6mg/L村庄的居民，从出生到79岁的累积ISHD死亡率分别为3.4%、3.5%、4.7%和6.6%。招募了一组263例患有黑脚病（BFD）（一种独特的砷相关外周血管疾病）的患者以及2293例砷中毒流行地区的非BFD居民，并进行了平均5.0年的随访。通过饮用自流井水的累积砷暴露与ISHD死亡率之间存在单调的生物学梯度关系。在按比例风险回归分析对年龄、性别、吸烟、体重指数、血清胆固醇和甘油三酯水平以及高血压和糖尿病疾病状态进行调整后，累积砷暴露量分别为0.1至9.9、10.0至19.9以及≥20.0mg/L - 年的人群与未暴露于砷的人群相比，相对风险分别为2.5、4.0和6.5。发现BFD患者的ISHD死亡率显著高于非BFD居民，多变量调整后的相对风险为2.5（95%CI，1.1至5.4）。
