Arsenic Exposure and Cardiovascular Disease: Evidence Needed to Inform the Dose-Response at Low Levels

  • Ana Navas-AcienEmail author
  • Tiffany R. Sanchez
  • Koren Mann
  • Miranda R. Jones
Environmental Epidemiology (F Laden and J Hart, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Environmental Epidemiology


Purpose of Review

Epidemiologic and experimental evidence support that exposure to moderate-to-high arsenic (As) is a cardiovascular disease (CVD) risk factor. Little is known, however, on the cardiovascular effects of low water As exposure (< 10 μg/L) through diet, particularly rice. The goal is to summarize the evidence on As and CVD and the research needs at low levels of exposure.

Recent Findings

Studies of populations in Taiwan, Chile, and Bangladesh have consistently shown that high water As (> 100 μg/L) constitutes a CVD risk factor. In experimental studies, chronic inorganic As in drinking water increased atherosclerotic lesions in mice. Cohort studies at low-to-moderate levels of exposure (< 100 μg/L) based on biomarkers or individual water As measures in American Indian from rural communities and in Whites and Hispanics from Colorado found higher risk of CVD incidence and mortality, particularly coronary heart disease (CHD) among those with higher arsenic exposure.


A major limitation of existent dose-response meta-analyses is the limited number of studies in populations exposed to water As at levels < 10 μg/L. Measuring metals, in particular arsenic, in general populations with comprehensive assessment of clinical cardiovascular disease can inform on the cardiovascular role of low-level arsenic and contribute to CVD prevention and control in general populations.


Arsenic Cardiovascular disease Dose-response Epidemiologic evidence 



The authors thank Anne E. Nigra for her support with this manuscript, in particular Figure 1 and the section on Sources of Arsenic Exposure in General Populations.

Funding information

This work was supported in part by grants from the National Institutes of Health (R01ES028758, R01ES025216, P42ES010349, P30ES009089).

Compliance with Ethical Standards

Conflict of Interest

Koren Mann reports grants from Canadian Institute of Health Research, during the conduct of the study. Ana Navas-Acien, Tiffany R. Sanchez, and Miranda R. Jones each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ana Navas-Acien
    • 1
    Email author
  • Tiffany R. Sanchez
    • 1
  • Koren Mann
    • 2
  • Miranda R. Jones
    • 3
  1. 1.Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkUSA
  2. 2.Department of Oncology, Division of Experimental MedicineMcGill UniversityQCCanada
  3. 3.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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