Environmental Metals and Cardiovascular Disease in Adults: A Systematic Review Beyond Lead and Cadmium
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Published systematic reviews concluded that there is moderate to strong evidence to infer a potential role of lead and cadmium, widespread environmental metals, as cardiovascular risk factors. For other non-essential metals, the evidence has not been appraised systematically. Our objective was to systematically review epidemiologic studies on the association between cardiovascular disease in adults and the environmental metals antimony, barium, chromium, nickel, tungsten, uranium, and vanadium. We identified a total of 4 articles on antimony, 1 on barium, 5 on chromium, 1 on nickel, 4 on tungsten, 1 on uranium, and 0 on vanadium. We concluded that the current evidence is not sufficient to inform on the cardiovascular role of these metals because of the small number of studies. Few experimental studies have also evaluated the role of these metals in cardiovascular outcomes. Additional epidemiologic and experimental studies, including prospective cohort studies, are needed to understand the role of metals, including exposure to metal mixtures, in cardiovascular disease development.
KeywordsCardiovascular Atherosclerosis Metals Systematic review Epidemiologic studies
Atomic absorption spectrometry
National Health and Nutrition Examination Survey
Maria Tellez-Plaza was supported by the Strategic Action for Research in Health sciences (CP12/03080 and PI15/00071), which is an initiative from Carlos III Health Institute Madrid and the Spanish Ministry of Economy and Competitiveness and co-funded with European Funds for Regional Development (FEDER). Ana Navas-Acien and Anne E. Nigra were supported by grants R01ES021367 and R01ES025216 from the National Institute of Environmental Health Sciences.
All authors conceptualized the review. A.E.N., A.R.H., M.T.P., and A.N.A. developed the search strategy. A.E.N. and A.R.H. reviewed all the retrieved abstracts. A.N.A. and M.T.P. acted as third reviewers in case of inconsistent article selection by A.E.N. and A.R.H. A.E.N., A.R.H., A.N.A., and M.T.P. drafted the data extraction tables. A.E.N. and A.R.H. assisted in editing data extraction tables. All the authors interpreted the data extraction tables. A.E.N., A.R.H., A.N.A., and M.T.P. wrote the initial draft of the manuscript. J.R. assisted in writing the manuscript. All authors read and approved the final manuscript.
Compliance with Ethical Standards
Conflict of Interest
Anne E. Nigra, Adrian Ruiz-Hernandez, Josep Redon, Ana Navas-Acien, and Maria Tellez-Plaza declare that they have no conflict 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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