Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis
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OBJECTIVE: To conduct a systematic review and meta-analysis of epidemiological studies investigating the association of arsenic, lead, cadmium, mercury, and copper with cardiovascular disease. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase, and Web of Science searched up to December 2017. REVIEW METHODS: Studies reporting risk estimates for total cardiovascular disease, coronary heart disease, and stroke for levels of arsenic, lead, cadmium, mercury, or copper were included. Two investigators independently extracted information on study characteristics and outcomes in accordance with PRISMA and MOOSE guidelines. Relative risks were standardised to a common scale and pooled across studies for each marker using random effects meta-analyses. RESULTS: The review identified 37 unique studies comprising 348 259 non-overlapping participants, with 13 033 coronary heart disease, 4205 stroke, and 15 274 cardiovascular disease outcomes in aggregate. Comparing top versus bottom thirds of baseline levels, pooled relative risks for arsenic and lead were 1.30 (95% confidence interval 1.04 to 1.63) and 1.43 (1.16 to 1.76) for cardiovascular disease, 1.23 (1.04 to 1.45) and 1.85 (1.27 to 2.69) for coronary heart disease, and 1.15 (0.92 to 1.43) and 1.63 (1.14 to 2.34) for stroke. Relative risks for cadmium and copper were 1.33 (1.09 to 1.64) and 1.81 (1.05 to 3.11) for cardiovascular disease, 1.29 (0.98 to 1.71) and 2.22 (1.31 to 3.74) for coronary heart disease, and 1.72 (1.29 to 2.28) and 1.29 (0.77 to 2.17) for stroke. Mercury had no distinctive association with cardiovascular outcomes. There was a linear dose-response relation for arsenic, lead, and cadmium with cardiovascular disease outcomes. CONCLUSION: Exposure to arsenic, lead, cadmium, and copper is associated with an increased risk of cardiovascular disease and coronary heart disease. Mercury is not associated with cardiovascular risk. These findings reinforce the importance of environmental toxic metals in cardiovascular risk, beyond the roles of conventional behavioural risk factors.
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Toxic metals such as As, Cd, Pb, and Hg are associated with cancer, cognitive impairment, cardiovascular diseases, and other chronic health conditions.
“Toxic metals such as As, Cd, Pb, and Hg are associated with cancer, cognitive impairment, cardiovascular diseases, and other chronic health conditions [228,229].”
From Navigating the potential of algal peptides: health effects, market applications, and scientific challenges (2026) · cites this paper as [229]
The Introduction links chronic exposure to arsenic, cadmium, and other toxic metals with cancer, while the Results link arsenic, cadmium, and lead with cardiovascular disease. The paper does not address cognitive impairment in the supplied passages, and its Discussion conclusion says mercury was not associated with cardiovascular risk. It therefore does not support the full claim for all four metals and conditions. (LLM, conf=0.89)
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Cites
Yaşlı Kadınlarda Üreme Sağlığı
Kokanalı, D., & Engin Üstün, Y. (n.d.) · DergiPark (Istanbul University) · Cited by 170,090 · see citing works
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
(2014) · Medical Entomology and Zoology · Cited by 17,633 · see citing works
Hazards of heavy metal contamination
Järup, L. (2003) · British Medical Bulletin · doi:10.1093/bmb/ldg032 · Cited by 6,508 · see citing works
Advances in metal-induced oxidative stress and human disease
Jomová, K., & Valko, M. (2011) · Toxicology · doi:10.1016/j.tox.2011.03.001 · Cited by 3,226 · see citing works
A review of soil heavy metal pollution from mines in China: Pollution and health risk assessment
Li, Z., Ma, Z., van der Kuijp, T. J., Yuan, Z., & Huang, L. (2013) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2013.08.090 · Cited by 2,864 · see citing works
Methods for Trend Estimation from Summarized Dose-Response Data, with Applications to Meta-Analysis
Greenland, S., & Longnecker, M. P. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116237 · Cited by 2,353 · see citing works
Copper toxicity, oxidative stress, and antioxidant nutrients
Gaetke, L. M. (2003) · Toxicology · doi:10.1016/s0300-483x(03)00159-8 · Cited by 2,166 · see citing works
Arsenic: toxicity, oxidative stress and human disease
Jomová, K., Jenisová, Z., Feszterová, M., Baroš, S., Líška, J., Hudecová, D., Rhodes, C. J., & Valko, M. (2011) · Journal of Applied Toxicology · doi:10.1002/jat.1649 · Cited by 1,435 · see citing works
Lead Exposure and Cardiovascular Disease—A Systematic Review
Navas‐Acién, A., Güallar, E., Silbergeld, E. K., & Rothenberg, S. J. (2006) · Environmental Health Perspectives · doi:10.1289/ehp.9785 · Cited by 1,117 · see citing works
Arsenic contamination, consequences and remediation techniques: A review
Singh, R., Singh, S., Parihar, P., Singh, V. P., & Prasad, S. M. (2014) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2014.10.009 · Cited by 1,101 · see citing works
Regression Models in Clinical Studies: Determining Relationships Between Predictors and Response
Harre, F. E., Lee, K. L., & Pollock, B. G. (1988) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/80.15.1198 · Cited by 960 · see citing works
A review of human carcinogens—Part C: metals, arsenic, dusts, and fibres
Straif, K., Benbrahim-Tallaa, L., Baan, R., Grosse, Y., Secretan, B., El Ghissassi, F., Bouvard, V., Guha, N., Freeman, C., Galichet, L., et al. (2009) · The Lancet Oncology · doi:10.1016/s1470-2045(09)70134-2 · Cited by 924 · see citing works
Clarke, R., Shipley, M. J., Lewington, S., Youngman, L. D., Collins, R., Marmot, M. G., & Peto, R. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010013 · Cited by 879 · see citing works
Mercury, Fish Oils, and the Risk of Myocardial Infarction
Güallar, E., Sanz-Gallardo, M. I., Veer, P. V., Bode, P., Aro, A., Gómez-Aracena, J., Kark, J. D., Riemersma, R. A., Martin-Moreno, J. M., & Kok, F. J. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa020157 · Cited by 716 · see citing works
Environmental lead exposure: a public health problem of global dimensions.
Tong, S., von Schirnding, Y. E., & Prapamontol, T. (2000) · PubMed · Cited by 683 · see citing works
Toxicological profile for mercury
Risher, J. F. (1999) · Cited by 682 · see citing works
[Environmental lead exposure: a public health problem with global dimensions].
Tong, S., von Schirnding, Y. E., & Prapamontol, T. (2002) · PubMed · Cited by 622 · see citing works
Arsenic, metals, fibres, and dusts.
(2012) · PubMed Central · Cited by 601 · see citing works
What can mendelian randomisation tell us about modifiable behavioural and environmental exposures?
Smith, G. D., & Ebrahim, S. (2005) · BMJ · doi:10.1136/bmj.330.7499.1076 · Cited by 545 · see citing works
Bjørge, T., Tretli, S., & Engeland, A. (2004) · American Journal of Epidemiology · doi:10.1093/aje/ · Cited by 492 · see citing works
Chen, Y., Graziano, J. H., Parvez, F., Liu, M., Slavkovich, V., Kalra, T., Argos, M., Islam, T., Ahmed, A., Rakibuz-Zaman, M., et al. (2011) · BMJ · doi:10.1136/bmj.d2431 · Cited by 454 · see citing works
Bhatnagar, A. (2006) · Circulation Research · doi:10.1161/01.res.0000243586.99701.cf · Cited by 453 · see citing works
Blood Lead Below 0.48 μmol/L (10 μg/dL) and Mortality Among US Adults
Menke, A., Muntner, P., Batuman, V., Silbergeld, E. K., & Güallar, E. (2006) · Circulation · doi:10.1161/circulationaha.106.628321 · Cited by 451 · see citing works
Arsenic Exposure and Cardiovascular Disease: A Systematic Review of the Epidemiologic Evidence
Navas‐Acién, A., Sharrett, A. R., Silbergeld, E. K., Schwartz, B. S., Nachman, K. E., Burke, T. A., & Güallar, E. (2005) · American Journal of Epidemiology · doi:10.1093/aje/kwi330 · Cited by 412 · see citing works
Arsenic Exposure and Cardiovascular Disease:An Updated Systematic Review
Moon, K. A., Güallar, E., & Navas‐Acién, A. (2012) · Current Atherosclerosis Reports · doi:10.1007/s11883-012-0280-x · Cited by 380 · see citing works
Lead-related nephrotoxicity: A review of the epidemiologic evidence
Ekong, E., Jaar, B. G., & Weaver, V. M. (2006) · Kidney International · doi:10.1038/sj.ki.5001809 · Cited by 366 · see citing works
Contaminants in drinking water
Fawell, J. K., & Nieuwenhuijsen, M. J. (2003) · British Medical Bulletin · doi:10.1093/bmb/ldg027 · Cited by 357 · see citing works
Cadmium Exposure and Incident Cardiovascular Disease
Téllez-Plaza, M., Güallar, E., Howard, B. V., Umans, J. G., Francesconi, K. A., Goessler, W., Silbergeld, E. K., Devereux, R. B., & Navas‐Acién, A. (2013) · Epidemiology · doi:10.1097/ede.0b013e31828b0631 · Cited by 355 · see citing works
Blood Lead Levels and Mortality
Lustberg, M. E., & Silbergeld, E. K. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.21.2443 · Cited by 333 · see citing works
Mercury and the Risk of Coronary Heart Disease in Men
Yoshizawa, K., Rimm, E. B., Morris, J. S., Spate, V. L., Hsieh, C.-C., Spiegelman, D. L., Stampfer, M. J., & Willett, W. C. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa021437 · Cited by 333 · see citing works
Virtanen, J. K., Voutilainen, S., Rissanen, T., Mursu, J., Tuomainen, T., Korhonen, M. J., Valkonen, V.-P., Seppänen, K., Laukkanen, J. A., & Salonen, J. T. (2004) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.0000150040.20950.61 · Cited by 327 · see citing works
Dose-Response Relationship Between Ischemic Heart Disease Mortality and Long-term Arsenic Exposure
Chen, C., Chiou, H., Chiang, M., Lin, L.-J., & Tai, T. Y. (1996) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.16.4.504 · Cited by 316 · see citing works
Cadmium Exposure and All-Cause and Cardiovascular Mortality in the U.S. General Population
Téllez-Plaza, M., Navas‐Acién, A., Menke, A., Crainiceanu, C. M., Pastor‐Barriuso, R., & Güallar, E. (2012) · Environmental Health Perspectives · doi:10.1289/ehp.1104352 · Cited by 310 · see citing works
Cadmium Exposure and Clinical Cardiovascular Disease: A Systematic Review
Téllez-Plaza, M., Jones, M. R., Dominguez-Lucas, A., Güallar, E., & Navas‐Acién, A. (2013) · Current Atherosclerosis Reports · doi:10.1007/s11883-013-0356-2 · Cited by 291 · see citing works
Schober, S. E., Mirel, L. B., Graubard, B. I., Brody, D. J., & Flegal, K. M. (2006) · Environmental Health Perspectives · doi:10.1289/ehp.9123 · Cited by 291 · see citing works
Continued Decline in Blood Lead Levels Among Adults in the United States
Muntner, P., Menke, A., DeSalvo, K. B., Rabito, F. A., & Batuman, V. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.18.2155 · Cited by 286 · see citing works
Arsenic Exposure and Hypertension: A Systematic Review
Abhyankar, L. N., Jones, M. R., Guallar, E., & Navas-Acien, A. (2012) · Environmental Health Perspectives · doi:10.1289/ehp.1103988 · Cited by 281 · see citing works
Cadmium Levels in Urine and Mortality among U.S. Adults
Menke, A., Muntner, P., Silbergeld, E. K., Platz, E. A., & Güallar, E. (2008) · Environmental Health Perspectives · doi:10.1289/ehp.11236 · Cited by 275 · see citing works
Association Between Exposure to Low to Moderate Arsenic Levels and Incident Cardiovascular Disease
Moon, K. A., Güallar, E., Umans, J. G., Devereux, R. B., Best, L. G., Francesconi, K. A., Goessler, W., Pollak, J., Silbergeld, E. K., Howard, B. V., et al. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-10-201311190-00719 · Cited by 273 · see citing works
Zinc, Copper, and Magnesium and Risks for All-Cause, Cancer, and Cardiovascular Mortality
Léone, N., Courbon, D., Ducimetière, P., & Zureik, M. (2006) · Epidemiology · doi:10.1097/01.ede.0000209454.41466.b7 · Cited by 270 · see citing works
Lamas, G. A., Goertz, C., Boineau, R., Mark, D. B., Rozema, T. C., Nahin, R. L., Lindblad, L., Lewis, E. F., Drisko, J., Lee, K. L., et al. (2013) · JAMA · doi:10.1001/jama.2013.2107 · Cited by 269 · see citing works
Toenail trace element levels as biomarkers: reproducibility over a 6-year period.
Garland, M., Morris, J. S., ROSNER, B. A., et al. (1993) · PubMed · Cited by 245 · see citing works
Metals in Urine and Peripheral Arterial Disease
Navas‐Acién, A., Silbergeld, E. K., Sharrett, A. R., Calderon-Aranda, E. S., Selvin, E., & Güallar, E. (2004) · Environmental Health Perspectives · doi:10.1289/ehp.7329 · Cited by 238 · see citing works
Marniemi, J., Alanen, E., Impivaara, O., Seppänen, R., Hakala, P., Rajala, T., & Rönnemaa, T. (2005) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2005.01.001 · Cited by 231 · see citing works
Mercury Exposure and Risk of Cardiovascular Disease in Two U.S. Cohorts
Mozaffarian, D., Shi, P., Morris, J. S., Spiegelman, D., Grandjean, P., Siscovick, D. S., Willett, W. C., & Rimm, E. B. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1006876 · Cited by 197 · see citing works
Serum Copper Concentration and Coronary Heart Disease among US Adults
Ford, E. S. (2000) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010168 · Cited by 196 · see citing works
Chêne, G., & Thompson, S. G. (1996) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a008971 · Cited by 195 · see citing works
Arsenic in Drinking Water and Adult Mortality
Sohel, N., Persson, L. Å., Rahman, M., Streatfield, P. K., Yunus, M., Ekström, E., & Vahter, M. (2009) · Epidemiology · doi:10.1097/ede.0b013e3181bb56ec · Cited by 183 · see citing works
Pierce, B. L., Kibriya, M. G., Lin, T., Jasmine, F., Argos, M., Roy, S., Paul-Brutus, R., Rahaman, R. O., Rakibuz‐Zaman, M., Parvez, F., et al. (2012) · PLoS Genetics · doi:10.1371/journal.pgen.1002522 · Cited by 181 · see citing works
Salonen, J. T., Salonen, R. M., Korpela, H., Suntioinen, S., & Tuomilehto, J. (1991) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116080 · Cited by 175 · see citing works
Mercury: assessing the environmental burden of disease at national and local levels.
Poulin, J., Gibb, H. J., & Prüss‐Üstün, A. (2012) · Cited by 175 · see citing works
SERUM COPPER AND ZINC AND THE RISK OF DEATH FROM CANCER AND CARDIOVASCULAR DISEASE
Kok, F. J., van Duijn, C. M., Hofman, A., et al. (1988) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114975 · Cited by 164 · see citing works
Serum calcium, magnesium, copper and zinc and risk of cardiovascular death.
Reunanen, A., Knekt, P., Marniemi, J., et al. (1996) · PubMed · Cited by 162 · see citing works
Nawrot, T. S., Hecke, É. V., Thijs, L., Richart, T., Kuznetsova, T., Jin, Y., Vangronsveld, J., Roels, H. A., & Staessen, J. A. (2008) · Environmental Health Perspectives · doi:10.1289/ehp.11667 · Cited by 156 · see citing works
Systematic review of publication bias in studies on publication bias
Dubben, H.-H., & Beck‐Bornholdt, H. (2005) · BMJ · doi:10.1136/bmj.38478.497164.f7 · Cited by 153 · see citing works
A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease
Moon, K. A., Oberoi, S., Barchowsky, A., Chen, Y., Güallar, E., Nachman, K. E., Rahman, M., Sohel, N., D’Ippoliti, D., Wade, T. J., et al. (2017) · International Journal of Epidemiology · doi:10.1093/ije/dyx202 · Cited by 152 · see citing works
Weisskopf, M. G., Jain, N. B., Nie, H., et al. (2009) · Circulation · doi:10.1161/circulationaha.108.827121 · Cited by 140 · see citing works
Copper and homocysteine in cardiovascular diseases
Kang, Y. J. (2010) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2010.11.004 · Cited by 134 · see citing works
Time to deliver: report of the WHO Independent High-Level Commission on NCDs
Nishtar, S., Niinistö, S., Sirisena, M., Vázquez, T. R., Skvortsova, V. I., Rubinstein, A., Mogae, F. G., Mattila, P., Hashemi, S. H. G., Kariuki, S. K., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31258-3 · Cited by 134 · see citing works
Cyclist route choice, traffic-related air pollution, and lung function: a scripted exposure study
Jarjour, S., Jerrett, M., Westerdahl, D., de Nazelle, A. J., Hanning, C., Daly, L., Lipsitt, J. M., & Balmes, J. R. (2013) · Environmental Health · doi:10.1186/1476-069x-12-14 · Cited by 133 · see citing works
Blackfoot Disease and Arsenic: A Never-Ending Story
Tseng, C. (2005) · Journal of Environmental Science and Health Part C · doi:10.1081/gnc-200051860 · Cited by 126 · see citing works
Markers of high fish intake are associated with decreased risk of a first myocardial infarction
Hallgren, C. G., Hallmans, G., Jansson, J., Marklund, S. L., Huhtasaari, F., Schütz, A., Strömberg, U., Vessby, B., & Skerfving, S. (2001) · British Journal Of Nutrition · doi:10.1079/bjn2001415 · Cited by 124 · see citing works
Arsenic, Reactive Oxygen, and Endothelial Dysfunction
Ellinsworth, D. C. (2015) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.115.223289 · Cited by 124 · see citing works
Arsenic in Drinking Water and Mortality for Cancer and Chronic Diseases in Central Italy, 1990-2010
D’Ippoliti, D., Santelli, E., Sario, M. D., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0138182 · Cited by 116 · see citing works
Tsuji, J. S., Pérez, V., Garry, M. R., & Alexander, D. D. (2014) · Toxicology · doi:10.1016/j.tox.2014.06.008 · Cited by 114 · see citing works
James, K. A., Byers, T., Hokanson, J. E., Meliker, J. R., Zerbe, G. O., & Marshall, J. A. (2014) · Environmental Health Perspectives · doi:10.1289/ehp.1307839 · Cited by 110 · see citing works
Arsenic exacerbates atherosclerotic lesion formation and inflammation in ApoE-/- mice
Srivastava, S., Vladykovskaya, E. N., Haberzettl, P., Sithu, S. D., D’Souza, S. E., & States, J. C. (2009) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2009.08.004 · Cited by 109 · see citing works
A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease
Moon, K. A., Oberoi, S., Barchowsky, A., Chen, Y., Güallar, E., Nachman, K. E., Rahman, M., Sohel, N., D’Ippoliti, D., Wade, T. J., et al. (2018) · International Journal of Epidemiology · doi:10.1093/ije/dyy073 · Cited by 109 · see citing works
Barregård, L., Sällsten, G., Fagerberg, B., et al. (2015) · Environmental Health Perspectives · doi:10.1289/ehp.1509735 · Cited by 98 · see citing works
Blood Lead as a Cardiovascular Risk Factor
Møller, L., & Kristensen, T. S. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116574 · Cited by 98 · see citing works
Tseng, C. (2008) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2008.02.013 · Cited by 97 · see citing works
Pocock, S., Shaper, A. G., Ashby, D., et al. (1988) · Environmental Health Perspectives · doi:10.1289/ehp.887823 · Cited by 95 · see citing works
Urinary cadmium and mortality among inhabitants of a cadmium-polluted area in Japan
Nakagawa, H., Nishijo, M., Morikawa, Y., Miura, K., Tawara, K., Kuriwaki, J.-I., Kido, T., Ikawa, A., Kobayashi, E., & Nogawa, K. (2005) · Environmental Research · doi:10.1016/j.envres.2005.08.014 · Cited by 93 · see citing works
Low-level arsenic in drinking water and risk of incident myocardial infarction: A cohort study
Monrad, M., Ersbøll, A. K., Sørensen, M., Nordsborg, R. B., Hansen, B., Gammelmark, A., Tjønneland, A. M., Overvad, K., & Raaschou‐Nielsen, O. (2017) · Environmental Research · doi:10.1016/j.envres.2017.01.028 · Cited by 88 · see citing works
Wennberg, M., Bergdahl, I., Stegmayr, B., Hallmans, G., Lundh, T., Skerfving, S., Strömberg, U., Vessby, B., & Jansson, J. (2007) · British Journal of Nutrition · doi:10.1017/s0007114507756519 · Cited by 87 · see citing works
Mitchell, E. J., Frisbie, S. H., & Sarkar, B. (2011) · Metallomics · doi:10.1039/c1mt00052g · Cited by 85 · see citing works
Chelation for Heavy Metals (Arsenic, Lead, and Mercury): Protective or Perilous?
Kosnett, M. J. (2010) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.2010.132 · Cited by 74 · see citing works
Exposure to Moderate Arsenic Concentrations Increases Atherosclerosis in ApoE−/− Mouse Model
Lemaire, M., Lemarié, C. A., Molina, M. F., et al. (2011) · Toxicological Sciences · doi:10.1093/toxsci/kfr097 · Cited by 72 · see citing works
Li, Q., Nishijo, M., Nakagawa, H., et al. (2011) · PubMed · Cited by 63 · see citing works
Katzung & Trevor's pharmacology : examination & board review
Trevor, A. J., Katzung, B. G., & Masters, S. B. (2005) · Cited by 63 · see citing works
Wennberg, M., Bergdahl, I. A., Hallmans, G., Norberg, M., Lundh, T., Skerfving, S., Strömberg, U., Vessby, B. O., & Jansson, J. (2010) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2010.29408 · Cited by 63 · see citing works
Blood Lead and Other Metal Biomarkers as Risk Factors for Cardiovascular Disease Mortality
Aoki, Y., Brody, D. J., Flegal, K. M., Fakhouri, T. H. I., Axelrad, D. A., & Parker, J. D. (2016) · Medicine · doi:10.1097/md.0000000000002223 · Cited by 61 · see citing works
Farzan, S. F., Chen, Y., Rees, J. R., Zens, M. S., & Karagas, M. R. (2015) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2015.05.013 · Cited by 57 · see citing works
The Combined Toxic and Genotoxic Effects of Cd and As to Plant Bioindicator Trifolium repens L
Ghiani, A., Fumagalli, P., Van, T. N., Gentili, R., & Citterio, S. (2014) · PLoS ONE · doi:10.1371/journal.pone.0099239 · Cited by 57 · see citing works
Cardiovascular disease and arsenic exposure in Inner Mongolia, China: a case control study
Wade, T. J., Xia, Y., Mumford, J. L., Wu, K., Le, X. C., Sams, E., & Sanders, W. E. (2015) · Environmental Health · doi:10.1186/s12940-015-0022-y · Cited by 56 · see citing works
Association of blood lead concentrations with mortality in older women: a prospective cohort study
Khalil, N., Wilson, J. W., Talbott, E. O., et al. (2009) · Environmental Health · doi:10.1186/1476-069x-8-15 · Cited by 53 · see citing works
Shiue, I. (2014) · Blood Pressure · doi:10.3109/08037051.2014.925228 · Cited by 52 · see citing works
Serum zinc and copper in myocardial infarction with particular reference to prognosis
Jain, V. K., & Mohan, G. (1991) · Biological Trace Element Research · doi:10.1007/bf02990200 · Cited by 51 · see citing works
Nakano, E., Williamson, M. P., Williams, N. H., et al. (2003) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2003.10.005 · Cited by 44 · see citing works
PREDIMED Study Investigators, Downer, M. K., Martínez‐González, M. Á., Gea, A., Stampfer, M. J., Wärnberǵ, J., Ruiz‐Canela, M., Salas‐Salvadó, J., Corella, D., Ros, E., et al. (2017) · BMC Cardiovascular Disorders · doi:10.1186/s12872-016-0435-8 · Cited by 42 · see citing works
Ruiz-Navarro, M. L., Navarro‐Alarcón, M., la Serrana, H. L. G.-D., et al. (1998) · The Science of The Total Environment · doi:10.1016/s0048-9697(98)00136-3 · Cited by 39 · see citing works
Liao, Y., Chen, C., Li, W.-F., Hsu, L., Tsai, L., Huang, Y., Sun, C.-W., Chen, W. J., & Wang, S. (2012) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2012.04.028 · Cited by 38 · see citing works
The Bangladesh Risk of Acute Vascular Events (BRAVE) Study: objectives and design
Chowdhury, R., Alam, D. S., Fakir, I. I., Adnan, S. D., Naheed, A., Tasmin, I., Monower, M. M., Hossain, F., Hossain, F. M., Rahman, M. M., et al. (2015) · European Journal of Epidemiology · doi:10.1007/s10654-015-0037-2 · Cited by 38 · see citing works
Self-citationWu, M., Chiou, H., Chen, C., Wang, Y., Hsieh, Y., Lien, L.-M., Lee, T., & Chen, C. (2010) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2010.08.005 · Cited by 38 · see citing works
Studies in copper status and atherosclerosis
KINSMAN, G. D., HOWARD, A. N., Stone, D. L., & MULLINS, P. A. (1990) · Biochemical Society Transactions · doi:10.1042/bst0181186 · Cited by 38 · see citing works
Waghe, P., Sarath, T. S., Gupta, P., Kandasamy, K., Choudhury, S., Harikumar, S. K., Mishra, S. K., & Sarkar, S. N. (2015) · Chemico-Biological Interactions · doi:10.1016/j.cbi.2015.06.014 · Cited by 37 · see citing works
Mortality of a cohort of workers in Great Britain with blood lead measurements
McElvenny, D. M., Miller, B. G., MacCalman, L., Sleeuwenhoek, A., van Tongeren, M., Shepherd, K., Darnton, A., & Cherrie, J. W. (2015) · Occupational and Environmental Medicine · doi:10.1136/oemed-2014-102637 · Cited by 37 · see citing works
Arsenite activates NFκB through induction of C-reactive protein
Druwe, I. L., Sollome, J. J., Sanchez-Soria, P., et al. (2012) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2012.04.005 · Cited by 35 · see citing works
Mortality among participants in a lead surveillance program
Chowdhury, R., Sarnat, S. E., Darrow, L. A., et al. (2014) · Environmental Research · doi:10.1016/j.envres.2014.03.008 · Cited by 34 · see citing works
Self-citationLei, L., Chang, X., Rentschler, G., Tian, L., Zhu, G., Cheng, X. J., Jin, T., & Bröberg, K. (2012) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2012.09.006 · Cited by 31 · see citing works
Blood lead and coronary heart disease risk among elderly men in Zutphen, The Netherlands.
Kromhout, D. (1988) · Environmental Health Perspectives · doi:10.1289/ehp.887843 · Cited by 30 · see citing works
Fields, S. (2005) · Environmental Health Perspectives · doi:10.1289/ehp.113-a164 · Cited by 28 · see citing works
Afridi, H. I., Kazi, T. G., Kazi, N. G., Kandhro, G. A., Baig, J. A., Jamali, M. K., Arain, M. B., Shah, A. Q., Shah, F., Khan, S., et al. (2010) · Biological Trace Element Research · doi:10.1007/s12011-010-8713-2 · Cited by 28 · see citing works
Daneshmand, R., Kurl, S., Tuomainen, T., & Virtanen, J. K. (2016) · British Journal Of Nutrition · doi:10.1017/s0007114516000982 · Cited by 25 · see citing works
Mercury in serum predicts low risk of death and myocardial infarction in Gothenburg women
Bergdahl, I. A., Ahlqwist, M., Barregård, L., Björkelund, C., Blomstrand, A., Skerfving, S., Sundh, V., Wennberg, M., & Lissner, L. (2012) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-012-0746-8 · Cited by 22 · see citing works
James, K. A., Byers, T., Hokanson, J. E., et al. (2015) · Environmental Health Perspectives · doi:10.1289/ehp.1509791r · Cited by 20 · see citing works
Interactive Effects of N6AMT1 and As3MT in Arsenic Biomethylation
Zhang, H., Ge, Y., He, P., Chen, X., Carina, A., Qiu, Y., Aga, D. S., & Ren, X. (2015) · Toxicological Sciences · doi:10.1093/toxsci/kfv101 · Cited by 17 · see citing works
Harrison, D. D. (1998) · OpenGrey (Institut de l'Information Scientifique et Technique) · Cited by 13 · see citing works
TRACE ELEMENT LEVELS IN SERUM AND URINE OF SUBJECTS DIED OF CORONARY HEART DISEASE
Niskanen, J., Marniemi, J., Piironen, O., et al. (1986) · Acta Pharmacologica et Toxicologica · doi:10.1111/j.1600-0773.1986.tb02775.x · Cited by 12 · see citing works
Health risks from toxic pollution
Lancet, T. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61862-5 · Cited by 12 · see citing works
Serum copper, ceruloplasmin & iron in ischaemic heart disease.
Misra, R., Bhambal, S. A., Np, M., et al. (1979) · PubMed · Cited by 9 · see citing works
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Pollution and health: a progress update
Fuller, R., Landrigan, P. J., Balakrishnan, K., Bathan, G., Bose-O'Reilly, S., Brauer, M., Caravanos, J., Chiles, T., Cohen, A., Corra, L., et al. (2022) · The Lancet Planetary Health · doi:10.1016/s2542-5196(22)00090-0 · Cited by 2,143 · see citing works
Rajagopalan, S., & Landrigan, P. J. (2021) · New England Journal of Medicine · doi:10.1056/nejmra2030281 · Cited by 350 · see citing works
Khaliq, M., Noor, Z., Moazzam, M., Saeed, F., Tul-Zohra, K., Tariq, E., Muhammad Shahbaz, H., & Khaliq, K. (2026) · Annals of Medicine · doi:10.1080/07853890.2026.2637282 · Cited by 4 · see citing works
“Toxic metals such as As, Cd, Pb, and Hg are associated with cancer, cognitive impairment, cardiovascular diseases, and other chronic health conditions [228,229].”
- Authors
- Chowdhury, R., Ramond, A., O’Keeffe, L. M., Shahzad, S., Kunutsor, S. K., Muka, T., Gregson, J., Willeit, P., Warnakula, S., Khan, H., Chowdhury, S., Gobin, R., Franco, O. H., & Di Angelantonio, E.
- Affiliations
- University of Cambridge (GB)
- University of Bristol (GB)
- University Hospitals Bristol NHS Foundation Trust (GB)
- Institute of Social and Preventive Medicine (CH)
- London School of Hygiene & Tropical Medicine (GB)
- Innsbruck Medical University (AT)
- Emory University (US)
- University of Guyana (GY)
- Corresponding author
- Shahzad, Sara
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2018-08-29
- Volume
- 362
- Pages
- k3310
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC6113772
- OpenAlex
- W2888857894
- Cited by
- 638
- References
- 114
- Citations by year
- 2026: 56 · 2025: 92 · 2024: 106 · 2023: 136 · 2022: 79 · 2021: 84 · 2020: 52 · 2019: 28 · 2018: 5
- FWCI
- 4.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by-nc)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion, cc-by-nc)
- Apollo
- Funders
- National Institute for Health and Care Research (NF-SI-0617-10113, NF-SI-0512-10165)
- British Heart Foundation (RG/13/13/30194)
- Medical Research Council (MR/M014509/1, MR/L003120/1, MR/N015959/1)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Heavy Metal Exposure and Toxicity
- Physical Sciences › Environmental Science › Pollution › Heavy metals in environment
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Environmental Toxicology and Ecotoxicology
- Keywords
- toxic metals, heavy metal exposure, cardiovascular disease, coronary artery disease, stroke, arsenic, lead, cadmium, mercury, copper, dose-response relationship, environmental pollution, cardiovascular risk factors, biomarkers of exposure, occupational exposure, dietary exposure, air pollution, water pollution, leaded gasoline, cardiovascular hospitalization
- MeSH terms
- Cardiovascular Diseases, Environmental Exposure, Environmental Monitoring, Environmental Pollutants, Environmental Pollution, Humans, Risk Factors, Risk Assessment, Metals, Heavy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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