Current Atherosclerosis Reports

, Volume 14, Issue 6, pp 542–555 | Cite as

Arsenic Exposure and Cardiovascular Disease:An Updated Systematic Review

  • Katherine Moon
  • Eliseo Guallar
  • Ana Navas-AcienEmail author
Nutrition (BV Howard, Section Editor)


In epidemiologic studies, high-chronic arsenic exposure has been associated with cardiovascular disease, despite methodological limitations. At low-moderate arsenic levels, the evidence was inconclusive. Here, we update a previous systematic review (Am J Epidemiol 2005;162:1037–49) examining the association between arsenic exposure and cardiovascular disease. Eighteen studies published since 2005 were combined with 13 studies from the previous review. We calculated pooled relative risks by comparing the highest versus the lowest exposure category across studies. For high exposure (arsenic in drinking water > 50 μg/L), the pooled relative risks (95 % confidence interval) for cardiovascular disease, coronary heart disease, stroke, and peripheral arterial disease were 1.32 (95 % CI:1.05–1.67), 1.89 (95 % CI:1.33–2.69), 1.08 (95 % CI:0.98–1.19), and 2.17 (95 % CI:1.47–3.20), respectively. At low-moderate arsenic levels, the evidence was inconclusive. Our review strengthens the evidence for a causal association between high-chronic arsenic exposure and clinical cardiovascular endpoints. Additional high quality studies are needed at low-moderate arsenic levels.


Arsenic Cardiovascular disease Meta-analysis Systematic review 



Confidence Interval


Coronary Heart Disease


Cardiovascular Disease


Peripheral Arterial Disease



This research is supported by grants from the US National Heart Lung and Blood Institute (R01HL090863) and the US National Institute of Environmental Health Sciences (R01ES021367).


No potential conflicts of interest relevant to this article were reported.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Katherine Moon
    • 1
  • Eliseo Guallar
    • 3
    • 4
    • 5
    • 6
  • Ana Navas-Acien
    • 2
    • 4
    • 7
    Email author
  1. 1.Department of Environmental Health SciencesJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of Environmental Health SciencesJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of Cardiovascular Epidemiology and Population GeneticsCentro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
  6. 6.Department of MedicineJohns Hopkins Medical InstitutionsBaltimoreUSA
  7. 7.Department of OncologyJohns Hopkins Medical SchoolBaltimoreUSA

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