Arsenic, Blood Pressure, and Hypertension in the Strong Heart Family Study Open Access

Abstract

Purpose: Arsenic is a well-known carcinogen and has been associated with adverse health effects, including cardiovascular disease. However, the association of arsenic with blood pressure at moderate exposure levels, such as those that occur in the Western United States, remains unclear. The aim of this study was to assess the cross-sectional associations between biomarkers of arsenic exposure and systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension prevalence (defined as SBP ≥140 mm Hg, DBP ≥90 mm Hg, or taking hypertension medication) in the Strong Heart Family Study, a family-based cohort of American Indians.

Methods: We included 2,086 Strong Heart Family Study participants at their baseline visit (1998-1999 or 2001-2003) who had complete data on urine arsenic species, urine creatinine, blood pressure, hypertension medication use, sex, age, body mass index (BMI), smoking status, drinking status, diabetes status, educational attainment, study center (Arizona, Oklahoma, or North and South Dakota), and recent physical activity. Our biomarker of inorganic arsenic exposure was the sum of inorganic and methylated arsenic species in urine. We used generalized estimating equations with exchangeable correlation structure conditional on family membership to estimate the association of a doubling of arsenic exposure biomarker levels with SBP or DBP (linear regressions) or hypertension prevalence (Poisson regressions), adjusting for urine creatinine, urine arsenobetaine, and measured confounders.

Results: The associations of a two-fold increase in inorganic and methylated urine arsenic species were +0.74 mm Hg (95% CI: +0.05, +1.44) for SBP, +0.49 mm Hg (95% CI: -0.03, +1.01) for DBP, and a prevalence ratio of 1.10 (95% CI: 0.99, 1.23) for hypertension, after adjustment for urine creatinine, urine arsenobetaine, and potential confounders, and accounting for clustering by family.

Conclusions: This study suggests a modest cross-sectional association of arsenic exposure biomarkers with blood pressure. However, potential for residual confounding, particularly from dietary determinants of blood pressure associated with routes of arsenic exposure, cannot be ruled out. A prospective study taking into account the effect of diet on both arsenic exposure and blood pressure is needed to better quantify any association that may exist between arsenic and blood pressure within this population.

Table of Contents

Table of Contents

Introduction................ 1

Methods...................... 4

Results........................ 8

Discussion.................. 11

Conclusions................ 14

References...................15

Tables...........................19

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Blood Pressure Hypertension Arsenic
Committee Chair / Thesis Advisor	Gribble, Matthew , Emory University
Committee Members	Liu, Yang, Emory University Tolbert, Paige, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs US (Federal) agency other than CDC

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