Subclinical CVD Detected in Kids With Higher Arsenic Burden

— Local Superfund site may contribute to inorganic arsenic exposure

A photo of the skyline of Syracuse, New York.

Greater arsenic exposure was linked to children harboring subclinical cardiovascular disease (CVD) as early as age 9, based on data from Syracuse, New York.

In this upstate community with a history of industrial waste, total arsenic level significantly correlated with carotid intima media thickness and concentric hypertrophy (the latter indicated by greater left ventricular mass and greater relative wall thickness) in school-age children, researchers led by Brooks Gump, PhD, MPH, of Syracuse University, New York, reported.

There was, on the other hand, no relationship between arsenic exposure and carotid-femoral pulse wave velocity, study authors reported in JAMA Network Open.

"We believe our study represents the first to date to identify an association between actual body burdens of arsenic (in this case, total arsenic) and subclinical CVD in children," they wrote. "Concentric hypertrophy is a particularly important outcome measure because it is strongly associated with future cardiac events."

According to these findings, the link between arsenic exposure and clinical and subclinical CVD seems to apply to a younger cohort than previously observed.

Gump's group found that in Syracuse, the geometric mean of the creatinine-adjusted total arsenic level in the population was 7.76 μg/g creatinine, which was higher than the nationwide estimate of 7.08 μg/g in a comparable age group in the 2003-2004 cycle of the National Health and Nutrition Examination Survey.

Sourced from the well-tested Skaneateles Lake, drinking water was ruled out as the source of arsenic in this community. Secondhand smoke also showed no relationship with arsenic exposure. Organic arsenic, not the inorganic component, appeared to be diet-driven.

A more likely source of total arsenic appeared to be historical pollution through air and soil contamination -- excess arsenic clustered around the southwest side of Syracuse, an area with known elevations of toxic metals from industrial waste -- study authors found.

"This area is currently a [S]uperfund site as a result of the industrial and municipal sewage discharge for more than 100 years, suggesting this as the likely route of exposure to inorganic arsenic species in our cohort. Residents of this area are predominantly Black; as such, this location has also been the focus of continued concerns with environmental justice," Gump and colleagues noted.

Whether arsenic provokes actual incident CVD remains to be determined, however.

The authors also acknowledged that their observational cross-sectional study design left room for uncontrolled confounding in probing a potential relationship between arsenic exposure and subclinical CVD.

"If further research suggests this association is causal, this finding would have important implications for future efforts at environmental remediation of this ubiquitous toxicant," they said.

Gump and colleagues drew upon the Environmental Exposures and Child Health Outcomes cohort for their study. Included were 245 pediatric participants recruited from the Syracuse metropolitan area in 2013-2017 who provided urine samples for arsenic testing.

Eligible children were ages 9 to 11. Girls accounted for 54% of the group, which was approximately 60% Black and 40% white. As a whole, the children tended to come from low-middle socioeconomic backgrounds.

Random testing for specific arsenic species was performed for roughly one in eight children who had total arsenic levels exceeding 20 μg/g.

Arsenobetaine and arsenocholine were considered dietary organic arsenic. Monomethlyarsonic acid, dimethylated arsenic acid, and unmetabolized inorganic arsenic species made up total inorganic arsenic.

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    Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow


The study was funded by grants from the National Institutes of Health and the National Institute of Health Children's Health Exposure Analysis Resource.

Gump and colleagues had no disclosures.

Primary Source

JAMA Network Open

Source Reference: Gump BB, et al "Exposure to arsenic and subclinical cardiovascular disease in 9- to 11-year-old children, Syracuse, New York" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.21379.