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Chronic Arsenic Poisoning and Increased Risk of Stroke

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Metal Ion in Stroke

Part of the book series: Springer Series in Translational Stroke Research ((SSTSR))

Abstract

Chronic arsenic poisoning is becoming an emerging epidemic in Asia and poses a major worldwide health problem. It was estimated that over 100 million people are exposed to arsenic-contaminated underground water worldwide. Epidemiological studies have shown that chronic arsenic poisoning from drinking water is associated with various atherosclerotic diseases, including ischemic stroke in a dose–response relationship. Findings from epidemiologic and mechanistic studies indicate that vascular inflammation and oxidative stress play critical roles in arsenic-induced atherosclerotic diseases. Animal models for arsenic-induced atherosclerosis illustrate that arsenic could accelerate and exacerbate atherosclerosis in apolipoprotein E-/low-density lipoprotein receptor-knockout mice. Arsenic-induced cardiovascular diseases, including ischemic stroke, may be as a result of interactions among genetics, environment as well as nutritional and metabolic factors. The cardiovascular effects of chronic arsenic poisoning have been established qualitatively and quantitatively, mostly in the high arsenic exposure areas of southwestern Taiwan. Recently, the moderate-to-low dose effect of arsenic on cardiovascular system has been found in few studies but still needs to be further confirmed in a large-scale epidemiologic studies by using proper clinical outcomes such as stroke. Stroke remains the third leading cause of mortality worldwide, and a small increased risk may indicate a large quantity of excess mortality.

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References

  • Bartoli D, Battista G, De Santis M, Iaia TE, Orsi D, Tarchi M, Pirastu R, Valiani M (1998) Cohort study of art glass workers in Tuscany, Italy: mortality from non-malignant diseases. Occup Med (Lond) 48:441–445

    Article  CAS  Google Scholar 

  • Binks K, Doll R, Gillies M, Holroyd C, Jones SR, McGeoghegan D, Scott L, Walker P (2005) Mortality experience of male workers at a United Kingdom tin smelter. Occup Med (Lond) 55:215–226

    Article  CAS  Google Scholar 

  • Bunderson M, Brooks DM, Walker DL, Rosenfeld ME, Coffin JD, Beall HD (2004) Arsenic exposure exacerbates atherosclerotic plaque formation and increases nitrotyrosine and leukotriene biosynthesis. Toxicol Appl Pharmacol 201:32–39

    Article  PubMed  CAS  Google Scholar 

  • Chen CJ, Wu MM, Lee SS, Wang JD, Chen SH, Wu HY (1988) Atherogenicity and carcinogenicity of high-arsenic artesian well water: multiple risk factors and related malignant neoplasms of blackfoot disease. Arteriosclerosis 18:452–460

    Google Scholar 

  • Chen CJ, Chiou HY, Chiang MH, Lin LJ, Tai TY (1996) Dose response relationship between ischemic heart disease mortality and long-term arsenic exposure. Arterioscler Thromb Vasc Biol 16:504–510

    Article  PubMed  CAS  Google Scholar 

  • Chen YC, Lin-Shiau SY, Lin JK (1998) Involvement of reactive oxygen species and caspase 3 activation in arsenite-induced apoptosis. J Cell Physiol 177:324–333

    Article  PubMed  CAS  Google Scholar 

  • Chen CJ, Hsu LI, Tseng CH, Hsueh YM, Chiou HY (1999) Emergent epidemics of arseniasis in Asia. In: Chappell WR, Abernathy CO, Calderon RL (eds) Arsenic: exposure and health effects. Elsevier, Amsterdam, pp 113–121

    Chapter  Google Scholar 

  • Chen CJ, Hsu LI, Wang CH, Shih WL, Hsu YH, Tseng MP, Lin YC, Chou WL, Chen CY, Lee CY, Wang LH, Cheng YC, Chen CL, Chen SY, Wang YH, Hsueh YM, Chiou HY, Wu MM (2005) Biomarkers of exposure, effect, and susceptibility of arsenic-induced health hazards in Taiwan. Toxicol Appl Pharmacol 206:198–206

    Article  PubMed  CAS  Google Scholar 

  • Chen Y, Factor-Litvak P, Howe GR, Graziano JH, Brandt-Rauf P, Parvez F, van Green A, Ahsan H (2007a) Arsenic exposure from drinking water, dietary intakes of B vitamins and folate, and risk of high blood pressure in Bangladesh: a population-based, cross-sectional study. Am J Epidemiol 165:541–552

    Article  PubMed  Google Scholar 

  • Chen Y, Santella RM, Kibriya MG, Wang Q, Kappil M, Verret WJ, Graziano JH, Ahsan H (2007b) Association between arsenic exposure from drinking water and plasma levels of soluble cell adhesion molecules. Environ Health Perspect 115:1415–1420

    PubMed  CAS  Google Scholar 

  • Chen Y, Parvez F, Liu M, Pesola GR, Gamble MV, Slavkovich V, Islam T, Ahmed A, Hasan R, Graziano JH, Ahsan H (2011) Association between arsenic exposure from drinking water and proteinuria: results from the Health Effects of Arsenic Longitudinal Study. Int J Epidemiol 40:828–835

    Google Scholar 

  • Chiou HY, Huang WI, Su CL, Chang SF, Hsu YH, Chen CJ (1997) Dose–response relationship between prevalence of cerebrovascular disease and ingested inorganic arsenic. Stroke 28:1717–1723

    Article  PubMed  CAS  Google Scholar 

  • Engel RR, Smith AH (1994) Arsenic in drinking water and mortality from vascular disease: an ecologic analysis in 30 counties in the United States. Arch Environ Health 9:418–427

    Article  Google Scholar 

  • Esterbauer H, Schaur RJ, Zollner H (1991) Chemistry and biochemistry of 4-hydroxynonenal, malonaldehyde and related aldehydes. Free Radic Biol Med 11:81–128

    Article  PubMed  CAS  Google Scholar 

  • Hayes JD, McLellan LI (1999) Glutathione and glutathione -dependent enzymes represent a coordinately regulated defense against oxidative stress. Free Radic Res 31:273–300

    Article  PubMed  CAS  Google Scholar 

  • Hertz-Picciotto I, Arrighi HM, Hu SW (2000) Does arsenic exposure increase the risk for circulatory disease? Am J Epidemiol 151:174–181

    Article  PubMed  CAS  Google Scholar 

  • Hsieh YC, Hsieh FI, Lien LM, Chou YL, Chiou HY, Chen CJ (2008) Risk of carotid atherosclerosis associated with genetic polymorphisms of apolipoprotein E and inflammatory genes among arsenic exposed residents in Taiwan. Toxicol Appl Pharmacol 227:1–7

    Article  PubMed  CAS  Google Scholar 

  • Hsueh YM, Wu WL, Huang YL, Chiou HY, Tseng CH, Chen CJ (1998) Low serum carotene level and increased risk of ischemic heart disease related to long-term arsenic exposure. Atherosclerosis 141:249–257

    Article  PubMed  CAS  Google Scholar 

  • Hsueh YM, Lin P, Chen HW, Shiue HS, Chung CJ, Tsai CT, Huang YK, Chiou HY, Chen CJ (2005) Genetic polymorphisms of oxidative and antioxidant enzymes and arsenic-related hypertension. J Toxicol Environ Health A 68:1471–1484

    Article  PubMed  CAS  Google Scholar 

  • Huang YK, Tseng CH, Huang YL, Yang MH, Chen CJ, Hsueh YM (2007) Arsenic methylation capability and hypertension risk in subjects living in arseniasis-hyperendemic areas in southwestern Taiwan. Toxicol Appl Pharmacol 218:135–142

    Article  PubMed  CAS  Google Scholar 

  • Jarup L, Pershagen G, Wall S (1989) Cumulative arsenic exposure and lung cancer in smelter workers: a dose-response study. Am J Ind Med 15:31–41

    Article  PubMed  CAS  Google Scholar 

  • Lau AT, He QY, Chiu JF (2004) A proteome analysis of the arsenite response in cultured lung cells: evidence for in vitro oxidative stress-induced apoptosis. Biochem J 382:641–650

    Article  PubMed  CAS  Google Scholar 

  • Lee PC, Ho IC, Lee TC (2005) Oxidative stress mediates sodium arsenite-induced expression of heme oxygenase-1, monocyte chemoattractant protein-1, and interleukin-6 in vascular smooth muscle cells. Toxicol Sci 85:541–550

    Article  PubMed  CAS  Google Scholar 

  • Lewis DR, Southwick JW, Ouellet-Hellstrom R, Recnch J, Calderon RL (1999) Drinking water arsenic in Utah: a cohort mortality study. Environ Health Perspect 107:359–365

    Article  PubMed  CAS  Google Scholar 

  • Libby P, Ridker PM, Hansson GK (2011) Progress and challenges in translating the biology of atherosclerosis. Nature 473:317–325

    Article  PubMed  CAS  Google Scholar 

  • Lisabeth LD, Ahn HJ, Chen JJ, Sealy-Jefferson S, Burke JF, Meliker JR (2010) Arsenic in drinking water and stroke hospitalizations in Michigan. Stroke 41:2499–2504

    Article  PubMed  CAS  Google Scholar 

  • Lubin JH, Fraumeni JF Jr (2000) Re: “Does arsenic exposure increase the risk for circulatory disease?” (Letter). Am J Epidemiol 152:290–293

    Article  PubMed  CAS  Google Scholar 

  • Mabuchi K, Lilienfeld AM, Snell LM (1980) Cancer and occupational exposure to arsenic: a study of pesticide workers. Prev Med 9:51–77

    Article  PubMed  CAS  Google Scholar 

  • Meliker JR, Wahl RL, Cameron LL, Nriagu JO (2007) Arsenic in drinking water and cerebrovascular disease, diabetes mellitus, and kidney disease in Michigan: a standardized mortality ratio analysis. Environ Health 6:4

    Article  PubMed  Google Scholar 

  • Morales KH, Ryan L, Brown KG, Kuo TL, Wu MM, Chen CJ (2000) Risk of internal cancers from arsenic in drinking water. Environ Health Perspect 108:655–661

    Article  PubMed  CAS  Google Scholar 

  • Nakadaira H, Endoh K, Katagiri M, Yamamoto M (2002) Elevated mortality from lung cancer associated with arsenic exposure for a limited duration. J Occup Environ Med 44:291–299

    Article  PubMed  CAS  Google Scholar 

  • Navas-Acien A, Scharrett AR, Silbergeld EK, Schwartz BS, Nachman KE, Bruke TA, Guallar E (2005) Arsenic and cardiovascular disease: a systemic review of the epidemiologic evidence. Am J Epidemiol 162:1027–1049

    Article  Google Scholar 

  • Nordstrom DK (2002) Worldwide occurrences of arsenic in ground water. Science 296:2143–2145

    Article  PubMed  CAS  Google Scholar 

  • Rosenberg HG (1974) Systemic arterial disease and chronic arsenicism in infants. Arch Pathol 97:360–365

    PubMed  CAS  Google Scholar 

  • Simeonova PP, Luster MI (2004) Arsenic and atherosclerosis. Toxicol Appl Pharmacol 198:444–449

    Article  PubMed  CAS  Google Scholar 

  • Srivastava S, Spite M, Trent JO, West MB, Ahmed Y, Bhatnagar A (2004) Aldose reductase-catalyzed reduction of aldehyde phospholipids. J Biol Chem 279:53395–53406

    Article  PubMed  CAS  Google Scholar 

  • Srivastava S, D’Souza SE, Sen U, States JC (2007) In utero arsenic exposure induces early onset of atherosclerosis in ApoE-/- mice. Reprod Toxicol 23:449–456

    Article  PubMed  CAS  Google Scholar 

  • States JC, Srivastava S, Chen Y, Barchowsky A (2009) Arsenic and cardiovascular disease. Toxicol Sci 107:312–323

    Article  PubMed  CAS  Google Scholar 

  • Tokudome S, Kuratsune M (1976) A cohort study on mortality from cancer and other causes among workers at a metal refinery. Int J Cancer 17:310–317

    Article  PubMed  CAS  Google Scholar 

  • Tollestrup K, Daling JR, Allard J (1995) Mortality in a cohort of orchard workers exposed to lead arsenate pesticide spray. Arch Environ Health 50:221–229

    Article  PubMed  CAS  Google Scholar 

  • Tsai SM, Wang TN, Ko YC (1999) Mortality for certain diseases in areas with high level of arsenic in drinking water. Arch Enviro Health 54:186–193

    Article  CAS  Google Scholar 

  • Tseng WP (1977) Effects and dose–response relationships of skin cancer and black foot disease with arsenic. Environ Health Perspect 19:109–119

    Article  PubMed  CAS  Google Scholar 

  • Tseng WP (1989) Blackfoot disease in Taiwan: a 30-year follow-up study. Angiology 40:547–558

    Article  PubMed  CAS  Google Scholar 

  • Tseng CH, Chong CK, Chen CJ, Tai TY (1996) Dose–response relationship between peripheral vascular disease and ingested arsenic among residents in blackfoot disease endemic villages in Taiwan. Atherosclerosis 120:125–133

    Article  PubMed  CAS  Google Scholar 

  • Tseng CH, Chong CK, Tseng CP, Hsueh YM, Chiou HY, Tseng CC, Chen CJ (2003) Long-term arsenic exposure and ischemic heart disease in arseniasis-hyperendemic villages in Taiwan. Toxicol Lett 127:15–21

    Article  Google Scholar 

  • Tsuda T, Nagira T, Yamamoto M, Kume Y (1990) An epidemiological study on cancer in certified arsenic poisoning patients in Toroku. Ind Health 28:53–62

    Article  PubMed  CAS  Google Scholar 

  • Vahter M, Concha G (2001) Role of metabolism in arsenic toxicity. Pharmacol Toxicol 89:1–5

    Article  PubMed  CAS  Google Scholar 

  • Wang CH (2011) Arsenic-induced carotid atherosclerosis, ventricular repolarization abnormalities and ischemic heart disease. In: Chen CJ, Chiou HY (eds) Health hazards of environmental arsenic poisoning: from epidemic to pandemic. World Scientific, Singapore, pp 109–133

    Chapter  Google Scholar 

  • Wang CH, Jeng JS, Yip PK, Chen CL, Hsu LI, Hsueh YM, Chiou HY, Wu MM, Chen CJ (2002) Biological gradient between long-term arsenic exposure and carotid atherosclerosis. Circulation 105:1804–1809

    Article  PubMed  CAS  Google Scholar 

  • Wang CH, Hsiao KC, Chen CL, Hsu LI, Chiou HI, Chen SY, Hsueh YM, Wu MM, Chen CJ (2007) A review of the epidemiologic literature on the role of environmental arsenic exposure and cardiovascular diseases. Toxicol Appl Pharmacol 222:314–326

    Article  Google Scholar 

  • Wang YH, Wu MM, Hong CT, Lien LM, Hsieh YC, Tseng HP, Chang SF, Su CL, Chiou HY, Chen CJ (2007b) Effects of arsenic exposure and genetic polymorphisms of p53, glutathione S-transferase M1, T1, and P on the risk of carotid atherosclerosis in Taiwan. Atherosclerosis 192:305–312

    Article  PubMed  CAS  Google Scholar 

  • Wang CH, Chen CL, Hsiao KC, Chiang FT, Hsu LI, Chiou HY, Hsueh YM, Wu MM, Chen CJ (2009) Increased risk of QT prolongation associated with atherosclerotic diseases in arseniasis-endemic area in southwestern coast of Taiwan. Toxicol Appl Pharmacol 239:320–324

    Article  PubMed  CAS  Google Scholar 

  • Wang CH, Chen CL, Hsiao KC, Chiou HY, Hsueh YM, Wu MM, Chen CJ (2010) Arsenic-induced QT dispersion is associated with atherosclerotic diseases and predicts long-term cardiovascular mortality in subjects with previous exposure to arsenic: a 17-year follow-up study. Cardiovasc Toxicol 10:17–26

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization (1981) Environmental health criteria 18: arsenic. World Health Organization, Geneva, pp 43–102

    Google Scholar 

  • Wu MM, Kuo TL, Hwang YH, Chen CJ (1989) Dose–response relationship between arsenic concentration in well water and mortality from cancers and vascular disease. Am J Epidemiol 130:1123–1131

    PubMed  CAS  Google Scholar 

  • Wu MM, Chiou HY, Wang TW, Chen CJ, Lee TC (2001) Association of arsenic exposure with increased reactive oxidants and decreased antioxidant capacity in a human population of Northeastern Taiwan. Environ Health Perspect 109:1011–1017

    PubMed  CAS  Google Scholar 

  • Wu MM, Chiou HY, Ho IC, Chen CJ, Lee TC (2003) Gene expression of inflammatory molecules in circulating lymphocytes form arsenic-exposed human subjects. Environ Health Perspect 111:1429–1438

    Article  PubMed  CAS  Google Scholar 

  • Xuan XZ, Lubin JH, Li JY et al (1993) A cohort study in southern China of tin miners exposed to radon and radon decay products. Health Phys 64:120–131

    Article  PubMed  CAS  Google Scholar 

  • Yang CY (2006) Dose arsenic exposure increase the risk of development of peripheral vascular diseases in humans? J Toxicol Environ Health A 69:1797–1804

    Article  PubMed  CAS  Google Scholar 

  • Yang Y, Yang Y, Xu Y, Lick SD, Awasthi YC, Boor PJ (2008) Endothelial glutathione-S-transferase A4-4 protects against oxidative stress and modulates iNOS expression through NF-kappaB translocation. Toxicol Appl Pharmacol 230:187–196

    Article  PubMed  CAS  Google Scholar 

  • Zierold KM, Knobeloch L, Anderson L (2004) Prevalence of chronic diseases in adults exposed to arsenic-contaminated drinking water. Am J Public Health 94:1936–1937

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, School of Medicine, Fu-Jen Catholic University, 510 Chungcheng Road, Hsinchuang, New Taipei City, Taiwan

    Chih-Hao Wang MD, PhD

  2. Genomics Research Center, Academia Sinica, 128 Academia Road Section 2, Nankang, Taipei, Taiwan

    Chien-Jen Chen ScD

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  1. Chih-Hao Wang MD, PhD
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  2. Chien-Jen Chen ScD
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Correspondence to Chih-Hao Wang MD, PhD .

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Editors and Affiliations

  1. , Department of Biomedical Sciences, Ohio University, 346 Irvine Hall, Athens, 45701, Ohio, USA

    Yang V. Li

  2. Loma Linda University, 11234 Anderson Street, Room 2562B, Loma Linda, 92354, California, USA

    John H. Zhang

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Wang, CH., Chen, CJ. (2012). Chronic Arsenic Poisoning and Increased Risk of Stroke. In: Li, Y., Zhang, J. (eds) Metal Ion in Stroke. Springer Series in Translational Stroke Research. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9663-3_32

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