Impact of drinking water hardness on carotid atherosclerosis and arterial stiffness: Insights from the "Corinthia" study

Background: Several investigations have highlighted the role of water quality in cardiovascular health. In the present study, we have investigated the effects of drinking water hardness on atherosclerotic burden in carotid arteries and arterial stiffness. Methods: "Corinthia" study was conducted in the homonym region in Greece from 2015 to 2017. Carotid atherosclerosis was assessed by intima-media thickness (IMT). Pulse wave velocity (PWV) was used to evaluate arterial stiffness. Tap-water samples were collected from the study area and analyzed for a variety of elements, as well as pH and total hardness. Results: Individuals living in lower drinking water hardness areas (Area 1) versus individuals living in higher water hardness areas (Area 2) had lower max IMT (p = 0.004) and were less susceptible to carotid plaque formation (p = 0.004). Interestingly, individuals over 65 years from Area 1 had lower mean IMT, max IMT, and less plaque formation (p < 0.001 for all). The mean value of PWV in the overall study population was below the 10 m/s cutoff, which defines arterial stiffness (9.15 +/- 2.79 m/s). Nevertheless, a marginally higher rate of vascular stiffening was noted in Area 2 vs. Area 1 (16.2% and 12.8%, respectively, p = 0.048). Conclusions: According to this cross-sectional study's findings, a positive association between extra hard water and carotid atherosclerotic burden was found. However, the association with arterial stiffness is unclear and should be investigated further. (c) 2023 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).