Cardiovascular disease

There is strong epidemiological and mechanistic evidence for a causal association between exposure to arsenic, cadmium, and lead and development of cardiovascular disease (CVD). There is relatively strong but less conclusive evidence for a causal relationship between methylmercury exposure and CVD. All these metals are suspected of inducing pathophysiological changes relevant to atherogenic disorders including increased oxidative stress, inflammatory response, and coagulation activity. It is well established that high exposure to ionizing irradiation increases the risk for both cardio- and cerebrovascular diseases. Occupational exposure to uranium is associated with low to intermediate exposure to ionizing irradiation. Epidemiological studies of CVD in such groups show diverging results and give no firm evidence for an increased risk. Cardiomyopathy has been associated with excessive intake of cobalt and iron. Deficiency of selenium has been related to dilated cardiomyopathy. Airborne beryllium exposure has been associated with heart disease, including both ischemic heart disease and cor pulmonale. Signs of cor pulmonale have also been observed after cobalt exposure among hard metal workers. Pulmonary fibrosis with an increased blood pressure in the pulmonary circulation is a likely mechanism in the development of cor pulmonale. For some metals (iron, magnesium, selenium, and zinc) an inverse relationship has been observed between intake or concentrations of circulating metal in blood and CVD. Lower intake or lower levels in blood are associated with increased risks of CVD. Prospective intervention studies with selenium supplementation have shown inconsistent results.