Arsenic Exposure in Relation to Ischemic Stroke The Reasons for Geographic and Racial Differences in Stroke Study

作者：Tsinovoi Cari L; Xun Pengcheng; McClure Leslie A; Carioni Vivian M O; Brockman John D; Cai Jianwen; Guallar Eliseo; Cushman Mary; Unverzagt Frederick W; Howard Virginia J; He Ka^*

来源：Stroke, 2018, 49(1): 19-+.

DOI：10.1161/STROKEAHA.117.018891

• arsenic
• environment exposures
• minerals
• monomethylarsonic acid
• risk
• stroke
• trace elements

Background and Purpose-The purpose of this case-cohort study was to examine urinary arsenic levels in relation to incident ischemic stroke in the United States.
Methods-We performed a case-cohort study nested within the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort. A subcohort (n=2486) of controls was randomly sampled within region-race-sex strata while all incident ischemic stroke cases from the full REGARDS cohort (n=671) were included. Baseline urinary arsenic was measured by inductively coupled plasma-mass spectrometry. Arsenic species, including urinary inorganic arsenic and its metabolites monomethylarsonic acid and dimethylarsinic acid, were measured in a random subset (n=199). Weighted Cox's proportional hazards models were used to calculate hazard ratios and 95% confidence intervals of ischemic stroke by arsenic and its species.
Results-The average follow-up was 6.7 years. Although incident ischemic stroke showed no association with total arsenic or total inorganic arsenic, for each unit higher level of urinary monomethylarsonic acid on a log-scale, after adjustment for potential confounders, ischemic stroke risk increased approximate to 2-fold (hazard ratio=1.98; 95% confidence interval: 1.12-3.50). Effect modification by age, race, sex, or geographic region was not evident.
Conclusions-A metabolite of arsenic was positively associated with incident ischemic stroke in this case-cohort study of the US general population, a low-to-moderate exposure area. Overall, these findings suggest a potential role for arsenic methylation in the pathogenesis of stroke, having important implications for future cerebrovascular research.

• 出版日期2018-1