Environmental Contributors to Cardiovascular Disease: Emerging Research on Heavy Metals and Air Pollution

September 25, 2018
2:00 pm US Eastern Time

Slides & Resources


Bruce Lanphear: Lead: An Overlooked Cause of Coronary Heart Disease

Ana Navas-Acien: Metals and Cardiovascular Disease: Evidence, Mechanisms, and
Opportunities for Prevention

Aruni Bhatnagar: Air Pollution and Heart Disease


Bruce Lanphear

Low-level lead exposure and mortality in US adults: a population-based cohort study.

Bruce P Lanphear, Stephen Rauch, Peggy Auinger, Ryan W Allen, Richard W Hornung.

Lancet Public Health. 2018 Apr;3(4):e177-e184. doi: 10.1016/S2468-2667(18)30025-2.

Ana Navas-Acien

Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3310

Chowdhury R, Ramond A, O’Keeffe LM, Shahzad S, Kunutsor SK, Muka T, Gregson J, Willeit P, Warnakula S, Khan H, Chowdhury S, Gobin R, Franco OH, Di Angelantonio E


Environmental metals and cardiovascular disease

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3435 

Tellez-Plaza M, Guallar E, Navas-Acien A


Declining exposures to lead and cadmium contribute to explaining the reduction of cardiovascular mortality in the US population, 1988-2004.

Ruiz-Hernandez A, Navas-Acien A, Pastor-Barriuso R, Crainiceanu CM, Redon J, Guallar E, Tellez-Plaza M.

Int J Epidemiol. 2017 Dec 1;46(6):1903-1912. doi: 10.1093/ije/dyx176. 


Association between exposure to low to moderate arsenic levels and incident cardiovascular disease. A prospective cohort study. 

Moon KA, Guallar E, Umans JG, Devereux RB, Best LG, Francesconi KA, Goessler W, Pollak J, Silbergeld EK, Howard BV, Navas-Acien A.

Ann Intern Med. 2013 Nov 19;159(10):649-59.


Arsenic exposure from drinking water and mortality from cardiovascular disease in Bangladesh: prospective cohort study.

Chen Y, Graziano JH, Parvez F, Liu M, Slavkovich V, Kalra T, Argos M, Islam T, Ahmed A, Rakibuz-Zaman M, Hasan R, Sarwar G, Levy D, van Geen A, Ahsan H.

BMJ. 2011 May 5;342:d2431. doi: 10.1136/bmj.d2431.


Cadmium exposure and incident peripheral arterial disease.

Tellez-Plaza M, Guallar E, Fabsitz RR, Howard BV, Umans JG, Francesconi KA, Goessler W, Devereux RB, Navas-Acien A.

Circ Cardiovasc Qual Outcomes. 2013 Nov;6(6):626-33. doi: 10.1161/CIRCOUTCOMES.112.000134.


Cadmium exposure and incident cardiovascular disease.

Tellez-Plaza M, Guallar E, Howard BV, Umans JG, Francesconi KA, Goessler W, Silbergeld EK, Devereux RB, Navas-Acien A.

Epidemiology. 2013 May;24(3):421-9. doi: 10.1097/EDE.0b013e31828b0631.


Lead, cadmium, smoking, and increased risk of peripheral arterial disease.

Navas-Acien A, Selvin E, Sharrett AR, Calderon-Aranda E, Silbergeld E, Guallar E.

Circulation. 2004 Jun 29;109(25):3196-201. Epub 2004 Jun 7.

Cardiovascular disease (CVD), the leading cause of death worldwide, causes over 15 million deaths each year. Deaths from CVD have declined in the US over the past 50 years, whereas global mortality rates have risen. Cardiovascular disease is usually attributed to tobacco use, hypertension, diabetes, dietary factors, and lack of physical activity, but toxic chemicals and pollutants are major contributors to CVD mortality.

Lead, a ubiquitous and toxic metal, is causally associated with hypertension and coronary heart disease. Until recently, the number of deaths in the U.S. attributable to lead exposure had not been estimated using a nationally representative cohort. It was also unclear if concentrations of lead in blood below the current action level for adults (5 µg/dL or 50 ppb) were associated with deaths from cardiovascular disease or coronary heart disease. Dr. Bruce Lanphear, Clinician Scientist at the BC Children’s Research Institute and a Professor in the Faculty of Health Sciences at Simon Fraser University, summarized the results of a new study on the number of deaths attributable to lead exposure in the US. He also described the potential contribution of the reduction in lead exposure to the decline in coronary artery disease over the past 50 years. 

Exposure to arsenic and other metals is a major global health problem. Consistent evidence supports that arsenic is a risk factor for cardiovascular disease above 10 µg/L, the current drinking water standard in the US and many other countries. Below 10 µg/L in water, the evidence is increasing although the dose-response relationship is unknown. Dr. Ana Navas-Acien, a physician-epidemiologist and a Professor at the Mailman School of Public Health at Columbia University, presented and discussed experimental and epidemiologic evidence assessing the dose-response between arsenic and multiple health endpoints including data from the Strong Heart Study, a prospective cohort study of cardiovascular disease and its risk factors in American Indian communities and the HEALS cohort in Bangladesh. Potential interventions to prevent and mitigate the cardiotoxic effects of metals were also presented. 

Particulate air pollution is ubiquitous in modern environments. The composition of air pollution varies from one location to another; however, fine and course particulate matter (PM) and gaseous copollutants such as ozone, nitrogen oxides, and sulfates in particular, have been associated with adverse health effects. Although exposure to PM and associated copollutants has been linked to multiple health outcomes, more than 80% of pre-mature mortality associated with exposure to PM could be attributed to heart disease. Dr. Aruni Bhatnagar, a Smith and Lucille Gibson Professor of Medicine at the University of Louisville, presented current evidence relating to the effects of air pollution on heart disease and discussed the mechanisms underlying the heightened vulnerability of cardiovascular tissues to air pollution exposure.

Featured Speakers

Bruce LanphearBruce Lanphear, MD, MPH, is a Clinician Scientist at the BC Children’s Research Institute and a Professor in the Faculty of Health Sciences at Simon Fraser University in Vancouver, British Columbia. He completed a NIH-funded fellowship in General & Community Pediatrics at the University of Rochester School of Medicine and, from 1997 to 2008, he was the Sloan Professor of Children’s Environmental Health at Cincinnati Children’s Hospital Medicine Center. Over the past decade, Dr. Lanphear has become increasingly vexed by our inability to control the “pandemic of consumption” – the largely preventable, pandemic of chronic disease and disability due to widespread exposure to industrial pollutants, environmental contaminants and excess consumption. He is leading an effort to produce videos to enhance public understanding of how our health is inextricably linked with the environment and elevate efforts to prevent disease. 


Ana Navas-AcienAna Navas-Acien, PhD, MD, MPH, is a Professor of Environmental Health Sciences at Columbia University Mailman School of Public Health. Her research investigates the long-term health effects of widespread environmental exposures (arsenic and other metals, tobacco smoke, e-cigarettes, air pollution), their interactions with genetic and epigenetic variants, and effective interventions for reducing involuntary environmental exposures. For more than 10 years she has been working on environment-related research in population-based cohort studies such as the Strong Heart Study, a study of cardiovascular disease and its risk factors in American Indian communities, and the Multi-Ethnic Study of Atherosclerosis (MESA), a study of cardiovascular, metabolic and lung disease in urban settings across the US. Both in the US and internationally, she conducts research to evaluate exposure to tobacco smoke including emerging public health challenges such as waterpipe smoking and e-cigarettes. Her research goals are to contribute to the reduction of environmental health disparities in both general and disproportionately exposed populations.


Aruni BhatnagarAruni Bhatnagar, PhD, FAHA, is widely regarded for spearheading the new field of Environmental Cardiology. Dr. Aruni Bhatnagar, a Smith and Lucille Gibson Professor of Medicine at the University of Louisville, has spent more than 25 years studying the impact of toxic substances, tobacco smoke constituents and environmental pollutants on heart disease. He is a graduate of Kanpur University, India and received his post-doctoral training at the University of Texas Medical Branch at Galveston. Dr. Bhatnagar is known for his pioneering work on the metabolism of toxic substances in ambient air and tobacco smoke, and how they affect the development of cardiovascular disease and diabetes. He has published over 225 research papers, commentaries and review articles, and 20 book chapters. A leader in cardiovascular health, he has participated in more than 50 peer-review panels of the National Institutes of Health, and has served as a member of the Institute of Medicine’s Committee on Secondhand Smoke Exposure and Acute Coronary Events, as well as the Committee on Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. For the last 7 years, Dr. Bhatnagar has served as Deputy Editor of the American Heart Association journal - Circulation Research. His research has been supported by the National Institutes of Health, the Environmental Protection Agency, the Department of Defense, and the American Heart Association. He currently serves as Director of the Diabetes and Obesity Center, and he was most recently named the new Director of the Envirome Institute, both at the University of Louisville. He also serves as Director of the American Heart Association Tobacco Regulation and Addiction Center. 


This webinar was moderated by Ted Schettler, MD, MPH, CHE's Science Director. It lasted for 60 minutes and was recorded for our call and webinar archive.