BACKGROUND Inorganic arsenic in drinking water (wAs) is linked to atherosclerosis and cardiovascular disease. However, risk is uncertain at lower levels present in US community water supplies (CWS), currently regulated at the federal maximum contaminant level of 10μg/L. OBJECTIVES We evaluated the relationship between long-term wAs exposure from CWS and cardiovascular disease in the California Teachers Study cohort. METHODS Using statewide health care administrative records from enrollment through follow-up (1995-2018), we identified fatal and nonfatal cases of ischemic heart disease (IHD) and cardiovascular disease (CVD). Participants' residential addresses were linked to a network of CWS boundaries and annual wAs concentrations (1990-2020). Most participants resided in areas served by a CWS (92%). Exposure was calculated as a time-varying, 10-year moving average up to a participant's event, death, or end of follow-up. Using Cox models, we estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of IHD or CVD. We evaluated wAs exposure categorized by concentration thresholds relevant to regulation standards (<1.00, 1.00-2.99, 3.00-4.99, 5.00-9.99, ≥10μg/L) and continuously using a log2-transformation (i.e., per doubling). Models were adjusted for baseline age, neighborhood socioeconomic status, race/ethnicity, body mass index (BMI), and smoking status. We also stratified analyses by age, BMI, and smoking status. RESULTS Our analysis included 98,250 participants, 6,119 IHD cases, and 9,936 CVD cases. The HRs for IHD at concentration thresholds (reference, <1μg/L) were 1.06 (95% CI: 1.00, 1.12), 1.05 (95% CI: 0.94, 1.17), 1.20 (95% CI: 1.02, 1.41), and 1.42 (95% CI: 1.10, 1.84) for 1.00-2.99μg/L, 3.00-4.99μg/L, 5.00-9.99μg/L, and ≥10μg/L, respectively. HRs for every doubling of wAs exposure were 1.04 (95% CI: 1.02, 1.06) for IHD and 1.02 (95% CI: 1.01, 1.04) for CVD. We observed statistically stronger risk among those ≤55 vs. >55 years of age at enrollment (pinteraction=0.006 and 0.012 for IHD and CVD, respectively). DISCUSSION Long-term wAs exposure from CWS, at and below the regulatory limit, may increase cardiovascular disease risk, particularly IHD. https://doi.org/10.1289/EHP14410.

中文翻译：

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加州教师研究中女性长期接触社区供水中的砷和患心血管疾病的风险。


背景 饮用水中的无机砷 （wAs） 与动脉粥样硬化和心血管疾病有关。然而，美国社区供水 （CWS） 中存在的较低水平的风险是不确定的，目前联邦最高污染水平为 10μg/L。目的 我们在加州教师研究队列中评估了 CWS 的长期 wAs 暴露与心血管疾病之间的关系。方法 使用从入组到随访 （1995-2018） 的全州医疗保健管理记录，我们确定了缺血性心脏病 （IHD） 和心血管疾病 （CVD） 的致死性和非致死性病例。参与者的居住地址与 CWS 边界和年度 wAs 浓度网络 （1990-2020） 相关联。大多数参与者居住在 CWS 服务的地区 （92%）。暴露计算为直到参与者事件、死亡或随访结束的 10 年移动平均值。使用 Cox 模型，我们估计了 IHD 或 CVD 风险的风险比 （HRs） 和 95% 置信区间 （95% CIs）。我们评估了按与监管标准相关的浓度阈值 （<1.00， 1.00-2.99， 3.00-4.99， 5.00-9.99， ≥10μg/L） 分类的 wAs 暴露，并连续使用 log2 转化 （即，每次加倍）。根据基线年龄、社区社会经济地位、种族/民族、体重指数 （BMI） 和吸烟状况调整模型。我们还按年龄、BMI 和吸烟状况对分析进行了分层。结果我们的分析包括 98,250 名参与者、6,119 例 IHD 病例和 9,936 例 CVD 病例。浓度阈值 （参考，<1μg/L） IHD 的 HR 为 1.06 （95% CI： 1.00， 1.12）、1.05 （95% CI： 0.94， 1.17）、1.20 （95% CI： 1.02， 1.41） 和 1.42 （95% CI： 1.10， 1.84） 对于 1.00-2.99μg/L、3.00-4.99μg/L、5.00-9。分别为 99μg/L 和 ≥10μg/L。IHD 每增加一倍 wAs 暴露的 HR 为 1.04 （95% CI： 1.02， 1.06），CVD 为 1.02 （95% CI： 1.01， 1.04）。我们观察到 ≤55 岁与 >55 岁入组时的风险在统计学上更强（IHD 和 CVD 的 pinteraction=0.006 和 0.012）。讨论 CWS 的长期 wAs 暴露，达到或低于监管限度，可能会增加心血管疾病风险，尤其是 IHD。https://doi.org/10.1289/EHP14410。