Water arsenic exposure and endothelial dysfunction in Bangladeshi adolescents

BACKGROUND AND AIM: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, with ~80% of CVD-related deaths occurring in low- and middle-income countries. Growing evidence suggests that chronic arsenic (As) exposure may contribute to CVD through its effect on endothelial dysfunction in adults. However, few studies have examined the influence of As exposure on cardiovascular health in children and adolescents. METHODS: To examine As’s relation to preclinical markers of endothelial dysfunction, we enrolled 200 adolescent children (ages 15-19 years; median: 17) of adult participants in the Health Effects of Arsenic Longitudinal Study (HEALS), in Araihazar, Bangladesh. Participant’s water As exposure was determined by recall of lifetime well usage. Wells are color coded to indicate As level (10 µg/L, 10-50 µg/L, 50 µg/L As). Endothelial function was measured by recording fingertip arterial pulsatile volume change using Endo-PAT2000 (Itamar Medical) and reactive hyperemia index (RHI) score, an independent CVD risk factor, was calculated from these measurements. RESULTS:In linear regression models adjusted for sex, age, education and weight at the time of RHI measurement, individuals who reported always using wells with ≥50 µg/L As had a lower level of RHI by 11.62% (95% CI: -20.94, -1.16, p=0.03), as compared to participants who drank exclusively from wells with 50 µg/L As. Sex-stratified analyses suggest that these associations were stronger in female participants. The use of wells with ≥50 µg/L As was associated with 14.87% lower RHI (95% CI: -25.59, -2.60, p=0.02) in females, as compared to 5.05% lower RHI (95% CI: -21.81, 15.29, p=0.60) in males for the same comparison. CONCLUSIONS:Our results suggest that chronic As exposure may be related to endothelial dyfunction and vascular reactivity in adolescents, with potential differences by sex. Further work is needed to confirm these findings and examine whether these changes may increase risk of later adverse cardiovascular health effects. KEYWORDS: Arsenic, adolescents, cardiovascular health, endothelial function, Bangladesh