Mercury exposure, cardiovascular disease, and mortality: A systematic review and dose-response meta-analysis

Background: There is evidence that exposure to mercury (Hg) may be a risk factor for cardiovascular disease (CVD). Objective: To conduct a systematic review of published studies and a meta-analysis of the results to examine the associations between chronic Hg exposure and CVD outcomes. Methods: We searched PubMed, Embase, and TOXLINE using previously developed strategies. Studies were selected according to a priori-defined inclusion criteria, and their qualities were assessed. Study estimates were extracted, and subgroup analyses were conducted to explore potential sources of heterogeneity: 1) fatal vs. nonfatal events, 2) cohort study vs. non-cohort study, and 3) inorganic Hg vs. methyl mercury (MeHg). Dose response meta-analyses were conducted for MeHg exposure and fatal/nonfatal ischemic heart disease (IHD), stroke, and all CVD. Results: A total of 14 studies reporting results collected from more than 34,000 participants in 17 countries were included in the meta-analysis. Hg exposure was associated with an increase in nonfatal IHD (relative risk (RR): 1.21 (0.98, 1.50)), all-cause mortality (RR: 1.21 (0.90, 1.62)), CVD mortality (RR: 1.68 (1.15, 2.45)), and mortality due to other heart diseases (RR: 1.50 (1.07, 2.11)). No association was observed between Hg exposure and stroke. A heterogeneous relationship was found between studies reporting fatal and nonfatal outcomes and between cohort and non-cohort studies. However, these differences were mainly due to differences in Hg exposure level. Occupational inorganic Hg exposure was associated with similar increases in different mortality outcomes. A J-shaped relationship between Hg exposure and different fatal/nonfatal outcomes was observed, with turning points at hair Hg concentrations of 1 mu g/g for IHD and 2 mu g/g for stroke and all CVD. Conclusion: Chronic exposure to Hg was associated with an increased risk of all-cause mortality and fatal/ nonfatal IHD. The risk of multiple cardiovascular endpoints starts to increase consistently at a hair Hg concentration of 2 mu g/g.

Automated summary

The study found a relationship between chronic exposure to mercury and cardiovascular diseases, including nonfatal ischemic heart disease and various causes of mortality, but not stroke. Different study types and exposure levels may affect the heterogeneity of study results. A hair mercury concentration of 2 μg/g was identified as a key point where cardiovascular disease risks start to increase.