Ionising radiation and cardiovascular disease: systematic review and meta-analysis.

Humans Cardiovascular Diseases / epidemiology Myocardial Ischemia / epidemiology Risk Factors France Radiation, Ionizing Coronary Artery Disease / complications

Journal

BMJ (Clinical research ed.)
ISSN: 1756-1833
Titre abrégé: BMJ
Pays: England
ID NLM: 8900488

Informations de publication

Date de publication:
08 03 2023
Historique:
entrez: 8 3 2023
pubmed: 9 3 2023
medline: 11 3 2023
Statut: epublish

Résumé

To systematically review and perform a meta-analysis of radiation associated risks of cardiovascular disease in all groups exposed to radiation with individual radiation dose estimates. Systematic review and meta-analysis. Excess relative risk per unit dose (Gy), estimated by restricted maximum likelihood methods. PubMed and Medline, Embase, Scopus, Web of Science Core collection databases. Databases were searched on 6 October 2022, with no limits on date of publication or language. Animal studies and studies without an abstract were excluded. The meta-analysis yielded 93 relevant studies. Relative risk per Gy increased for all cardiovascular disease (excess relative risk per Gy of 0.11 (95% confidence interval 0.08 to 0.14)) and for the four major subtypes of cardiovascular disease (ischaemic heart disease, other heart disease, cerebrovascular disease, all other cardiovascular disease). However, interstudy heterogeneity was noted (P<0.05 for all endpoints except for other heart disease), possibly resulting from interstudy variation in unmeasured confounders or effect modifiers, which is markedly reduced if attention is restricted to higher quality studies or those at moderate doses (<0.5 Gy) or low dose rates (<5 mGy/h). For ischaemic heart disease and all cardiovascular disease, risks were larger per unit dose for lower dose (inverse dose effect) and for fractionated exposures (inverse dose fractionation effect). Population based excess absolute risks are estimated for a number of national populations (Canada, England and Wales, France, Germany, Japan, USA) and range from 2.33% per Gy (95% confidence interval 1.69% to 2.98%) for England and Wales to 3.66% per Gy (2.65% to 4.68%) for Germany, largely reflecting the underlying rates of cardiovascular disease mortality in these populations. Estimated risk of mortality from cardiovascular disease are generally dominated by cerebrovascular disease (around 0.94-1.26% per Gy), with the next largest contribution from ischaemic heart disease (around 0.30-1.20% per Gy). Results provide evidence supporting a causal association between radiation exposure and cardiovascular disease at high dose, and to a lesser extent at low dose, with some indications of differences in risk between acute and chronic exposures, which require further investigation. The observed heterogeneity complicates a causal interpretation of these findings, although this heterogeneity is much reduced if only higher quality studies or those at moderate doses or low dose rates are considered. Studies are needed to assess in more detail modifications of radiation effect by lifestyle and medical risk factors. PROSPERO CRD42020202036.

Identifiants

DOI: 10.1136/bmj-2022-072924 PMID: 36889791 PMC: PMC10535030
pubmed: 36889791
doi: 10.1136/bmj-2022-072924
pmc: PMC10535030
doi:

Types de publication

Meta-Analysis Systematic Review Journal Article Research Support, N.I.H., Intramural Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

e072924

Subventions

Organisme : NCI NIH HHS
ID : R01 CA197422
Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: AJE has received speaker fees from Ionetix; has received consulting fees from WL Gore & Associates; has received authorship fees from Wolters Kluwer Healthcare–UpToDate; and has received grants to his institution from Attralus, Canon Medical Systems, Eidos Therapeutics, GE Healthcare, Pfizer, Roche Medical Systems, WL Gore & Associates, and XyloCor Therapeutics; none of these are related to the present work. Otherwise no other authors declare any competing interests.

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Auteurs

Mark P Little (MP)

Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA mark.little@nih.gov.
ORCID: 0000-0003-0980-7567

Tamara V Azizova (TV)

Clinical Department, Southern Urals Biophysics Institute, Ozyorsk, Chelyabinsk Region, Russia.

David B Richardson (DB)

Department of Environmental and Occupational Health, Irvine Program in Public Health, University of California Irvine, Irvine, CA, USA.

Soile Tapio (S)

Technische Universität München, Munich, Germany.

Marie-Odile Bernier (MO)

Institut de Radioprotection et de Sureté Nucléaire, Fontenay aux Roses, France.

Michaela Kreuzer (M)

Federal Office for Radiation Protection, Neuherberg, Germany.

Francis A Cucinotta (FA)

Department of Health Physics and Diagnostic Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.

Dimitry Bazyka (D)

National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.

Vadim Chumak (V)

National Research Center for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.

Victor K Ivanov (VK)

Medical Radiological Research Center of Russian Academy of Medical Sciences, Obninsk, Russia.

Lene H S Veiga (LHS)

Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA.

Alicia Livinski (A)

National Institutes of Health Library, National Institutes of Health, Bethesda, MD, USA.

Kossi Abalo (K)

Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
Department of Immunology Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden.

Lydia B Zablotska (LB)

Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Andrew J Einstein (AJ)

Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA.

Nobuyuki Hamada (N)

Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Komae, Tokyo, Japan.

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