Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks

Mark P. Little, Tamara V. Azizova, Dimitry Bazyka, Simon D. Bouffler, Elisabeth S C Cardis, Sergey Chekin, Vadim V. Chumak, Francis A. Cucinotta, Florent de Vathaire, Per Hall, John D. Harrison, Guido Hildebrandt, Victor Ivanov, Valeriy V. Kashcheev, Sergiy V. Klymenko, Michaela Kreuzer, Olivier Laurent, Kotaro Ozasa, Thierry Schneider, Soile TapioAndrew M. Taylor, Ioanna Tzoulaki, Wendy L. Vandoolaeghe, Richard Wakeford, Lydia B. Zablotska, Wei Zhang, Steven E Lipshultz

Research output: Contribution to journalArticle

159 Citations (Scopus)

Abstract

Background: Although high doses of ionizing radiation have long been linked to circulatory disease, evidence for an association at lower exposures remains controversial. However, recent analyses suggest excess relative risks at occupational exposure levels. Objectives: We performed a systematic review and meta-analysis to summarize information on circulatory disease risks associated with moderate- and low-level whole-body ionizing radiation exposures. Methods: We conducted PubMed/ISI Thomson searches of peer-reviewed papers published since 1990 using the terms "radiation" AND "heart" AND "disease," OR "radiation" AND "stroke," OR "radiation" AND "circulatory" AND "disease." Radiation exposures had to be whole-body, with a cumulative mean dose of < 0.5 Sv, or at a low dose rate (< 10 mSv/day). We estimated population risks of circulatory disease from low-level radiation exposure using excess relative risk estimates from this meta-analysis and current mortality rates for nine major developed countries. R esults: Estimated excess population risks for all circulatory diseases combined ranged from 2.5%/Sv [95% confidence interval (CI): 0.8, 4.2] for France to 8.5%/Sv (95% CI: 4.0, 13.0) for Russia. C onclusions: Our review supports an association between circulatory disease mortality and low and moderate doses of ionizing radiation. Our analysis was limited by heterogeneity among studies (particularly for noncardiac end points), the possibility of uncontrolled confounding in some occupational groups by lifestyle factors, and higher dose groups (> 0.5 Sv) generally driving the observed trends. If confirmed, our findings suggest that overall radiation- related mortality is about twice that currently estimated based on estimates for cancer end points alone (which range from 4.2% to 5.6%/Sv for these populations).

Original languageEnglish
Pages (from-to)1503-1511
Number of pages9
JournalEnvironmental Health Perspectives
Volume120
Issue number11
DOIs
StatePublished - Nov 1 2012

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Ionizing Radiation
Meta-Analysis
Radiation
Mortality
Population
Whole-Body Irradiation
Occupational Exposure
PubMed
Heart Diseases
Stroke
Neoplasms
Radiation Exposure

Keywords

  • Cancer
  • Circulatory disease
  • Heart disease
  • Radiation
  • Stroke

ASJC Scopus subject areas

  • Health, Toxicology and Mutagenesis
  • Public Health, Environmental and Occupational Health

Cite this

Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks. / Little, Mark P.; Azizova, Tamara V.; Bazyka, Dimitry; Bouffler, Simon D.; Cardis, Elisabeth S C; Chekin, Sergey; Chumak, Vadim V.; Cucinotta, Francis A.; de Vathaire, Florent; Hall, Per; Harrison, John D.; Hildebrandt, Guido; Ivanov, Victor; Kashcheev, Valeriy V.; Klymenko, Sergiy V.; Kreuzer, Michaela; Laurent, Olivier; Ozasa, Kotaro; Schneider, Thierry; Tapio, Soile; Taylor, Andrew M.; Tzoulaki, Ioanna; Vandoolaeghe, Wendy L.; Wakeford, Richard; Zablotska, Lydia B.; Zhang, Wei; Lipshultz, Steven E.

In: Environmental Health Perspectives, Vol. 120, No. 11, 01.11.2012, p. 1503-1511.

Research output: Contribution to journalArticle

Little, MP, Azizova, TV, Bazyka, D, Bouffler, SD, Cardis, ESC, Chekin, S, Chumak, VV, Cucinotta, FA, de Vathaire, F, Hall, P, Harrison, JD, Hildebrandt, G, Ivanov, V, Kashcheev, VV, Klymenko, SV, Kreuzer, M, Laurent, O, Ozasa, K, Schneider, T, Tapio, S, Taylor, AM, Tzoulaki, I, Vandoolaeghe, WL, Wakeford, R, Zablotska, LB, Zhang, W & Lipshultz, SE 2012, 'Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks', Environmental Health Perspectives, vol. 120, no. 11, pp. 1503-1511. https://doi.org/10.1289/ehp.1204982
Little, Mark P. ; Azizova, Tamara V. ; Bazyka, Dimitry ; Bouffler, Simon D. ; Cardis, Elisabeth S C ; Chekin, Sergey ; Chumak, Vadim V. ; Cucinotta, Francis A. ; de Vathaire, Florent ; Hall, Per ; Harrison, John D. ; Hildebrandt, Guido ; Ivanov, Victor ; Kashcheev, Valeriy V. ; Klymenko, Sergiy V. ; Kreuzer, Michaela ; Laurent, Olivier ; Ozasa, Kotaro ; Schneider, Thierry ; Tapio, Soile ; Taylor, Andrew M. ; Tzoulaki, Ioanna ; Vandoolaeghe, Wendy L. ; Wakeford, Richard ; Zablotska, Lydia B. ; Zhang, Wei ; Lipshultz, Steven E. / Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks. In: Environmental Health Perspectives. 2012 ; Vol. 120, No. 11. pp. 1503-1511.
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T1 - Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks

AU - Little, Mark P.

AU - Azizova, Tamara V.

AU - Bazyka, Dimitry

AU - Bouffler, Simon D.

AU - Cardis, Elisabeth S C

AU - Chekin, Sergey

AU - Chumak, Vadim V.

AU - Cucinotta, Francis A.

AU - de Vathaire, Florent

AU - Hall, Per

AU - Harrison, John D.

AU - Hildebrandt, Guido

AU - Ivanov, Victor

AU - Kashcheev, Valeriy V.

AU - Klymenko, Sergiy V.

AU - Kreuzer, Michaela

AU - Laurent, Olivier

AU - Ozasa, Kotaro

AU - Schneider, Thierry

AU - Tapio, Soile

AU - Taylor, Andrew M.

AU - Tzoulaki, Ioanna

AU - Vandoolaeghe, Wendy L.

AU - Wakeford, Richard

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AU - Zhang, Wei

AU - Lipshultz, Steven E

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N2 - Background: Although high doses of ionizing radiation have long been linked to circulatory disease, evidence for an association at lower exposures remains controversial. However, recent analyses suggest excess relative risks at occupational exposure levels. Objectives: We performed a systematic review and meta-analysis to summarize information on circulatory disease risks associated with moderate- and low-level whole-body ionizing radiation exposures. Methods: We conducted PubMed/ISI Thomson searches of peer-reviewed papers published since 1990 using the terms "radiation" AND "heart" AND "disease," OR "radiation" AND "stroke," OR "radiation" AND "circulatory" AND "disease." Radiation exposures had to be whole-body, with a cumulative mean dose of < 0.5 Sv, or at a low dose rate (< 10 mSv/day). We estimated population risks of circulatory disease from low-level radiation exposure using excess relative risk estimates from this meta-analysis and current mortality rates for nine major developed countries. R esults: Estimated excess population risks for all circulatory diseases combined ranged from 2.5%/Sv [95% confidence interval (CI): 0.8, 4.2] for France to 8.5%/Sv (95% CI: 4.0, 13.0) for Russia. C onclusions: Our review supports an association between circulatory disease mortality and low and moderate doses of ionizing radiation. Our analysis was limited by heterogeneity among studies (particularly for noncardiac end points), the possibility of uncontrolled confounding in some occupational groups by lifestyle factors, and higher dose groups (> 0.5 Sv) generally driving the observed trends. If confirmed, our findings suggest that overall radiation- related mortality is about twice that currently estimated based on estimates for cancer end points alone (which range from 4.2% to 5.6%/Sv for these populations).

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KW - Circulatory disease

KW - Heart disease

KW - Radiation

KW - Stroke

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