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Increased intima-media thickness in rayon workers after long-term exposure to carbon disulfide
Axel Schramm1, Wolfgang Uter2, Meike Brandt3
1Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany. axel.schramm@uk-erlangen.de.
Introduction:
Long-term exposure to carbon disulfide (CS2) is associated with increased cardiovascular mortality. However, previous studies on actual vascular changes showed heterogeneous results. Intima-media thickness of the carotid arteries (IMT) represents an established marker of atherosclerosis and a reasonable surrogate marker for cardiovascular risk. IMT was examined in a large cohort of CS2 exposed workers and the association with cumulative CS2 exposure analysed.
Methods:
In a cross-sectional examination, 290 exposed and 137 non-exposed workers in a German rayon-manufacturing plant were assessed. Individual cumulative exposure was calculated from this assessment combined with the results of two cross-sectional studies in 1992 and 1999 and department-specific annual means of ambient (CECS2) and individual biological (CETTCA) monitoring results obtained 1992-2009. Furthermore, cumulative duration of working in CS2-exposed departments (CEYEARS) was calculated. Examination included assessment of a broad set of known cardiovascular risk factors and IMT measurement of the carotid arteries on both sides. Multiple linear regression analyses were performed with IMT as outcome and three variants of cumulative exposure (duration of exposure, cumulative CS2, and cumulative TTCA) as well as categorised maximum CS2 exposure, all adjusted for cardiovascular risk factors.
Results:
All models of cumulative exposure showed a significant increase in IMT in the group with the highest level of exposure: CEYEARS > 20 years, β = 0.045 mm; CECS2 > 270 ppm × years, β = 0.052 mm; CETTCA > 33 mg/g creatinine × years, β = 0.038 mm. Alternatively, addressing maximum exposure, workers with CS2 exposure of >10 ppm in at least 3 years exhibited a significant IMT increase (β = 0.068 mm).
Conclusion:
Long-term CS2 exposure is an independent risk factor concerning IMT changes. The amount of IMT increase, in a similar range as that associated with other cardiovascular risk factors, might be clinically relevant.
