Exploration of Cardiology

Table 1

Clues and pitfalls for the role of toxic metals in the risk of CHD

Clues	References	Pitfalls	References
As
Associated with developmental and cardiovascular outcomes in humans	[40]	Few observational studies conducted	[13, 22, 45, 46]
Potential teratogen	[39–44]	Inconsistent results due to differences in the study design, sample size, and methods of exposure assessment	[13, 22, 45, 46]
Significant associations with total CHD and septal defects	[22, 45, 46]	Lack of information on As levels in food and possibility of recall bias on dietary habits	[46]
Cd
Associations with outcomes in the cardiovascular system	[84]	Few and inconsistent data because of heterogeneity between studies	[14, 22, 89]
Association with congenital anomalies and other adverse reproductive outcomes	[85–88]
Association observed between co-exposure to Cd and other toxic elements and CHD	[90]
Pb
Associated with adverse effects at birth and somewhat with certain subgroups of congenital anomalies	[107, 108]	Heterogeneity among studies due to different measurement sources	[22]
	[107, 108]	Small sample size of studies	[109]
Hg
Evidence for an association birth outcomes	[132–135]	Few studies performed with conflicting results	[13, 22]
Association with NTD in human and animal studies	[41, 136–139]	Few studies performed with conflicting results	[13, 22]