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Chapter 110: Environment and Heart Disease

Toxic chemicals in the environment are significant causes of disease, specifically cardiovascular disease. Which of the following substances is known to be cardiotoxic?

A. Air pollution

B. Metals

C. Organophosphate insecticides

D. Nitrates

E. All of the above

The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 110) Substances known to be cardiotoxic include air pollution (option A);1,2 metals (option B),3 including lead, mercury, arsenic, cobalt, and thallium; halogenated hydrocarbons, including chlorinated, brominated, and fluorinated compounds; organophosphate insecticides (option C); nitrates (option D); and carbon disulfide.

Which of the following cardiovascular diseases is linked to toxic chemical exposures in the environment?

A. Hypertension

B. Arrhythmias

C. Peripheral vascular injury

D. Both A and B are correct

E. All of the above are correct

The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 110) Diseases of the heart and cardiovascular system that are linked to toxic chemical exposures in the environment include arrhythmias (option B), hypertension (option A), peripheral vascular injury (option C), cardiomyopathy, acute myocardial infarction (MI), stroke, and sudden death. Toxic chemicals that disrupt endocrine signaling can increase the risk for cardiovascular disease by causing elevated lipid levels and increasing the risk for obesity, the metabolic syndrome, and diabetes.4,5 There is a high likelihood that beyond the known cardiotoxic chemicals, there are other chemicals in the modern environment whose toxicity to the heart and cardiovascular system has not yet been recognized.6 These undiscovered cardiotoxins will be found hidden in plain sight among the > 80,000 new synthetic chemicals that have been invented in the past half century, which are used widely in consumer products, and which because of failure of stewardship by the chemical industry and by governments have never been tested for safety or toxicity.6 People are widely exposed to these materials, and annual national surveys conducted by the Centers for Disease Control and Prevention find measurable levels of > 100 untested synthetic chemicals in the bodies of virtually all Americans.7

What is the most important source of atmospheric particulates in the developed, modern urban environment?

A. Household air pollution

B. Combustion of fossil fuels

C. Agricultural operations


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