Exposure to insulating materials and risk of coronary artery diseases: a cross-sectional study

Our plain-English summary of Exposure to insulating materials and risk of coronary artery diseases: a cross-sectional study, by S. Moitra, A.F. Tabrizi, F. Khadour, et al (Frontiers in Public Health, 2023).

The study

• Authors: S. Moitra, A.F. Tabrizi, F. Khadour, L. Henderson, L. Melenka, P. Lacy
• Journal: Frontiers in Public Health
• Published: 2023;11:1235189
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Although previous reports link exposure to insulating materials with an increased risk of mesothelioma and chronic respiratory diseases, studies evaluating their associations with the risk of coronary artery diseases (CAD) are lacking.

Aims: We aimed at evaluating the associations between exposure to insulating materials and the 10-year risk of CAD among insulators.

Methods: In this cross-sectional study, we recruited 643 adults (≥18 years), full-time insulators from the Local 110 Heat and Frost Insulators and Allied Workers Union in Edmonton, Alberta. We obtained demographic information, personal and family history, and job-exposure history, including experience (years) and types of exposure to insulating materials. Clinical profiling including Framingham risk scores (FRS) was assessed.

Results: Of all insulators, 89% were men (mean ± SD age: 47 ± 12 years), 27% had a parental history of cardiac diseases, and 22% had a comorbid chronic respiratory disease. In total, 53% reported exposure to asbestos, while 61, 82, and 94% reported exposure to ceramic fibers, fiberglass, and mineral fibers, respectively. In single-exposure multivariable regression models adjusted for experience, marital status, and body mass index (BMI), asbestos was found to be associated with higher FRS (β: 1.004; 95%CI: 0.003-2.00). The association remained consistent in multi-exposure models and a higher association was found between asbestos exposure and FRS among insulators with comorbid chronic respiratory disease.

Conclusion: Our study demonstrates that apart from cancer and chronic respiratory diseases, asbestos exposure may also have a cardiac effect, thus warranting the need for systematic surveillance to protect workers from the adverse effects of these materials.

Copyright © 2023 Moitra, Tabrizi, Khadour, Henderson, Melenka and Lacy.

In plain English

This cross-sectional study asked whether insulators' exposure to insulating materials was linked to predicted heart disease risk. The authors screened 843 members of the Local 110 Heat and Frost Insulators and Allied Workers Union in Edmonton, Alberta, between 2011 and 2014. Excluding people with heart and certain other conditions left 643 insulators (89% men, average age 47). Each worker reported yes or no exposure to several materials, and 53% reported asbestos. The outcome was the Framingham risk score, a calculated 10-year cardiovascular risk estimate, not diagnosed disease. After adjustment for marital status, body mass index and years in insulation work, only asbestos was linked to a higher score (coefficient 1.004; 95% confidence interval (CI) 0.003 to 2.00). This association was significantly larger (interaction p = 0.007) among insulators with chronic respiratory disease (coefficient 3.05; 95% CI 0.61 to 5.50) than among those without it (coefficient 0.36; 95% CI -0.72 to 1.43, which includes zero). The authors concluded that asbestos exposure is associated with a higher risk of coronary artery disease. They stated that the design could not show cause, and that asbestos type and level were not measured.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional study of union insulators
• Who was studied: 843 unionized insulators from the Local 110 Heat and Frost Insulators and Allied Workers Union in Edmonton, Alberta, Canada, recruited 2011 to 2014. After excluding those with current or previous heart and certain other conditions, 643 were analyzed: 571 (89%) men, mean age 47 (SD 12) years.
• Exposure: Self-reported yes/no occupational exposure to insulating materials: aerogels, asbestos, calcium silicate, carbon fibers, ceramic fibers, fiberglass and mineral fibers. 343 of 643 (53%) reported asbestos exposure. The type of asbestos and the exposure level were not recorded.
• Main results:
  • Mean Framingham risk score among the 643 insulators was 7.3 (SD 6.6).
  • In unadjusted single-exposure models, asbestos, ceramic fibers and fiberglass were each associated with higher Framingham risk score (coefficients ranging from 1.28 to 4.66; all p less than 0.05).
  • In adjusted single-exposure models (marital status, BMI, years of insulation work), only asbestos remained significantly associated with higher Framingham risk score: coefficient 1.004 (95% CI 0.003 to 2.00).
  • In a model including all exposures together, only asbestos remained associated with higher Framingham risk score: coefficient 1.08 (95% CI 0.05 to 2.10).
  • The coefficient for asbestos was 1.14 (95% CI 0.06 to 2.23) in men and -0.18 (95% CI -1.31 to 0.97) in women, but the difference between the sexes was not statistically significant (p = 0.13).
  • The association between asbestos and Framingham risk score was larger among insulators with chronic respiratory disease (coefficient 3.05; 95% CI 0.61 to 5.50) than among those without (0.36; 95% CI -0.72 to 1.43; p for interaction 0.007).
  • Alcohol use, physical activity outside work and parental history of heart disease did not have a clinically important influence on the associations.
• The authors' conclusion: The authors concluded that occupational exposure to insulation materials, particularly asbestos, is associated with a higher risk of coronary artery disease in insulators. They added that they could not confirm the association as a cause.
• Limitations the authors state:
  • The cross-sectional design could not establish a causal link between asbestos exposure and coronary artery disease.
  • Exposure was recorded only as yes or no. The level of exposure, the specific type of asbestos or other fiber, and cumulative exposure were not measured.
  • Details of personal protective equipment use were not available.
  • No detailed biochemical studies, such as oxidative stress assessment, were performed.
  • There was no detailed information on other workplace exposures such as physical and chemical agents or heat and cold.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Insulator, Exposure History, Mineral Fiber, Asbestos Exposure.

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