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      Does Water Hardness Have Preventive Effect on Cardiovascular Disease?

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          Abstract

          Background:

          The aim of this study is to investigate the association of calcium and magnesium concentration of drinking water with cardiovascular disease (CVDs) in urban and rural areas of a city in Iran.

          Methods:

          This case-control study was conducted in 2012 in Khansar County in Isfahan province, Iran. We used the official data of the Provincial health center regarding the chemical analysis data of urban and rural areas including the hardness, calcium and magnesium content of drinking water. Data of patients hospitalized for CVD in the only specialty hospital of the city was gathered for the years of 2010 and 2011.

          Results:

          In 2010, water calcium content above 72 mg/L was associated with reduced number of CVDs in 1000 population; whereas in 2011 this decrease in CVDs was observed for calcium levels of more than 75 mg/L. In 2010, the level of water Mg content ranged from 23 to 57 mg/L. By increasing Mg hardness level above 31 mg/L in 2010 and above 26 mg/L in 2011 were associated with decreased number of CVDs in 1000 people. decrease.

          Conclusions:

          Our study suggests favorable protective effects of water hardness, mainly water magnesium content, on CVDs. Water hardness, as well as calcium and magnesium content of drinking water may have a protective role against CVDs. Further experimental studies are necessary to determine the underlying mechanisms and longitudinal studies are required to study the clinical impacts of the current findings.

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          Most cited references13

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          Potential Health Impacts of Hard Water

          In the past five decades or so evidence has been accumulating about an environmental factor, which appears to be influencing mortality, in particular, cardiovascular mortality, and this is the hardness of the drinking water. In addition, several epidemiological investigations have demonstrated the relation between risk for cardiovascular disease, growth retardation, reproductive failure, and other health problems and hardness of drinking water or its content of magnesium and calcium. In addition, the acidity of the water influences the reabsorption of calcium and magnesium in the renal tubule. Not only, calcium and magnesium, but other constituents also affect different health aspects. Thus, the present review attempts to explore the health effects of hard water and its constituents.
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            Relationship between Tap Water Hardness, Magnesium, and Calcium Concentration and Mortality due to Ischemic Heart Disease or Stroke in the Netherlands

            Background Conflicting results on the relationship between the hardness of drinking water and mortality related to ischemic heart disease (IHD) or stroke have been reported. Objectives We investigated the possible association between tap water calcium or magnesium concentration and total hardness and IHD mortality or stroke mortality. Methods In 1986, a cohort of 120,852 men and women aged 55–69 years provided detailed information on dietary and other lifestyle habits. Follow-up for mortality until 1996 was established by linking data from the Central Bureau of Genealogy and Statistics Netherlands. We calculated tap water hardness for each postal code using information obtained from all pumping stations in the Netherlands. Tap water hardness was categorized as soft [ 2.0 mmol/L CaCO3). The multivariate case-cohort analysis was based on 1,944 IHD mortality and 779 stroke mortality cases and 4,114 subcohort members. Results For both men and women, we observed no relationship between tap water hardness and IHD mortality [hard vs. soft water: hazard ratio (HR) = 1.03; 95% confidence interval (CI), 0.85–1.28 for men and HR = 0.93; 95% CI, 0.71–1.21 for women) and stroke mortality (hard vs. soft water HR = 0.90; 95% CI, 0.66–1.21 and HR = 0.86; 95% CI, 0.62–1.20, respectively). For men with the 20% lowest dietary magnesium intake, an inverse association was observed between tap water magnesium intake and stroke mortality (HR per 1 mg/L intake = 0.75; 95% CI, 0.61–0.91), whereas for women with the 20% lowest dietary magnesium intake, the opposite was observed. Conclusions We found no evidence for an overall significant association between tap water hardness, magnesium or calcium concentrations, and IHD mortality or stroke mortality. More research is needed to investigate the effect of tap water magnesium on IHD mortality or stroke mortality in subjects with low dietary magnesium intake.
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              Spatial Analysis of the Relationship between Mortality from Cardiovascular and Cerebrovascular Disease and Drinking Water Hardness

              Previously published scientific papers have reported a negative correlation between drinking water hardness and cardiovascular mortality. Some ecologic and case–control studies suggest the protective effect of calcium and magnesium concentration in drinking water. In this article we present an analysis of this protective relationship in 538 municipalities of Comunidad Valenciana (Spain) from 1991–1998. We used the Spanish version of the Rapid Inquiry Facility (RIF) developed under the European Environment and Health Information System (EUROHEIS) research project. The strategy of analysis used in our study conforms to the exploratory nature of the RIF that is used as a tool to obtain quick and flexible insight into epidemiologic surveillance problems. This article describes the use of the RIF to explore possible associations between disease indicators and environmental factors. We used exposure analysis to assess the effect of both protective factors—calcium and magnesium—on mortality from cerebrovascular (ICD-9 430–438) and ischemic heart (ICD-9 410–414) diseases. This study provides statistical evidence of the relationship between mortality from cardiovascular diseases and hardness of drinking water. This relationship is stronger in cerebrovascular disease than in ischemic heart disease, is more pronounced for women than for men, and is more apparent with magnesium than with calcium concentration levels. Nevertheless, the protective nature of these two factors is not clearly established. Our results suggest the possibility of protectiveness but cannot be claimed as conclusive. The weak effects of these covariates make it difficult to separate them from the influence of socioeconomic and environmental factors. We have also performed disease mapping of standardized mortality ratios to detect clusters of municipalities with high risk. Further standardization by levels of calcium and magnesium in drinking water shows changes in the maps when we remove the effect of these covariates.
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                Author and article information

                Journal
                Int J Prev Med
                Int J Prev Med
                IJPVM
                International Journal of Preventive Medicine
                Medknow Publications & Media Pvt Ltd (India )
                2008-7802
                2008-8213
                February 2014
                : 5
                : 2
                : 159-163
                Affiliations
                [1]Department of Environmental Health Engineering, Isfahan University of Medical Sciences, Isfahan, Iran
                [1 ]Department of Environmental Engineering, Environment Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                [2 ]School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
                Author notes
                Correspondence to: Parinaz Poursafa, Environment Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: p.poursafa@ 123456hlth.mui.ac.ir
                Article
                IJPVM-5-159
                3950737
                976decca-634c-44b1-be38-6a0d166bb38c
                Copyright: © International Journal of Preventive Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 June 2013
                : 30 November 2013
                Categories
                Original Article

                Health & Social care
                calcium,cardiovascular disease,iran,magnesium,water hardness
                Health & Social care
                calcium, cardiovascular disease, iran, magnesium, water hardness

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