A Systematic Review of Epidemiological Associations between Low and Moderate Doses of Ionizing Radiation and Late Cardiovascular Effects, and Their Possible Mechanisms (original) (raw)
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1 January 2008 A Systematic Review of Epidemiological Associations between Low and Moderate Doses of Ionizing Radiation and Late Cardiovascular Effects, and Their Possible Mechanisms
M. P. Little,E. J. Tawn,I. Tzoulaki,R. Wakeford,G. Hildebrandt,F. Paris,S. Tapio,P. Elliott
Author Affiliations +
M. P. Little,1,* E. J. Tawn,2,** I. Tzoulaki,1 R. Wakeford,3 G. Hildebrandt,4 F. Paris,5 S. Tapio,6,7 P. Elliott1
1aDepartment of Epidemiology and Public Health, Imperial College Faculty of Medicine, London W2 1PG,
2bWestlakes Research Institute, Cumbria, CA24 3JY, United Kingdom
3cDalton Nuclear Institute, University of Manchester, Pariser Building, Manchester, M60 1QD, United K
4dDepartment of Radiotherapy and Radiation Oncology, University of Leipzig, 04103 Leipzig, Germany
5eINSERM U 601, Department of Cancer Research, University of Nantes, 44093 Nantes Cedex 01, France
6fFederal Office for Radiation Protection, Department of Radiation Protection and Health, 85764 Neuhe
7gGSF, Institute of Radiation Biology, 85764 Oberschleissheim, Germany
* Address for correspondence: Department of Epidemiology and Public Health, Imperial College Faculty of Medicine, Norfolk Place, London W2 1PG, UK; mark.little@imperial.ac.uk
** Current address: University of Central Lancashire, Westlakes Science Park, Moor Row, Cumbria, CA24 3JY, UK
Abstract
Little, M. P., Tawn, E. J., Tzoulaki, I., Wakeford, R., Hildebrandt, G., Paris, F., Tapio, S. and Elliott, P. A Systematic Review of Epidemiological Associations Between Low and Moderate Doses of Ionizing Radiation and Late Cardiovascular Effects, and Their Possible Mechanisms. Radiat. Res. 169, 99–109 (2008).
The link between high doses of ionizing radiation and damage to the heart and coronary arteries is established. In this paper, we systematically review the epidemiological evidence for associations between low and moderate doses (<5 Gy) of ionizing radiation and late-occurring cardiovascular disease. Risks per unit dose in epidemiological studies vary over at least two orders of magnitude, possibly a result of confounding factors. An examination of possible biological mechanisms indicates that the most likely causative effect of radiation exposure is damage to endothelial cells and subsequent induction of an inflammatory response, although it seems unlikely that this would extend to low-dose and low-dose-rate exposure. However, a role for somatic mutation has been proposed that would indicate a stochastic effect. In the absence of a convincing mechanistic explanation of epidemiological evidence that is less than persuasive at present, a cause-and-effect interpretation of the reported statistical associations cannot be reliably inferred, although neither can it be reliably excluded. Further epidemiological and biological evidence will allow a firmer conclusion to be drawn.
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M. P. Little, E. J. Tawn, I. Tzoulaki, R. Wakeford, G. Hildebrandt, F. Paris, S. Tapio, and P. Elliott "A Systematic Review of Epidemiological Associations between Low and Moderate Doses of Ionizing Radiation and Late Cardiovascular Effects, and Their Possible Mechanisms," Radiation Research 169(1), 99-109, (1 January 2008). https://doi.org/10.1667/RR1070.1
Received: 20 April 2007; Accepted: 1 August 2007; Published: 1 January 2008
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