People with heavy exposure to arsenic, lead, cadmium or copper may be more likely to develop cardiovascular disease, a review of existing studies suggests.

While these elements occur naturally in the earth’s crust, certain metals can also appear at unsafe levels in drinking water, food, and air as a result of agricultural and industrial practices, mining, and smoking, the research team notes in The BMJ. Copper and lead, for example, can seep into drinking water from corroded pipes, while arsenic and cadmium can accumulate in groundwater due to runoff from factories and crop irrigation systems and are also found in cigarette smoke.

For the analysis, researchers examined data from 37 earlier studies with a total of almost 350,000 participants. Overall, about 13,000 people had heart attacks, bypass surgery or other events related to heart disease and about 4,200 had a stroke.

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