AbstractMechanistic evidence suggests that arsenic expo-sure from drinking water increases the production of reactive oxygen species and influences inflammatory responses and endothelial nitric oxide homeostasis. These arsenic-induced
events may lead to endothelial dysfunction that increases the risk of atherosclerosis and cardiovascular disease. We reviewed accumulating epidemiologic evidence that evaluated the association between arsenic exposure and intermediate markers and subclinical measures that predict future cardio vascular risk. Cross-sectional studies have indicated positive associations between high or low-to-moderate levels of arse-nic exposure with indices of subclinical atherosclerosis, QT interval prolongation, and circulating markers of endothelial dysfunction. The evidence is limited for other intermediate endpoints such as markers of oxidative stress and inflamma-tion, QT dispersion, and lipid profiles. Prospective studies are needed to enhance the causal inferences of the effects of arsenic on subclinical endpoints of cardiovascular disease, especially at lower arsenic exposure levels. Keywords Arsenic exposure.Cardiovascular disease. Subclinical atherosclerosis.QTc prolongation.Oxidative stress .Inflammation .Endothelial dysfunction. Susceptibility