ORIGINAL ARTICLE

Exposure to cobalt in the production of cobalt and cobalt compounds and its effect on the heart

A Linna¹, P Oksa², K Groundstroem³, M Halkosaari⁴, P Palmroos², S Huikko², J Uitti²

¹ Kokkola Zinc Oy, Kokkola, Finland
² Tampere Regional Institute of Occupational Health, Tampere, Finland and Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland
³ Tampere School of Public Health, University of Tampere, and Department of Medicine, Tampere University Hospital, Tampere, Finland
⁴ Keski-Pohjanmaa Central Hospital, Kokkola, Finland

Correspondence to:
Correspondence to:
Dr A Linna
PO Box 26, 67101 Kokkola, Finland; asko.linna{at}boliden.com

Aims: To investigate whether exposure to cobalt in cobalt plants has any measurable effect on the cardiovascular system.

Methods: Occupational, cross sectional study, using a self administered questionnaire, blood pressure measurement, electrocardiography, and laboratory tests in which 203 male workers with at least one year of exposure to cobalt and 94 unexposed controls participated. Echocardiography was performed on a subset of 122 most highly exposed cobalt workers, of which 109 were analysed, and on 60 controls, of which 57 were analysed. Analysis of covariance and a multiple regression analysis were used to evaluate the data.

Results: Two of the echocardiography parameters measured were associated with cobalt exposure. In the higher exposure group the left ventricular isovolumic relaxation time (mean 53.3, 49.1, and 49.7 ms in the high exposure, low exposure, and control groups respectively) and the deceleration time of the velocity of the early rapid filling wave (mean 194.3, 180.5, and 171.7 ms for those in the high exposure, low exposure, and control groups respectively) were prolonged, indicating altered left ventricular relaxation and early filling.

Conclusion: Cumulative exposure to cobalt was found to be associated with the results of Doppler echocardiography measurements, indicating altered diastole. This finding supports the hypothesis that cobalt accumulation in the myocardium could affect myocardial function. Whether this finding has clinical implications remains to be evaluated.

Abbreviations: DT, deceleration time; ECG, electrocardiography; EF, ejection fraction; FS, fractional shortening; IVRT, isovolumic relaxation time; IVSD, diastolic interventricular septum; LVEDD, left ventricular end diastolic diameter; LVPWD, left ventricular posterior wall; S-ANP-N, N-terminal atrial natriuretic peptide; S-CDT, carbohydrate deficient transferrin; S-GT, gamma-glutamyl transferase

Keywords: cardiomyopathy; cobalt exposure; work related heart disease

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