Association Between Occupational Exposure to Pesticides and Cardiovascular Disease Incidence: The Kuakini Honolulu Heart Program

J Am Heart Assoc. 2019 Oct;8(19):e012569. doi: 10.1161/JAHA.119.012569. Epub 2019 Sep 25.


Background Previously, Kuakini Honolulu Heart Program researchers reported that occupational exposure to pesticides was significantly associated with total mortality. The current study examines occupational exposure to pesticides in relation to incident cardiovascular disease, defined as coronary heart disease or cerebrovascular accident. Methods and Results With the Occupational Safety Health Administration exposure scale used as an estimate of exposure, statistical analyses were performed on a cohort of 7557 Japanese-American men from the Kuakini Honolulu Heart Program. Hazard ratios for cardiovascular disease incidence were calculated for various levels of pesticide exposure using Cox proportional hazards models. In the first 10 years of follow-up, a positive association was observed between age-adjusted cardiovascular disease incidence and high levels of pesticide exposure (hazard ratio=1.46, 95% CI=1.10-1.95, P=0.009). This relationship remained significant after adjustment for other cardiovascular disease risk factors (hazard ratio=1.42, 95% CI=1.05-1.92, P=0.021). No significant association for coronary heart disease or cerebrovascular accident incidence with pesticide exposure was observed when examined separately, possibly due to a smaller number of events. Conclusions These findings suggest that occupational exposure to pesticides may play a role in the development of cardiovascular diseases. The results are novel, as the association between occupational exposure to pesticides and cardiovascular disease incidence has not been examined previously in this unique cohort.

Keywords: Honolulu Heart Program; Honolulu‐Asia Aging Study; cardiovascular disease; cerebrovascular accident; coronary heart disease; occupational exposure; pesticide exposure.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Agricultural Workers' Diseases / chemically induced*
  • Agricultural Workers' Diseases / diagnosis
  • Agricultural Workers' Diseases / epidemiology*
  • Hawaii / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Occupational Exposure / adverse effects*
  • Occupational Health*
  • Pesticides / adverse effects*
  • Risk Assessment
  • Risk Factors


  • Pesticides