Int Arch Occup Environ Health (1997) 70: 61±66 Ó Springer-Verlag 1997

ORIGINAL ARTICLE

Hsien-Wen Kuo á Jim-Shoung Lai á Mike Lin á Eai-Seung Su

Effects of exposure to carbon disul®de (CS2) on electrocardiographic

features of ischemic heart disease among viscose rayon factory workers

Received: 29 August 1995 / Accepted: 17 January 1997

Abstract The objective of the study was to evaluate

viscose plant workers for electrocardiographic manifes-
tations resulting from exposure to carbon disul®de
(CS2). A total of 162 workers (118 in an exposure group
and 44 in a reference group) were evaluated using a
health questionnaire, physical check-up, biochemical
analysis of blood samples and electrocardiograms
(ECG). The exposure group consisted of workers in the
following areas: viscose manufacturing, cellophane
processing, ripening, and ®lament spinning. Reference
group workers were from the administrative oce,
rolling area, pulp processing, and testing oce. Only
slight di€erences were found in the biochemical analyses
of the two groups, with the exception of sodium (Na)
levels. Personal and area sampling results were found to
have a high variation due to di€erent locations within
the plant and a wide range of manufacturing processes.
Highest CS2 concentrations were found in the ripening
area (54.60 ppm) and the ®lament spinning area
(19.60 ppm). Using a multiple logistic regression model
to control variables (age, gender, body mass index, du-
ration of employment, cholesterol, smoking, and alco-
hol), we found a relative risk for ECG abnormalities
4.18 times signi®cantly higher for the exposure group.
The authors feel that the installation of an adequate
ventilation system could greatly reduce the risk of
workers developing CS2-induced cardiovascular abnor-
malities.
Key words Carbon disul®de á ECG testing á Viscose
rayon factory
H.-W. Kuo (&) á J.-S. Lai á M. Lin á E.-S. Su
Institute of Environmental Health, China Medical College,
91 Hsueh-Shin Road, Taichung,
Taiwan, Republic of China
Fax: (886) 4-2019901
Introduction
Within the rayon manufacturing industry, the use of
carbon disul®de (CS2) as a solvent is widespread, par-
ticularly in the areas of cellophane casting and ®lament
spinning. In 1979, the World Health Organization
(WHO 1979) conducted a study which determined that
at low concentrations with long-term exposure, CS2
toxicity may harm many organ systems, including the
neurological and cardiovascular systems. Regarding the
latter, prolonged CS2 exposure can lead to atheroscle-
rosis and ischemic heart disease (Benowitz 1990).
In the USA, allowable exposure levels vary from
3 mg/m3 (National Institute for Occupational Safety
and Health, NIOSH) to 30 mg/m3 (American Confer-
ence of Governmental Industrial Hygienists, ACGIH)
compared with 60 mg/m3 in Taiwan (Taiwan Porvincial
Labor Department, 1992). In an Occupational Safety
and Health Administration Study (OSHA 1978), ex-
posed workers had a 2.5±5 times greater risk of devel-
oping coronary heart disease. In 1968 Gavrilescu
published a study evaluating the e€ects of CS2 exposure.
After exposing 138 workers in a rayon manufacturing
plant to levels of CS2 varying from 20 to 42 mg/m3,
30.4% exhibited signs of atherosclerosis and 23.2% hy-
pertension. Triglyceride and cholesterol levels were also
reported to be abnormally elevated. In 1984 Sugimoto
et al. tested rayon workers in a plant in the People's
Republic of China. Results of fundus, blood pressure,
and cholesterol tests showed no di€erences between ex-
posure and reference groups due to a low level (6 mg/
m3) of CS2 exposure. In 1987 Sweetnam et al. studied the
e€ects of CS2 exposure on ischemic heart disease in
rayon plant workers. They found that CS2 exposure was
highest in the ®lament spinning area. These workers had
the highest standardized mortality ratio (SMR) of any
workers in the plant. In 1988 MacMahon and Monson
found results consistent with Sweetnam's and the former
noted increased rates of atherosclerosis and suicide in his
study group (MacMahon and Monson 1988). In 1991
62

Kamal et al. evaluated CS2 exposure levels of 20±45 ppm Statistical methods
on 362 rayon manufacturing workers. Using electro-
Using an SAS software package (SAS 1992) the chi-square test,
cardiogram (ECG) analysis, a signi®cant di€erence be- t-test, and logical regression were applied to analyze the data. The
tween the reference and exposure groups was found in overall level of signi®cance was set at 0.05.
long P duration, QRS, R±R, P±R, and Q±T intervals.
However, Kamal did not ®nd a clear link between long-
term exposure and increased risk of cardiovascular ab- Results
normalities (Kamal et al. 1991). Drexler et al. (1995)
asserted there are no consistent data linking exposure to Personal characteristics listed in Table 1 re¯ect the fact
CS2 and development of coronary heart disease. The that the exposure group consisted of 113 males and 5
present study is signi®cant because it was the ®rst of its females. Variables such as average height and weight,
kind conducted in Taiwan. The objective was to evaluate drinking and smoking habits, and body mass index
the e€ect of CS2 exposure on the cardiovascular system. (BMI) were much higher in the exposure group. Simi-
larities between the groups included age (approximately
50 years) and duration of work experience (approxi-
Materials and methods mately 25 years). Education levels for all subjects was
Subjects
relatively low (67.8% completed elementary school and
6.0% completed college/university in the exposure group
The subjects comprised 162 workers with a minimum of 1 year's and 52.3% and 6.8% in the reference group, respec-
work in a viscose rayon plant in central Taiwan. A questionnaire tively). The di€erence in prevalence of diseases was
was used to determine personal data (age, height, weight, gender, nonsigni®cant between the two groups. Approximately
level of education, smoking history, and alcohol consumption),
occupational history (duration of employment, previous jobs, and 9% of all subjects underwent treatment for an existing
use of personal protective equipment), and medical history (fo- cardiovascular condition. Exposure group results found
cusing speci®cally on the cardiovascular system). 8.5% of subjects had hypertension and 5.8% had pre-
The exposure group consisted of 118 workers in the manufac- vious diagnosis of renal diseases. Equivalent ®gures in
turing areas (viscose manufacturing, cellophane processing, ripen-
ing, and ®lament spinning). The reference group was 44 workers in the reference group were 11.4% and 5.9%, respectively.
non-manufacturing areas (administration, rolling, pulp processing, Table 2 shows much higher results for the exposure
laboratory work). Concentrations of CS2 were assessed using area group in terms of area sampling and personal sampling.
and personal sampling methods. A preliminary estimate of CS2 Area sampling for the exposure group showed that
levels in the manufacturing area was made using a detection tube.
Result were used to determine area and personal sampling pro-
cesses. Samples were collected using activated charcoal (SKC cat.
no. 226-01, 100 mg/50 mg) through which air was passed at a rate Table 1 Characteristics of workers in carbon disul®de (CS2)
of 100 ml/min using a calibrated pump (SKC, model 222-3). Area exposure and reference groups
samples of CS2 were collected at a height of 100±150 cm from 26
di€erent locations, all within the main manufacturing area. Per- Variable Exposure group Reference group
sonal sampling apparatus was ®tted on 26 workers' collars, near the (n ˆ 118) (n ˆ 44)
mouth. Samples were collected using charcoal and desorbed with
toluene then analyzed using gas chromatography with ¯ame pho- Age (year)a 49.8 ‹ 7.6 51.3 ‹ 4.3
tometric detector (FPD). Desorption eciency of the charcoal tube (24±63) (41±74)
was determined by the spiked tube method at 1/2, 1 and 2 times the Duration of 23.7 ‹ 9.4 25.6 ‹ 7.0
threshold limit value (TLV). The average desorption eciency was employment (year)a (1±36) (4±36)
93.2%. Height (cm)* a 164.5 ‹ 6.4 161.5 ‹ 6.5
A complete medical examination was performed by a physician (147±185) (149±176)
according to standard procedures. The following were measured: Weight (kg)* a
65.4 ‹ 9.6 61.9 ‹ 10.6
blood pressure, height, weight, alanine aminotransferase (ALT), (45±95) (43±92)
aspartate aminotransferase (AST), serum cholesterol (T-CHL), BMI(kg/cm2)a 24.2 ‹ 3.1 23.6 ‹ 3.0
triglyceride (TG), high-density lipoprotein (HDL), low-density li- (16.3±33.0) (18.5±33.2)
poprotein (LDL), very low-density lipoprotein (VLDL), electrolyte Gender ratio (M/F)* 113/5 26/18
levels (sodium, potassium, calcium), ECG levels (Mecordisuny 501 Levels of education
BX, Fukuda, Tokyo). The ECGs were evaluated by two board- Elementary school 80 (67.8%) 23 (52.3%)
certi®ed cardiologists, who had no previous knowledge of the Junior school 19 (16.0%) 8 (18.2%)
subjects with regard to medical history or exposure to CS2. Senior school 12 (10.2%) 10 (22.7%)
Workers were required to avoid physical activity and smoking for College/university 7 (6.0%) 3 (6.8%)
at least 1 h prior to the medical examination. The ECG apparatus Smoke cigarettes* 63 (55.2%) 12 (27.2%)
was calibrated regularly under 1 mV, producing 10 mm de¯ection, Consume alcohol* 53 (46.5%) 11 (25.0%)
with a paper speed of 25 mm/s. Subjects were tested for heart rate Consume co€ee 7 (5.9%) 5 (11.4%)
and rhythm, QRS duration, P±R and Q±T intervals ST segment Prevalence of diseases
depression, left axis deviation (LAD), left ventricular hypertrophy Hypertension 10 (8.5%) 5 (11.4%)
(LVH) and right axis deviation (RAD) (Table 4). All diagnostic Heart diseases 11 (9.2%) 4 (9.1%)
criteria were de®ned according to Sokolow's criteria (Sokolow et al. Diabetes mellitus 5 (4.2%) 1 (2.3%)
1990). ECG abnormal criteria included: cardiac arrhythmia, Renal diseases 7 (5.8%) 3 (6.9%)
chamber enlargement, abnormal axis deviation, abnormal heart Asthma 3 (2.5%) 0 (0.0%)
rate, conduction disturbance, and myocardial ischemia. Two
*
medical examinations were conducted on the workers in 1990 and P < 0.05
a
1992. Consistent measurement was found to be kappa = 0.8. Means ‹ SD (range)