Are there associations between drinking water quality parameters (nitrate, water hardness, calcium, magnesium) and mortality from cardiovascular diseases (including coronary heart disease) and colorectal cancer in the Netherlands?
Assessment of drinking water safety (Environ Int 2022, PMID 35760029) — a 10 mg/L increase in magnesium was associated with a reduced risk for coronary heart disease mortality (HR: 0.95, 95% CI: 0.90, 0.99). The abstract for Assessment of drinking water safety states no limitations.
Source: Environ Int 2022, PMID 35760029 ↗ · Research map · How Magellan grades evidence · evidence confidence: medium
Environ Int · 2022 · PMID 35760029 · DOI 10.1016/j.envint.2022.107356
Higher magnesium in drinking water was linked to lower coronary heart disease mortality, while higher calcium and water hardness were linked to increased cardiovascular disease mortality.
The question
Are there associations between drinking water quality parameters (nitrate, water hardness, calcium, magnesium) and mortality from cardiovascular diseases (including coronary heart disease) and colorectal cancer in the Netherlands?
What they tested
The study aims to explore associations, suggesting an underlying hypothesis that such associations might exist, given public concern about long-term intake health risks.
How they did it
A cohort of 6,998,623 Dutch residents aged 30 or older, living at the same address for at least five years as of January 1, 2008, was created using national administrative databases. Drinking water concentrations from 2000-2010 were used as exposure indicators. Age-stratified Cox proportional hazards models were applied to analyze associations between water quality parameters and cause-specific mortality.
What they found
A 10 mg/L increase in magnesium was associated with a reduced risk for coronary heart disease mortality (HR: 0.95, 95% CI: 0.90, 0.99). A 100 mg/L increase in calcium was associated with an increased risk for cardiovascular disease mortality (HR: 1.08, 95% CI: 1.03, 1.13). A 2.5 mmol/L increase in water hardness was associated with an increased risk for cardiovascular disease mortality (HR: 1.06, 95% CI: 1.01, 1.10). An elevated risk for coronary heart disease mortality was observed at calcium concentrations below 30 mg/L, but no overall exposure-response relation was found for calcium. No other statistically significant associations were found for other combinations of water quality parameters and causes of death.
| Magnesium (10 mg/L increase) vs. Coronary Heart Disease Mortality | 0.95 | |
|---|---|---|
| Calcium (100 mg/L increase) vs. Cardiovascular Disease Mortality | 1.08 | |
| Water Hardness (2.5 mmol/L increase) vs. Cardiovascular Disease Mortality | 1.06 |
Hazard Ratios (HR) for mortality per specified increase in drinking water parameters. An HR below 1 indicates reduced risk, while an HR above 1 indicates increased risk.
What it means
This explorative study identified a protective effect of magnesium against coronary heart disease mortality and an increased risk of cardiovascular disease mortality associated with calcium concentration and water hardness in drinking water.
Limitations
The study is explorative, and while it identified associations, it did not establish causality. The abstract does not explicitly state other limitations.
Where the published abstract does not list limitations, we say so rather than inventing them. Read the full paper on PubMed before drawing conclusions.
The paper at a glance
| Title | Assessment of drinking water safety in the Netherlands using nationwide exposure and mortality data |
|---|---|
| Journal | Environ Int |
| Year | 2022 |
| PMID | 35760029 ↗ |
| DOI | 10.1016/j.envint.2022.107356 ↗ |
| Topic | Environment, air, water & exposures |
Read the source: PubMed record (authors, abstract, full citation) ↗ · Publisher via doi.org ↗
Where Magellan uses this paper
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Mineral Remineralization Drops
Observational cohort studies and meta-analyses link higher magnesium intake—including magnesium in drinking water—with lower blood pressure and reduced risk of stroke, heart failure, type-2 diabetes, and all-cause mortality, and randomized controlled trials show that magnesium supplementation modestly lowers blood…
Mineral remineralization drops add dissolved minerals—principally magnesium and calcium—back into water…
Research describes the compound or intervention studied. It is not a claim about any specific product.
Molecules & mechanisms in this paper
Each of these is named in the paper’s own words above. Open the monograph for the full mechanism and its other citations.
Cite this page
These citations point at this summary. To cite the original paper with its full author list, use the PubMed record or doi.org.
Magellan Longevity. (2026). Are there associations between drinking water quality parameters (nitrate, water hardness, calcium, magnesium) and mortality from cardiovascular diseases (including coronary heart disease) and colorectal cancer in the Netherlands? [Plain-English summary of Environ Int 2022, PMID 35760029, DOI 10.1016/j.envint.2022.107356]. Magellan Longevity. https://magellanlongevity.com/study/d35760029.html@misc{magellan_d35760029,
title = {Are there associations between drinking water quality parameters (nitrate, water hardness, calcium, magnesium) and mortality from cardiovascular diseases (including coronary heart disease) and colorectal cancer in the Netherlands?},
author = {{Magellan Longevity}},
year = {2026},
howpublished = {\url{https://magellanlongevity.com/study/d35760029.html}},
note = {Plain-English summary of PubMed PMID 35760029; DOI 10.1016/j.envint.2022.107356; Environ Int 2022. Reviewed by Gabriel Radu, DO},
urldate = {2026-08-11}
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