---
title: "Assessment of drinking water safety in the Netherlands using…"
description: "Higher magnesium in drinking water was linked to lower coronary heart disease mortality, while higher calcium and water hardness were linked to increased…"
url: "https://magellanlongevity.com/study/d35760029.md"
canonical: "https://magellanlongevity.com/study/d35760029.html"
html: "https://magellanlongevity.com/study/d35760029.html"
type: "study"
study_key: "d35760029"
journal: "Environ Int"
year: 2022
pmid: "35760029"
doi: "10.1016/j.envint.2022.107356"
citations: 1
updated: 2026-09-02
author: "Gabriel Radu, DO"
author_credentials: "Physiatrist (PM&R). NY medical license 275110. NPI 1376861765."
publisher: "Magellan Longevity"
content_format: "markdown"
---

# Assessment of drinking water safety in the Netherlands using nationwide exposure and mortality data

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## Citation

| Field | Value |
| --- | --- |
| Journal | Environ Int |
| Year | 2022 |
| PMID | [35760029](https://pubmed.ncbi.nlm.nih.gov/35760029/) |
| DOI | [10.1016/j.envint.2022.107356](https://doi.org/10.1016/j.envint.2022.107356) |
| Study key | d35760029 |

## Takeaway

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?

## Hypothesis

The study aims to explore associations, suggesting an underlying hypothesis that such associations might exist, given public concern about long-term intake health risks.

## Methods

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.

## Results

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.

## Conclusion

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.

## Verbatim from the abstract

> magnesium was associated with a reduced risk for mortality due to coronary heart disease

## Associations Between Drinking Water Parameters and Mortality Risk

| Measure | Hazard Ratio (HR) |
| --- | --- |
| 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.*

## Where this study is used on Magellan

This paper is one of the citations behind the evidence grade on the pages below. Grades are assigned from the published research and are independent of affiliate commissions.

| Compound or device | Evidence grade | Graded pages |
| --- | --- | --- |
| Mineral Remineralization Drops | Emerging evidence | [Mineral Remineralization Drops](https://magellanlongevity.com/p/191.md) |

## Reference

1. **Assessment of drinking water safety in the Netherlands using nationwide exposure and mortality data**
   Environ Int 2022 · [PMID 35760029](https://pubmed.ncbi.nlm.nih.gov/35760029/) · [DOI 10.1016/j.envint.2022.107356](https://doi.org/10.1016/j.envint.2022.107356)

   > magnesium was associated with a reduced risk for mortality due to coronary heart disease

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## Scope and disclosures

Educational information, not medical advice. Nothing here is intended to diagnose, treat, cure, or prevent any disease. Talk to your physician before starting any supplement or device, especially if you are pregnant, nursing, or taking medication.

Editorial firewall: evidence grades are assigned from the published research and are independent of any affiliate commission. As an Amazon Associate, Magellan Longevity earns from qualifying purchases.

Reviewed for accuracy by a board-certified physician (DO).