The protective role of hard drinking water against cardiovascular diseases is well documented by numerous studies. This article describes the impact of Ca and Mg contents in the drinking water with different water hardness on the cardiovascular system (arterial stiffness, arterial age) of residents of the Krupina district, the Slovak Republic. The research was based on the measurements of arterial stiffness, including the measurements of aortic pulse wave velocity (PWVao) and the calculation of the arterial age of the residents. In total, 144 randomly selected residents were included in measurements, divided into the two groups according to Ca and Mg contents in drinking water (water hardness). The first group was supplied with soft drinking water (total dissolved solids (TDS): 200–300 mg·L⁻¹, Ca: 20–25 mg·L⁻¹, Mg: 5–10 mg·L⁻¹). The second group of residents was supplied with harder drinking water (TDS: 500–600 mg·L⁻¹, Ca: 80–90 mg·L⁻¹, Mg: 25–30 mg·L⁻¹). Differences in arterial stiffness between the two groups of respondents were documented. Higher arterial stiffness (low flexibility of arteries) was determined for a group of residents supplied with soft drinking water. This was reflected in higher PWVao levels, higher number of pathological cases (PWVao > 10 m·s⁻¹), and arterial age of respondents compared to their actual age. The “absolute” difference between the arterial and actual age between the two evaluated groups of residents (soft vs. harder water) was nearly 5 years on average. The higher arterial stiffness and age of residents that consumed soft drinking water indicate the health significance of lower contents of Ca and Mg in drinking water as an environmental risk factor of cardiovascular diseases. Measuring arterial stiffness of residents in the areas supplied with soft drinking water can be used as a non-invasive approach in the prevention of cardiovascular risks.

The US EPA health risk assessment method is currently widely used to assess human health risks for many environmental constituents. It is used for risk assessment from the exposure to various contaminants exceeding tolerable or safe reference doses, determined e.g., for drinking water, soil, air and food. It accepts widely that excess contents of non-essential elements (e.g., As, Pb or Sb) in environmental compartments represent a general risk to human health. However, contrary to toxic trace elements, deficient contents of essential (biogenic) elements e.g., F, I, Se, Zn, Fe, Ca or Mg may represent even higher health risk. Therefore, we propose to extend the human health risk assessment by calculating the health risk for deficient content and intake of essential elements, and to introduce the terms Average Daily Missing Dose (ADMD), Average Daily Required Dose (ADRD) and Average Daily Accepted Dose (ADAD). We propose the following equation to calculate the Hazard Quotient (HQ) of health risk from deficient elements: HQ_d = ADRD/ADAD. At present, there are no reference concentrations or doses of essential elements in each environmental compartment in world databases (Integrated Risk Information System IRIS, The Risk Assessment Information System RAIS). ADRD and ADMD can be derived from different regulatory standards or guidelines (if they exist) or calculated from actual regional data on the state of population health and content of essential elements in the environment, e.g., in groundwater or soil. This methodology was elaborated and tested on inhabitants of the Slovak Republic supplied with soft drinking water with an average Mg content of 5.66 mg·L⁻¹. The calculated ADMD of Mg for these inhabitants is 0.314 mg·kg⁻¹·day⁻¹ and HQ_d is equal to 2.94, indicating medium risk of chronic diseases. This method extending traditional health risk assessment is the first attempt to quantify deficient content of essential elements in drinking water. It still has some limitations but also has potential to be further developed and refined through its testing in other countries.