Since many years we have tried to demonstrate that certain writers overestimate medical consequences of low-dose exposure to ionizing radiation [1,2], well in agreement with the interests of governments selling petroleum and natural gas. The overestimation contributes to the strangulation of nuclear energy, supporting appeals to dismantle nuclear power plants (NPPs). The use of atomic energy for electricity production is on the agenda today due to growing needs of the humankind. NPPs are compact thus preserving land. Health risks and environmental damage are maximal for coal and oil, lower for natural gas and much lower for atomic energy - the cleanest, safest and practically inexhaustible energy resource [3,4].

Worldwide annual doses from the natural background radiation (NBR) are generally expected to be in the range of 1-10 mSv, with 2.4 mSv being the estimated global average [5]. Some national averages are ≥10 mSv [6]. In Europe, mean annual doses from NBR are ≥5-7 mSv in several countries [7]. The average annual dose to residents of the Russian Federation (RF) in 2020 ranged from 2.47 mSv (Kamchatka) to 9.06 mSv (Altai) with a mean value 4.18 mSv [8]. There are many populated places in the world where the dose rate from NBR is 10-100 times higher than the global average e.g. 260 mGy/year in Ramsar, Iran [9], or 70 mGy/year at some locations in Kerala, India, with no health risks reliably proven [9-11]. According to the UNSCEAR, “as far as whole body doses are concerned, the six million residents of the areas of the former SU deemed contaminated received average effective doses for the period 1986-2005 of about 9 mSv, whereas for the 98 million people considered in the three republics, the average effective dose was 1.3 mSv, a third of which was received in 1986. This represents an insignificant increase over the dose due to background radiation over the same period (~50 mSv)” [12]. Individual doses in exposed cohorts of the Urals are comparable (discussed below). Outside the former Soviet Union (SU), individual doses from the Chernobyl fallout were much lower: the first year doses after the accident reached 1 mSv only at singular locations in Central Europe; all country overages being ≤1 mSv/year [13]. For comparison, a CT scan produces a dose within the range 2-20 mSv [14]. Annual individual doses in the vicinity of NPPs have been estimated in the range 0.001-0.5 mSv [5].

The Chernobyl accident has been exploited to strangle the worldwide development of atomic energy [3]; but it was necessary for a certain period: nuclear technologies should have been prevented from spreading to countries governed by unpredictable regimes. Today the latter definition is applicable to RF and some other militarized nations. There are no thinkable alternatives to nuclear energy these days: non-renewable energy sources will become more expensive, contributing to excessive population growth in fossil fuel producing countries and poverty elsewhere. The worldwide introduction of the nuclear power is a necessity, but it will be possible only after a concentration of authority in a powerful international executive based in most developed countries. It would enable construction of nuclear facilities in optimally suitable places, regardless of national borders, considering all socio-political, geological and other conditions. Obviously, durable peace is needed because nuclear facilities are potential war targets.

The overpopulation leads to overcrowding, pollution of air and water. Ecological damage and depletion of non-renewable resources are proportional to the population size. Humankind can choose to check population growth by reducing the birth rate - instead of raising the death rate by means of wars, famine, and epidemics, as it was throughout the history. The ongoing industrial development of the previously underdeveloped countries is precarious because environment protection measures are observed less rigorously there and, most importantly, because of the large scale of this process, proportional to the population size. Exhaustion of fossil fuel resources and environmental pollution provide another argument in favor of the nuclear energy. Producers of gas and oil are obviously interested in overestimation of biological effects of low-dose exposures to ionizing radiation in order to strangle the development of nuclear energy.

These days, the single most important consideration against nuclear facilities is that they are potential war targets. Escalation of military conflicts contributes to boosting fossil fuel prices. Chernobyl accident has been exploited for the same purpose. According to our observations, the unofficial directive to exaggerate Chernobyl consequences was issued in the former SU in the late 1980s - early 1990s, when studies of that kind were started or planned e.g. [15,16]. Apparently, some foreign nationals have followed the directive from Moscow. Today there are no alternatives to the nuclear power; especially for Europe, where large hydroelectric power stations cannot be built.

Previously we have commented on some works by Alfred Körblein, Hagen Scherb and co-workers [17,18]. Using mathematical calculations, Körblein alleged a cause-effect relationship of the Chernobyl fallout with perinatal mortality increase in the former SU and even in Western Europe; references and comments are in [18]. The following arguments should be recollected in this connection: (1) correlations (especially weak ones) do not prove causality; (2) there have been potent social confounding factors in action since 1986; (3) vested interests: initially after the Chernobyl accident prevailed the aspiration after international aid and cooperation; later on, the interests of fossil fuel producers have predominated; (4) data from the former SU may have been manipulated in accordance with the above-mentioned interests; (5) shutdowns of NPPs in Germany make the country dependent on Russia; (6) variations of natural background radiation (NBR) worldwide are larger than average surplus from Chernobyl on contaminated territories let alone non-contaminated ones. Cancer-related and other aspects of the problem have been discussed elsewhere [1,19].

This mini-review is focused on cardio- and cerebrovascular conditions. The circulatory diseases have been chosen for this analysis because some claimed risks for low radiation doses, discussed here and elsewhere [2,20], are apparently far from reality. Unrealistic cardiovascular risks at low-dose exposures call in question cancer-related and other risks reported by the same researchers. Recent systematic review of radiation and cardiovascular diseases (CVD) highlighted substantial inter-study heterogeneity [21]. The author agrees with Mark P. Little [22] that some Russian mortality data are likely to be unreliable and should therefore not be used for epidemiologic analysis, in particular, certain worker studies e.g. [23-26]. A narrative review, analyzing mechanisms, may be more informative than systematic one, embracing together data of different reliability.

This is a narrative review based both on the international literature and Russian-language publications. The search was performed mainly on the PubMed and other databases, on the Internet, in libraries and the electronic database eLibrary.ru. The data from the literature have been reviewed and synthesized on the basis of the author's observations since the 1970s [27].

In earlier publications by Russian researchers no cancer incidence elevation was reported in cohorts with average exposures ≤0.5 Sv or among employees of the Mayak Production Association (MPA - one of the largest and oldest nuclear facilities in RF) [28-33]. The absolute risk of leukemia per 1 Gy and 10000 man-years was found to be 3.5-fold smaller in the Techa river cohort compared to the Life Span Study (LSS) of atomic bomb survivors in Japan. This was reasonably explained by a higher efficiency of the acute exposure compared to chronic one. Later on, the same researchers started claiming similar risks for cancer and other diseases in the Techa river, MPA and East Urals Radioactive Trace (EURT) cohorts, on one hand, vs. atomic bomb survivors on the other hand [34-36]. Similarly, an earlier study found a reduction of cancer mortality in the EURT cohort compared with the general population [31]. An earlier review confirmed the same level of both cancer and all-cause mortality in the EURT cohort and the control [29]. In a later report based on the same cohort, the authors avoided direct comparisons but fitted their data into a linear model. The configurations of dose-response curves are inconclusive but the authors claimed an elevated cancer risk in the EURT population [37]. An unofficial directive was apparently behind this ideological shift noticed around the year 2005. Trimming of statistics has been not unusual in the former SU [38]. Potential motives have been discussed previously: financing, international help after the Chernobyl accident, publication pressure, writing of dissertations and papers for scientific careers, stirring anti-nuclear protests in other countries and strangulation of nuclear energy for the boosting of fossil fuel prices. Some publications about radioactive contaminations in the former SU have common features: large volume, plentiful details and mathematical calculations, but no clear insight into medical consequences. Supposed associations of cardio- and cerebrovascular conditions with low-dose radiation exposure are discussed below. Obvious overestimation of radiation-related cardiovascular risks casts doubt on analogous cancer data by the same and other scientists [2]. More details are in [2,39].

In earlier reports, an incidence elevation of cardio- and cerebrovascular diseases, if even found in MPA, Techa river and EURT populations, was not accompanied by a mortality increase [40-42]. This can be reasonably explained by a greater diagnostic effectiveness in people having higher doses with recording of mild and questionable cases. However, in a recent paper based on the MPA cohort, an increased excess relative risk (ERR/Gy) of mortality from ischemic heart disease was claimed for the low-dose range of 5-50 mGy/year [43]. Enhanced risks of CVD were alleged for Chernobyl, MPA, Techa river and EURT populations, where average doses have been comparable with those from NBR, overviewed in the Introduction above. The doses in studied populations have been protracted over decades: the MPA workers were employed since 1948-1982. For example, the mean dose of gamma-radiation was 0.54 Gy in men and 0.44 Gy among women in a MPA cohort study, where the incidence of arteriosclerosis in lower limbs was reported to correlate with the accumulated dose [44]. Average doses in the Techa river cohort were 34-35 mGy; while the follow-up was since the 1950s [45], so that the dose rates were comparable with NBR. The authors acknowledged that the risks for doses ≤0.1 Gy may be smaller than those calculated on the basis of the linear model [46].

The uncertain and biased data should not be used for calculations of the Dose and Dose Rate Effectiveness Factor (DDREF). Earlier publications from RF stressed the higher biological efficiency of acute exposures compared to chronic and fractionated ones [30]. Later on, the same scientists claimed that the International Commission on Radiological Protection (ICRP) underestimates cancer risks from chronic exposures, and suggested to use DDREF = 1.0, which implies an equal damage from acute and chronic exposure of the same accumulated dose [47]. The latter is evidently incongruous with dose rates comparable to those from NBR. The “inverse dose-fractionation effect” (more damage from protracted than from acute exposures), claimed by some researchers for exposures ≤0.1 Gy [48], was probably caused by bias or artefacts. Dose-effect relationships after low-dose exposures should be clarified in experiments.

It has been rightly noted in a review that a “diagnosis (by a physician knowing the patient’s history) could vary with dose” [21]. We have emphasized this bias long-since [2,49]. Mild and borderline derangements are more often diagnosed in exposed people due to more thorough examinations and the subjects’ attention to their own health. Certainly, suchlike bias pertains not only to cardiovascular but also to other diseases. Besides, there is a strong confounding factor due to the fact that, at least in the former SU, there is a tendency to overuse CVD in death certificates, which has influenced official statistics [50]. Numerous cases of unclear death have statistically been embraced as caused by CVD. The relatively high incidence and mortality of CVD in exposed populations can be explained by the screening effect with registration of mild cases especially in persons with higher doses, additionally confounded by unsubstantiated postmortem diagnoses [50].

A recent study based on the MPA cohort analyzed 9469 cases of cerebrovascular diseases including 2078 strokes. The following statements seem to be contradictory: “Cerebrovascular diseases incidence was found to be significantly associated with cumulative radiation dose” and “No significant associations of either stroke or its types with cumulative gamma-ray dose of external exposure or alpha-particle dose of internal exposure were found” [51]. It can be reasonably expected that with more arterial occlusions and stenoses there would be more strokes. An explanation for the discrepancy is the dose-dependent diagnostic quality and the screening effect especially in subjects with higher doses, where mild and borderline conditions would be recorded more frequently. On the contrary, strokes are usually diagnosed based on distinct morphological and/or clinical criteria, the overdiagnosis being less probable. The authors [51] should have concluded that there was no incidence increase of stroke after the low dose exposures. By including overdiagnosed mild conditions, they were able to produce a conclusion that low-dose radiation elevates the frequency of cerebrovascular diseases.

The unreliability of data about mild circulatory derangements is confirmed by the following considerations. Greater risks of cerebrovascular diseases at higher doses in females than in males [51] agree with the known tendency that women in Russia care more than men about their health. Middle-aged and elderly males are visibly underrepresented among visitors of healthcare institutions; hence the worldwide greatest gender gaps in the life expectancy: countries of the former SU crown the list (Wikipedia: List of countries by life expectancy). Accordingly, the diagnostics in women is on average more efficient and reliable than in men. Moreover, as mentioned above, atherosclerosis and other age-related cardiovascular conditions have been habitually written into autopsy reports and death certificates without evidence [50].

Another citation to be commented: “The estimates of the cerebrovascular diseases incidence risk significantly decreased with the increasing duration of employment for the entire cohort (p < 0.001)” and, at the same time, “a significant decrease in cerebrovascular diseases incidence risk with increasing attained age was observed in both males and females” [51]. The incidence of cerebrovascular diseases is known to increase with age; so that the above quotes are compatible with a protective role of radiation. Apparently, effects of dose fractionation were confounded by time-related factors, in particular, by the age and time since the exposure start, neither of which had been adjusted for in the studies under discussion. Obviously, accumulated professional exposure would correlate with the employment duration and hence with the age.

The excess relative risk (ERR/Gy) of cerebrovascular conditions among MPA workers was claimed to be even higher than in the LSS [52,53]. Of note, some LSS data assessments are compatible with hormesis [53-56]. For solid cancer mortality including leukemia among atomic bomb survivors, a positive dose response was found for those who received ≤0.5 Sv; but the significance vanished if doses of ≤0.2 Sv were considered [57]. In particular, the data about renal cancer in men were compatible with a U-shaped dose-response and a negative ERR at low-to-moderate doses [55]. A preceding article by the same researchers showed different dose-response curves for males and females [58]. Other studies found no significant risks for kidney cancer from low doses [59,60]. The inter-study heterogeneity makes assessment of risk problematic [48]. Apparently, epidemiological data have too many uncertainties for a reliable evaluation of low-dose effects, let alone ideological bias and data manipulation. More objective data can be received in animal experiments.

Animal Experiments and Radiotherapy

Dose levels associated with cardiac derangements in animal experiments and in humans after radiotherapy have been much higher than averages in the cohorts discussed above [61-64]. Results of experiments are generally not supportive of detrimental effects of low doses, with possible exception of genetically modified cancer-prone or otherwise susceptible animals. In certain experimental and epidemiological studies, low doses turned out to be protective against cardiovascular and other adverse effects i.e. compatible with hormesis [64-70]. The risk of heart disease in humans increases after high-dose therapeutic radiation (typically 30-40 Gy), such as that received for treatment of Hodgkin's lymphoma and breast cancer [71]. Myocardial fibrosis develops after exposures ≥30 Gy. An increased risk of coronary disease has been reported after radiotherapy with doses 7.6-18.4 Gy [62], which is still much higher than averages in the cohorts discussed above. Moreover, cancer patients tend to recollect the circumstances related to radiation better than controls [72]. This recall bias, contributing to dose-effect correlations, might be active also in other diseases. As mentioned in the Introduction, unrealistic cardiovascular risks at low-dose exposures call in question cancer risks reported by the same and other researchers. The overtreatment of supposedly radiation-related lesions has been discussed previously [2,19].

Mechanisms of damage at low doses remain speculative and the evidence inconclusive [48,73]. Summarizing the above and previously published arguments [2,39,49], the harm caused by anthropogenic radiation would tend to zero with a dose rate decreasing down to a wide range level of NBR. The damage and repair are normally in a dynamic equilibrium. Accordingly, there must be an optimal exposure level, as it is for many environmental agents: ultraviolet light, various chemical elements and compounds including products of water radiolysis [74]. Moreover, evolutionary adaptation to a changing environmental factor would lag behind its current value and correspond to some average from the past. NBR has been decreasing during the time of life existence on the Earth [75]. The shape of the dose-response relationship can be predicted on the basis of general considerations. There are many potentially noxious agents in the environment. The lower would be anthropogenic radioactivity, the less would be its share compared to NBR and other environmental factors. In this connection, the following claim is potentially misleading: “When considering the effects of irradiation on human health, it is necessary to clearly distinguish between the effects of increased background radiation to which adaptation can occur over many generations at the population level and the effects of irradiation as a result of accidents or medical procedures” [76]. It is the effective dose and dose rate that are important but not the source - natural vs. anthropogenic. Admittedly, contribution from NBR in some places is mainly due to alpha particles, which may have an effect on tissue specific doses and their effects [77]. Current understanding indicates that while high-LET (linear energy transfer) radiation including alpha rays is generally more potent, the circulatory system is not especially sensitive to it. According to the meta-analysis of biological (not epidemiological) studies, high-LET radiation is only slightly more effective than low-LET radiation, although substantial inter-study heterogeneity complicates interpretation [78]. Dose-effect relationships should be studied in large-scale experiments. Further work in this direction would quantify radiosensitivity of different animal species enabling more precise extrapolations to humans. Dose reconstructions in human populations are often inexact, being compatible with NBR.

The weightiest consideration against NPPs is that they are potential war targets. Therefore, small reactors should be deployed more broadly: they are less vulnerable and can be used by the military [79,80]. Escalation of conflicts contributes to boosting of fossil fuel prices. Apparently, this is one of the motives to unleash the war in Ukraine, of the appeals to use nuclear weapons and declarations of jihad [81,82]. The Chernobyl accident was exploited for the same purpose [3]. By analogy, the war damage and shutdown of the Zaporozhie NPP (the largest in Europe) has elevated demands for fossil fuels.

The author of this article interviewed pathologists, cytologists and other experts, who participated in diagnostics of post-Chernobyl malignancy. Some of them agreed that consequences of the accident had been overestimated, and the role of vested interests was pointed out. It was also stated that sets of histological specimens from a single patient were sometimes subdivided into several ones, creating “dead souls” that influenced statistics. Causes of the overestimation of Chernobyl consequences included unreliability of Chernobyl-related data, originating from the former SU, a nonchalant attitude towards scientific misconduct in general and trimming of statistics in particular [38]. Other potential confounders and uncertainties were discussed by elsewhere [83,84].

As mentioned in the Introduction, the unofficial directive to exaggerate Chernobyl consequences was issued in the late 1980s - early 1990s, when studies of that kind were started or planned e.g. [15,16]. In the beginning, this facilitated international aid and cooperation as well as writing of dissertations and papers for scientific careers. The interpretation of data from exposed cohorts in the Urals has changed later, after the year 2000. This latter change was apparently aimed at the strangulation of nuclear energy i.e. boosting of the fossil fuel prices. Of note, politically motivated misinterpretations have resulted in consequences that likely had greater adverse health effects than radiation e.g. the overtreatment of thyroid and bladder lesions [19,85]. Groundless discussions of congenital malformations with reprinting newspaper images of disfigured children [86,87] may contribute to anxiety in pregnant women thus elevating the abortion rate with interruption of wanted pregnancies [18]. The psychological and social impact of the post-Chernobyl radiophobia is well known.

Today there are no alternatives to the nuclear power; especially for Europe, where large hydroelectric stations cannot be built. The fossil fuels will become increasingly expensive, contributing to excessive population growth in gas- and oil-producing countries and poverty elsewhere. The worldwide use of nuclear energy must be managed by a powerful executive based in the most developed parts of the world. It would prevent nuclear technologies from spreading to politically unstable regions and permit construction of nuclear power plants in optimally suitable places, notwithstanding national borders, considering all socio-political, geophysical and other conditions. In this way, nuclear catastrophes like the Fukushima Daiichi, caused by the earthquake and tsunami, or in Chernobyl, favored by negligence and disregard for written instructions [88,89], would be avoided. The Chernobyl accident caused trans-boundary pollution, being potentially classified as environmental crime [90]. As mentioned above, the accident has been exploited for the strangulation of nuclear energy and boosting fossil fuel prices [3]. Besides, in the beginning, it was used by the ruling class (so-called Nomenklatura [91]) to destabilize the Soviet society in order to privatize the state property. It would be speculation to claim that there was an intention, but nothing can be excluded in a society largely devoid of morality and religion [92]. The number of control rods in the reactor was only half the minimum required for safe operation [93]. An emergency power system had been shut off, which is forbidden during online operations [94]. Reportedly, this was done to conduct an experiment [93,95], which might have been a pretext to cover up sabotage. The crew kept violating instructions until they had run the reactor into the unstable state [94].

Furthermore, the centralized management of the nuclear industry would create jobs for specialists; otherwise the expertise in nuclear physics will relocate to the countries lacking the Green and other sorts of opposition. In future, nuclear fission will be probably replaced by fusion, which is intrinsically safer [96]. Obviously, international trust and cooperation are needed for that. Dismantling of NPPs in Germany and other countries causes increasing dependence on Russia. Displacement of the power to the East will come along with losses of some values such as the independence of science, not to name more general concepts. Europe has been the cradle not only of the modern science, technology and medicine, but also of humanitarian values that are used more or less globally today. Nuclear research and technology employs objectively thinking scientists: the laws of physics are not steerable by directives like man-made laws and mores.

Medical consequences of low-dose exposures to ionizing radiation have been systematically overestimated. This initiative originated from RF and some Green activists, who factually acted on behalf of the fossil fuel producers, contributing to strangulation of atomic energy production. Both the Chernobyl accident and Ukraine war with shutdown of the Europe’s largest NPP have contributed to the maintenance of high fossil fuel prices. The overestimation of the radiation-related harm is most obvious in regard to cardiovascular conditions; whereas the average doses, claimed to be associated with risks in some epidemiological studies, are much lower than those leading to cardiac damage in experiments and after radiotherapy. The overestimation of radiation-related cardiovascular risks casts doubt on the relevant cancer data by the same and other researchers.

In view of political and economical rivalries, current radiation safety regulations are exceedingly restrictive and should be revised to become more workable. Strictly observed realistic safety norms will bring more benefit for the public health than excessive restrictions that would be neglected in the countries with prevailing disrespect for laws and regulations, bringing to the trespassers economic advantages. The principle ALARP (as low as reasonably practicable) should replace the ALARA (as low as reasonably achievable) as a basis for radiation safety regulations [97,98]; whereas the “reasonably practicable” depends on economic, demographic and military realities. It is obviously better to physically survive than to avoid several millisieverts per annum, generally remaining within the limits of NBR. Safe implementation of nuclear power should be managed by an authority based in developed countries. Economy must become independent from politically unpredictable regimes [99], including those using petrodollars to undermine civilization [100].

Declaration

No conflict of interest

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