Key PointsQuestionWhat is the association between total arsenic in urine and subclinical cardiovascular disease in children?FindingsIn this cross-sectional study of 245 children aged 9 to 11 years, higher total arsenic was geographically clustered and associated with significantly greater carotid intima media thickness as well as concentric cardiac hypertrophy.MeaningThese findings suggest that arsenic exposure may increase the risk of subclinical cardiovascular disease in children residing in certain areas with historic pollution in Syracuse.