As a group, cardiovascular disease (CVD) is the leading cause of death worldwide. It killed twice as many people as infectious and parasitic disease and three times as many people as all forms of cancer. ere are other crucial risk factors next to the major risk factors identi�ed by the �ramingham Heart Study. In the last few years, detailed studies showed the correlation between environmental pollution and the development of CVD. e question, which environmental toxin is particularly harmful, is answered by CERCLA Priority List of Hazardous Substances with the following toxins: arsenic, lead, and mercury. e effect of these potential toxic metals on the development of cardiovascular diseases includes pathomechanisms as the accumulation of free radicals, damage of endothelial nitric oxide synthase, lipid peroxidation, and endocrine in�uences. is leads to the damage of vascular endothelium, atherosclerosis, high blood pressure, and an increased mortality from cardiovascular diseases. e cardiovascular effects of arsenic, lead, and mercury exposure and its impact on cardiovascular mortality need to be included in the diagnosis and the treatment of CVD.
Although biomonitoring for lead toxicity is based on hemotoxicity, lead is known to act through many other pathological mechanisms. For example, lead is known to damage beta-receptors and the renin-angiotensinaldosterone system, leading to increases in blood pressure (1); this is not included in biomonitoring. At any rate, lead's hypertensive activity has been known for 120 years and the American environmental agency considered it appropriate to publish a systematic review of cardiovascular damage from lead in March 2007, containing 130 references (2). This should be considered in Germany too. It was repeatedly clear in this article that the toxicity of a substance is influenced by the sum of many different factors. This has also been pointed out by Emily F. Madden of the American Food and Drug Administration (FDA). At the end of a review of the interactions between multiple environmental or occupational exposures to heavy metals in the development of cancer, she concluded that the combined effects of different metals may be greater than the sum of their individual effects (3). Perhaps then the cumulative effects of different metals might also effect the development of disease, even when they are all within the normal ranges. In my opinion, these aspects of chronic and complex exposure to heavy metals and pollutants deserve more attention, as this could help to guarantee comprehensive protection of the population, particularly of children and of people who are already ill.
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