Blood Lead Levels and Cardiovascular Disease Risk: Results from the Korean National Health and Nutrition Examination Survey

Liu

et al. 2022

Front. Public Health

BackgroundResearch on the association between blood lead (Pb) and lipid biomarkers have yielded inconsistent results, and epidemiological studies on blood Pb levels and hyperlipidemia are scarce. The present study aimed to examine the association between blood Pb levels and hyperlipidemia in adults from the National Health and Nutrition Examination Survey (NHANES).MethodsA total of 43,196 participants in the NHANES from 1999 to 2018 were included in the final analysis. Hyperlipidemia was determined based on the National Cholesterol Education Program guidelines. Blood Pb levels were assessed using inductively-coupled plasma mass spectrometry. Weighted multivariable logistic regression analysis and subgroup analysis were conducted to determine the correlation between blood Pb levels and hyperlipidemia.ResultsIn the multivariable logistic regression model, high blood Pb levels were significantly associated with hyperlipidemia after adjusting for confounders (OR 1.41; 95%CI: 1.18–1.67). Furthermore, elevated blood Pb levels were associated with an increased risk of hyperlipidemia across the four quartile (Q) groups (Q1: OR 1.00; Q2: OR 1.16 [95%CI: 1.04–1.29]; Q3: OR 1.39 [95%CI: 1.21–1.59]; and Q4: OR 1.33 [95%CI: 1.15–1.54]; P for trend <0.05). Significant moderating effects were found in the subgroup analysis stratified by age, education, hypertension, and diabetes (P < 0.05). In sensitivity analysis, the ORs for hyperlipidemia across the quartiles of blood Pb levels were 1.00, 1.17 (95%CI: 1.05–1.30), 1.42 (95%CI: 1.24–1.62), and 1.38 (95%CI: 1.19–1.60) for Q1, Q2, Q3, and Q4, respectively (P for trend <0.001) after removing adults with arteriosclerotic cardiovascular disease, and the ORs were 1.00, 1.13 (95%CI: 1.01–1.25), 1.38 (95%CI: 1.21–1.56), and 1.32 (95%CI: 1.16–1.52) for Q1, Q2, Q3, and Q4, respectively (P for trend <0.001) after including pregnant women.ConclusionThe current study showed a positive association between blood lead levels and hyperlipidemia.

Section: Discussionmentioning

confidence: 91%

Association between blood lead levels and hyperlipidemiais: Results from the NHANES (1999–2018)

Liu

et al. 2022

Front. Public Health

“…ESA therapy carries dose-dependent clinical risk, including thromboembolism and cardiovascular disease. [30][31][32][33] Simultaneously, lead confers toxic effects on several other organs not addressed in this study, including neurocognitive [34][35][36] and cardiovascular [37][38][39] disease, both of which are disproportionately prevalent in the CKD commu-nity. Furthermore, because lead itself is nephrotoxic, 40 ongoing exposure may accelerate CKD progression 41,42 leading to a feed-forward cycle in which lead exposure drives its own accumulation due to impaired excretion.…”

Section: Discussionmentioning

confidence: 99%

Household Water Lead and Hematologic Toxic Effects in Chronic Kidney Disease

Danziger,

Willetts,

Larkin

et al. 2024

JAMA Intern Med

ImportanceThe consequences of low levels of environmental lead exposure, as found commonly in US household water, have not been established.ObjectiveTo examine whether commonly encountered levels of lead in household water are associated with hematologic toxicity among individuals with advanced kidney disease, a group known to have disproportionate susceptibility to environmental toxicants.Design, Setting, and ParticipantsCross-sectional analysis of household water lead concentrations and hematologic outcomes was performed among patients beginning dialysis at a Fresenius Medical Care outpatient facility between January 1, 2017, and December 20, 2021. Data analysis was performed from April 1 to August 15, 2023.ExposureConcentrations of lead in household water were examined in categorical proportions of the Environmental Protection Agency’s allowable threshold (15 μg/L) and continuously.Main Outcomes and MeasuresHematologic toxic effects were defined by monthly erythropoiesis-stimulating agent (ESA) dosing during the first 90 days of incident kidney failure care and examined as 3 primary outcomes: a proportion receiving maximum or higher dosing, continuously, and by a resistance index that normalized to body weight and hemoglobin concentrations. Secondarily, hemoglobin concentrations for patients with data prior to kidney failure onset were examined, overall and among those with concurrent iron deficiency, thought to increase gastrointestinal absorption of ingested lead.ResultsAmong 6404 patients with incident kidney failure (male, 4182 [65%]; mean [SD] age, 57 [14] years) followed up for the first 90 days of dialysis therapy, 12% (n = 742) had measurable lead in household drinking water. A higher category of household lead contamination was associated with 15% (odds ratio [OR], 1.15 [95% CI, 1.04-1.27]) higher risk of maximum monthly ESA dosing, 4.5 (95% CI, 0.8-8.2) μg higher monthly ESA dose, and a 0.48% (95% CI, 0.002%-0.96%) higher monthly resistance index. Among patients with pre–kidney failure hemoglobin measures (n = 2648), a higher household lead categorization was associated with a 0.12 (95% CI, −0.23 to −0.002) g/dL lower hemoglobin concentration, particularly among those with concurrent iron deficiency (multiplicative interaction, P = .07), among whom hemoglobin concentrations were 0.25 (95% CI, −0.47 to −0.04) g/dL lower.ConclusionThe findings of this study suggest that levels of lead found commonly in US drinking water may be associated with lead poisoning among susceptible individuals.

“…Furthermore, recent studies have also found that blood lead was associated with an increased risk of carotid atherosclerosis and hypertension (19,33). Besides clinical diseases, the side effects of blood lead were also observed in subclinical diseases, namely, several studies have demonstrated that blood lead was related to poor cardiovascular metabolic parameters, obesity, metabolic disorder and impaired left ventricular systolic function (12,16,(34)(35)(36)(37)(38). In addition to blood lead, other studies have also revealed that urine lead and dietary lead intake were positively correlated with CVD risk factors, metabolic syndrome or allcause mortality (39,40).…”

Section: Discussionmentioning

confidence: 99%

Lead exposure is non-linearly associated with subclinical myocardial injury in the general population without cardiovascular disease

Wang

Huang²,

Li³

et al. 2022

Front. Public Health

Background and aimsGrowing studies have focused on the effect of lead exposure on human circulatory system, while the relationship between lead exposure and subclinical myocardial injury (SC-MI) is still poorly known. Therefore, this study was to explore the effect of lead exposure on SC-MI.MethodsThe study included 6,272 individuals aged 40 and older without cardiovascular disease (CVD) from the third National Health and Nutrition Examination Survey. Blood lead was used as an alternative marker of lead exposure. Multivariable logistic regression models, restricted cubic spline and threshold effect analyses were performed to investigate the effect of blood lead on SC-MI.ResultsAfter adjusting for age, sex, race, diabetes, hypertension, systolic blood pressure, body mass index, waist-to-hip ratio, triglycerides, total cholesterol, creatinine, fasting plasma glucose and hemoglobin Alc, higher blood lead level was independently related to higher risk of SC-MI (OR 1.047, 95% CI [1.018, 1.077]; P = 0.003). Restricted cubic spline curve showed that there was a non-linear correlation between blood lead and SC-MI. Threshold effect analysis determined that the inflection point of blood lead was 3.8 ug/dl. When the blood lead level was higher than 3.8 ug/dl, there was an independent positive correlation between blood lead level and the risk of SC-MI (OR 1.031, 95% CI [1.009, 1.053]; P < 0.01). And similar associations were also observed among subgroups of male, ≤60 years, >60 years, never smoker, non-Hispanic White, non-Hispanic Black or without hypertension and diabetes.ConclusionsBlood lead was non-linearly related to SC-MI in population free from CVD.