Association of low-level lead exposure with all-cause and cardiovascular disease mortality in US adults with hypertension: evidence from the National Health and Nutrition Examination Survey 2003–2010
Abstract Background To explore the association of low-level lead exposure with all-cause mortality and cardiovascular disease (CVD) mortality among hypertensive patients. Methods This cohort study enrolled 6453 adults with hypertension from the National Health and Nutrition Examination Survey 2003–2...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Archives of Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13690-023-01148-6 |
| _version_ | 1797453815389093888 |
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| author | Lili Wang Chaofan Wang Tao Liu Haochen Xuan Xiaoqun Li Xiangxiang Shi Feng Dai Junhong Chen Dongye Li Tongda Xu |
| author_facet | Lili Wang Chaofan Wang Tao Liu Haochen Xuan Xiaoqun Li Xiangxiang Shi Feng Dai Junhong Chen Dongye Li Tongda Xu |
| author_sort | Lili Wang |
| collection | DOAJ |
| description | Abstract Background To explore the association of low-level lead exposure with all-cause mortality and cardiovascular disease (CVD) mortality among hypertensive patients. Methods This cohort study enrolled 6453 adults with hypertension from the National Health and Nutrition Examination Survey 2003–2010 and followed mortality information through December 31, 2019. The baseline population were divided into four groups based on quartiles of blood lead levels (Q1: < 1.2 μg/dL, Q2: 1.2–1.6 μg/dL, Q3: 1.7–2.4 μg/dL, Q4: 2.5–4.9 μg/dL). The correlation of blood lead levels to mortality was investigated by Kaplan–Meier survival curves, restricted cubic spline (RCS), proportional hazard regression model, and subgroup analysis. Results During a median follow-up period of 136 (interquartile range 113, 164) months, a total of 1943 (30.1%) deaths were documented, among which 553 (28.5%) were due to CVD. Blood lead showed a linear dose–response relationship with all-cause and CVD mortality. After adequate adjusting for confounders, the risk of all-cause death rose by 23% for each unit increase in continuous variable blood lead (hazard ratio (HR): 1.23; 95% confidence interval (CI):1.16–1.30). When blood lead was a quartile group variable, participants in the Q 4 group had a 73% higher risk of death than those in the Q 1 group (HR:1.73; 95% CI: 1.43–2.10; P for trend < 0.001). The association for CVD mortality was analogous. The concordant results were achieved in the subgroup analysis. Conclusion Elevated blood lead levels were strongly associated with an increased all-cause and CVD mortality in adults with hypertension, even at the reference range of blood lead. |
| first_indexed | 2024-03-09T15:28:18Z |
| format | Article |
| id | doaj.art-784e0b97a03846868a1947866faba4e0 |
| institution | Directory Open Access Journal |
| issn | 2049-3258 |
| language | English |
| last_indexed | 2024-03-09T15:28:18Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Archives of Public Health |
| spelling | doaj.art-784e0b97a03846868a1947866faba4e02023-11-26T12:24:58ZengBMCArchives of Public Health2049-32582023-08-0181111310.1186/s13690-023-01148-6Association of low-level lead exposure with all-cause and cardiovascular disease mortality in US adults with hypertension: evidence from the National Health and Nutrition Examination Survey 2003–2010Lili Wang0Chaofan Wang1Tao Liu2Haochen Xuan3Xiaoqun Li4Xiangxiang Shi5Feng Dai6Junhong Chen7Dongye Li8Tongda Xu9Department of Cardiology, The Affiliated Hospital of Xuzhou Medical UniversityDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical UniversityDepartment of Cardiology, Jinshan Branch of Shanghai Sixth People’s HospitalDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical UniversityDepartment of General Practice, The Affiliated Hospital of Xuzhou Medical UniversityDepartment of General Practice, The Affiliated Hospital of Xuzhou Medical UniversityDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical UniversityDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical UniversityDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical UniversityDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical UniversityAbstract Background To explore the association of low-level lead exposure with all-cause mortality and cardiovascular disease (CVD) mortality among hypertensive patients. Methods This cohort study enrolled 6453 adults with hypertension from the National Health and Nutrition Examination Survey 2003–2010 and followed mortality information through December 31, 2019. The baseline population were divided into four groups based on quartiles of blood lead levels (Q1: < 1.2 μg/dL, Q2: 1.2–1.6 μg/dL, Q3: 1.7–2.4 μg/dL, Q4: 2.5–4.9 μg/dL). The correlation of blood lead levels to mortality was investigated by Kaplan–Meier survival curves, restricted cubic spline (RCS), proportional hazard regression model, and subgroup analysis. Results During a median follow-up period of 136 (interquartile range 113, 164) months, a total of 1943 (30.1%) deaths were documented, among which 553 (28.5%) were due to CVD. Blood lead showed a linear dose–response relationship with all-cause and CVD mortality. After adequate adjusting for confounders, the risk of all-cause death rose by 23% for each unit increase in continuous variable blood lead (hazard ratio (HR): 1.23; 95% confidence interval (CI):1.16–1.30). When blood lead was a quartile group variable, participants in the Q 4 group had a 73% higher risk of death than those in the Q 1 group (HR:1.73; 95% CI: 1.43–2.10; P for trend < 0.001). The association for CVD mortality was analogous. The concordant results were achieved in the subgroup analysis. Conclusion Elevated blood lead levels were strongly associated with an increased all-cause and CVD mortality in adults with hypertension, even at the reference range of blood lead.https://doi.org/10.1186/s13690-023-01148-6HypertensionBlood leadAll-cause mortalityCardiovascular disease mortalityCohort study |
| spellingShingle | Lili Wang Chaofan Wang Tao Liu Haochen Xuan Xiaoqun Li Xiangxiang Shi Feng Dai Junhong Chen Dongye Li Tongda Xu Association of low-level lead exposure with all-cause and cardiovascular disease mortality in US adults with hypertension: evidence from the National Health and Nutrition Examination Survey 2003–2010 Archives of Public Health Hypertension Blood lead All-cause mortality Cardiovascular disease mortality Cohort study |
| title | Association of low-level lead exposure with all-cause and cardiovascular disease mortality in US adults with hypertension: evidence from the National Health and Nutrition Examination Survey 2003–2010 |
| title_full | Association of low-level lead exposure with all-cause and cardiovascular disease mortality in US adults with hypertension: evidence from the National Health and Nutrition Examination Survey 2003–2010 |
| title_fullStr | Association of low-level lead exposure with all-cause and cardiovascular disease mortality in US adults with hypertension: evidence from the National Health and Nutrition Examination Survey 2003–2010 |
| title_full_unstemmed | Association of low-level lead exposure with all-cause and cardiovascular disease mortality in US adults with hypertension: evidence from the National Health and Nutrition Examination Survey 2003–2010 |
| title_short | Association of low-level lead exposure with all-cause and cardiovascular disease mortality in US adults with hypertension: evidence from the National Health and Nutrition Examination Survey 2003–2010 |
| title_sort | association of low level lead exposure with all cause and cardiovascular disease mortality in us adults with hypertension evidence from the national health and nutrition examination survey 2003 2010 |
| topic | Hypertension Blood lead All-cause mortality Cardiovascular disease mortality Cohort study |
| url | https://doi.org/10.1186/s13690-023-01148-6 |
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