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Zhang A, Wei P, Ding L, Zhang H, Jiang Z, Mi L, Yu F, Tang M. Associations of serum lead, cadmium, and mercury concentrations with all-cause and cause-specific mortality among individuals with cardiometabolic multimorbidity. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 280:116556. [PMID: 38852466 DOI: 10.1016/j.ecoenv.2024.116556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
Epidemiological evidence indicates an association between exposure to toxic metals and the occurrence of cardiometabolic diseases (CMDs). However, the impact of exposure to harmful metallic elements, such as lead (Pb), cadmium (Cd), and mercury (Hg), on mortality in individuals with cardiometabolic multimorbidity (CMM) remains uncertain. Therefore, in this study, we analyzed data from 4139 adults diagnosed with CMM from the National Health and Nutrition Examination Survey 1999-2016. CMM was defined as the presence of at least two CMDs (hypertension, diabetes, stroke, and coronary artery disease). Over an average follow-up period of 9.0 years, 1379 deaths from all causes, 515 deaths related to cardiovascular disease (CVD), and 215 deaths attributable to cancer were recorded. After adjusting for potential covariates, serum Pb concentrations were not associated with all-cause, CVD, or cancer mortality. Participants exposed to Cd had an elevated risk of all-cause mortality (hazard ratio [HR], 1.23; 95 % CI, 1.16-1.30), CVD-related mortality (HR, 1.23; 95 % CI, 1.12-1.35), and cancer-related mortality (HR, 1.29; 95 % CI, 1.13-1.47). Participants with serum Hg levels in the highest quantile had lower risks of all-cause (HR, 0.64; 95 % CI, 0.52-0.80) and CVD-related (HR, 0.62; 95 % CI, 0.44-0.88) mortality than did those in the lowest quantile. Stratified analyses revealed significant interactions between serum Cd concentrations and age for CVD-related mortality (P for interaction =0.011), indicating that CMM participants aged < 60 years who were exposed to Cd were at a greater risk of CVD-related mortality. A nonlinear relationship was observed between serum Cd concentrations and all-cause (P for nonlinear relationship = 0.012) and CVD-related (P for nonlinear relationship < 0.001) mortality. Minimizing Cd exposure in patients with CMM may help prevent premature death.
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Affiliation(s)
- Aikai Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Peijian Wei
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Ding
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Hongda Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Zihan Jiang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Lijie Mi
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Fengyuan Yu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
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Wang Q, Wu J, Dong X, Niu W. Trends in urine lead and associated mortality in US adults: NHANES 1999-2018. Front Nutr 2024; 11:1411206. [PMID: 38873569 PMCID: PMC11169937 DOI: 10.3389/fnut.2024.1411206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Objectives This study aimed to describe the trends of urine lead among US adults aged ≥45 years and to explore its association with all-cause and disease-specific mortality. Methods This study enrolled 9,669 participants from the National Health and Nutrition Examination Survey, 1999-2018. Trends in urine lead were described by logistic regression analysis using the survey cycle as a continuous variable. Cox proportional hazard regression analyses were used to quantify the association between urine lead and mortality. Results There was an obvious decline in urine lead concentrations from 1.203 μg/L (95% confidence interval [CI]: 1.083-1.322) in 1999-2000 to 0.478 μg/L (95% CI: 0.433-0.523) in 2017-2018, and this decline was statistically significant (P < 0.001). Referring to the first tertile of urine lead concentrations, risk magnitude for all-cause mortality was significantly and linearly increased after adjustment (P = 0.026 and 0.020 for partially and fully adjusted models, respectively), and significance was attained for the comparison of the third vs. first tertile after full adjustment (hazard ratio [HR]: 1.17, 95% CI: 1.01 to 1.35). Treating urine lead continuously, the risk for all-cause mortality was statistically significant (HR: 1.18 and 1.19, 95% CI: 1.01 to 1.39 and 1.00 to 1.40 for partially and fully adjusted models). For cardiovascular disease-specific and cancer-specific mortality, there was no hint of statistical significance. Conclusions Our findings indicated that urine lead exhibited a declining trend from 1999-2000 to 2017-2018 in US adults aged ≥45 years, and high urine lead was a significant and independent risk factor for all-cause mortality.
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Affiliation(s)
- Qiong Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Jing Wu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoqun Dong
- Department of Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Wenquan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
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Xiao S, Wang Z, Zuo R, Zhou Y, Wang Z, Chen T, Liu N. Association of serum five heavy metals level with all-cause and cause-specific mortality: a large population-based cohort study. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2024; 59:130-154. [PMID: 38613167 DOI: 10.1080/10934529.2024.2339776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
The study aimed to explore the association between five heavy metals exposure (Cadmium, Lead, Mercury, Manganese, and Selenium) and mortality [all-cause, cardiovascular disease (CVD), and cancer-related]. We integrated the data into the National Health and Nutrition Examination Survey from 2011 to 2018 years. A total of 16,092 participants were recruited. The link between heavy metals exposure and mortality was analyzed by constructing a restricted cubic spline (RCS) curve, Cox proportional hazard regression model, and subgroup analysis. The RCS curve was used to show a positive linear relationship between Cadmium, Lead, and all-cause mortality. In contrast, there was a negative linear correlation between Mercury and all-cause mortality. Additionally, Manganese and Selenium also had a J-shaped and L-shaped link with all-cause mortality. The positive linear, positive linear, negative liner, J-shaped, and L-shaped relationships were observed for Cadmium, Lead, Mercury, Manganese, and Selenium and CVD mortality, respectively. Cadmium, Lead, Mercury, and Selenium were observed to exhibit positive linear, U-shaped, negative linear, and L-shaped relationships with cancer-related mortality, respectively. There was an increase and then a decrease in the link between Manganese and cancer-related morality. This study revealed the correlation between the content of different elements and different types of mortality in the U.S. general population.
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Affiliation(s)
- Shengjue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zhenwei Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, Henan, China
| | - Ronghua Zuo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yufei Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Zhongkai Wang
- Department of Radiology, Center of Interventional Radiology & Vascular Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, P.R. China
| | - Tian Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Naifeng Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
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Taube N, Kabir R, Ebenebe OV, Garbus H, Alam El Din SM, Illingworth E, Fitch M, Wang N, Kohr MJ. Prenatal arsenite exposure alters maternal cardiac remodeling during late pregnancy. Toxicol Appl Pharmacol 2024; 483:116833. [PMID: 38266874 PMCID: PMC10922692 DOI: 10.1016/j.taap.2024.116833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/08/2024] [Accepted: 01/21/2024] [Indexed: 01/26/2024]
Abstract
Exposure to inorganic arsenic through drinking water is widespread and has been linked to many chronic diseases, including cardiovascular disease. Arsenic exposure has been shown to alter hypertrophic signaling in the adult heart, as well as in utero offspring development. However, the effect of arsenic on maternal cardiac remodeling during pregnancy has not been studied. As such, there is a need to understand how environmental exposure contributes to adverse pregnancy-related cardiovascular events. This study seeks to understand the impact of trivalent inorganic arsenic exposure during gestation on maternal cardiac remodeling in late pregnancy, as well as offspring outcomes. C57BL/6 J mice were exposed to 0 (control), 100 or 1000 μg/L sodium arsenite (NaAsO2) beginning at embryonic day (E) 2.5 and continuing through E17.5. Maternal heart function and size were assessed via transthoracic echocardiography, gravimetric measurement, and histology. Transcript levels of hypertrophic markers were probed via qRT-PCR and confirmed by western blot. Offspring outcomes were assessed through echocardiography and gravimetric measurement. We found that maternal heart size was smaller and transcript levels of Esr1 (estrogen receptor alpha), Pgrmc1 (progesterone receptor membrane component 1) and Pgrmc2 (progesterone receptor membrane component 2) reduced during late pregnancy with exposure to 1000 μg/L iAs vs. non-exposed pregnant controls. Both 100 and 1000 μg/L iAs also reduced transcription of Nppa (atrial natriuretic peptide). Akt protein expression was also significantly reduced after 1000 μg/L iAs exposure in the maternal heart with no change in activating phosphorylation. This significant abrogation of maternal cardiac hypertrophy suggests that arsenic exposure during pregnancy can potentially contribute to cardiovascular disease. Taken together, our findings further underscore the importance of reducing arsenic exposure during pregnancy and indicate that more research is needed to assess the impact of arsenic and other environmental exposures on the maternal heart and adverse pregnancy events.
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Affiliation(s)
- Nicole Taube
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Raihan Kabir
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Obialunanma V Ebenebe
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Haley Garbus
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sarah-Marie Alam El Din
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emily Illingworth
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael Fitch
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nadan Wang
- Cardiology Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark J Kohr
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Taube N, Kabir R, Ebenebe OV, Garbus H, Din SMAE, Illingworth E, Fitch M, Wang N, Kohr MJ. Prenatal Arsenite Exposure Alters Maternal Cardiac Remodeling During Late Pregnancy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.28.559986. [PMID: 37808684 PMCID: PMC10557683 DOI: 10.1101/2023.09.28.559986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Exposure to inorganic arsenic through drinking water is widespread and has been linked to many chronic diseases, including cardiovascular disease. Arsenic exposure has been shown to alter hypertrophic signaling in the adult heart, as well as in-utero offspring development. However, the effect of arsenic on maternal cardiac remodeling during pregnancy has not been studied. As such, there is a need to understand how environmental exposure contributes to adverse pregnancy-related cardiovascular events. This study seeks to understand the impact of trivalent inorganic arsenic exposure during gestation on maternal cardiac remodeling in late pregnancy, as well as offspring outcomes. C57BL/6J mice were exposed to 0 (control), 100 or 1000 µg/L sodium arsenite (NaAsO 2 ) beginning at embryonic day (E) 2.5 and continuing through E17.5. Maternal heart function and size were assessed via transthoracic echocardiography, gravimetric measurement, and histology. Transcript levels of hypertrophic markers were probed via qRT-PCR and confirmed by western blot. Offspring outcomes were assessed through echocardiography and gravimetric measurement. We found that exposure to 1000 µg/L iAs abrogated normal physiologic growth of the maternal heart during late pregnancy and reduced transcript levels of estrogen receptor alpha (ERα), progesterone receptor membrane component 1 (Pgrmc1) and progesterone receptor membrane component 2 (Pgrmc2). Both 100 and 1000 µg/L iAs also reduced transcription of protein kinase B (Akt) and atrial natriuretic peptide (ANP). Akt protein expression was also significantly reduced after 1000 µg/L iAs exposure in the maternal heart with no change in activating phosphorylation. This significant abrogation of maternal cardiac hypertrophy suggests that arsenic exposure during pregnancy can potentially contribute to cardiovascular disease. Taken together, our findings further underscore the importance of reducing arsenic exposure during pregnancy and indicate that more research is needed to assess the impact of arsenic and other environmental exposures on the maternal heart and adverse pregnancy events.
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Zhang Y, Liu M, Xie R. Associations between cadmium exposure and whole-body aging: mediation analysis in the NHANES. BMC Public Health 2023; 23:1675. [PMID: 37653508 PMCID: PMC10469832 DOI: 10.1186/s12889-023-16643-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Even though cadmium (Cd) exposure and cellular senescence (telomere length) have been linked in previous studies, composite molecular aging biomarkers are more significant and reliable factors to consider when examining the connection between metal exposure and health outcomes. The purpose of this research was to assess the association between urinary cadmium (U-Cd) and whole-body aging (phenotypic age). METHODS Phenotypic age was calculated from chronological age and 9 molecular biomarkers. Multivariate linear regression models, subgroup analysis, and smoothing curve fitting were used to explore the linear and nonlinear relationship between U-Cd and phenotypic age. Mediation analysis was performed to explore the mediating effect of U-Cd on the association between smoking and phenotypic age. RESULTS This study included 10,083 participants with a mean chronological age and a mean phenotypic age of 42.24 years and 42.34 years, respectively. In the fully adjusted model, there was a positive relationship between U-Cd and phenotypic age [2.13 years per 1 ng/g U-Cd, (1.67, 2.58)]. This association differed by sex, age, and smoking subgroups (P for interaction < 0.05). U-Cd mediated a positive association between serum cotinine and phenotypic age, mediating a proportion of 23.2%. CONCLUSIONS Our results suggest that high levels of Cd exposure are associated with whole-body aging.
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Affiliation(s)
- Ya Zhang
- Department of Gland Surgery, The Affiliated Nanhua Hospital, Hengyang Medical school, University of South China, Hengyang, 421002, China
| | - Mingjiang Liu
- Department of Hand & Microsurgery, The Affiliated Nanhua Hospital, Hengyang Medical school, University of South China, No.336 Dongfeng South Road, Zhuhui District, Hunan Province, Hengyang, 421002, China
| | - Ruijie Xie
- Department of Hand & Microsurgery, The Affiliated Nanhua Hospital, Hengyang Medical school, University of South China, No.336 Dongfeng South Road, Zhuhui District, Hunan Province, Hengyang, 421002, China.
- Hengyang Medical school, University of South China, Hengyang, 421002, China.
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Wang L, Wang C, Liu T, Xuan H, Li X, Shi X, Dai F, Chen J, Li D, Xu T. 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. Arch Public Health 2023; 81:146. [PMID: 37574566 PMCID: PMC10424362 DOI: 10.1186/s13690-023-01148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
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.
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Affiliation(s)
- Lili Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Tao Liu
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Xiaoqun Li
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Xiangxiang Shi
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Feng Dai
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China.
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, China.
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Chen S, Shen R, Shen J, Lyu L, Wei T. Association of blood cadmium with all-cause and cause-specific mortality in patients with hypertension. Front Public Health 2023; 11:1106732. [PMID: 37469695 PMCID: PMC10353433 DOI: 10.3389/fpubh.2023.1106732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/15/2023] [Indexed: 07/21/2023] Open
Abstract
Background Cadmium is a commonly found heavy metal with a prolonged biological half-life, which results in long-term health burden for the population. Prior studies have demonstrated an association between blood cadmium and hypertension. However, few studies examined the relationship between blood cadmium and long-term health outcomes in patients with hypertension. This study aimed to investigate the association of blood cadmium with mortality in patients with hypertension. Methods This study analyzed data from the National Health and Nutrition Examination Survey 1999-2012. Complex sampling-weighted multivariate Cox proportional hazards models were used to evaluate the hazard ratios (HRs) of all-cause, cardiovascular, and Alzheimer's disease mortality in patients with hypertension classified by blood cadmium concentrations' quantiles. Results The study included 12,208 patients with hypertension with a median follow-up duration of 10.8 years. During this period, there were 4,485 all-cause deaths, including 1,520 cardiovascular deaths and 180 Alzheimer's disease deaths. Compared with the lowest quintile of blood cadmium (≤0.25 μg/L) group, the highest quintile of blood cadmium (≥0.80 μg/L) group's adjusted HRs were 1.85 (95% CI, 1.59-2.14) for all-cause mortality, 1.76 (95% CI, 1.33-2.34) for cardiovascular mortality, and 3.41 (95% CI, 1.54-7.51) for Alzheimer's disease mortality. Additionally, the adjusted HR for cardiovascular mortality was 2.12 (95% CI, 1.36-3.30) in never-smoking patients with hypertension. Conclusion Higher blood cadmium is associated with increased risks of all-cause, cardiovascular, and Alzheimer's disease mortality in patients with hypertension. The effect of blood cadmium on cardiovascular mortality may be more pronounced in never-smoking hypertensive patients.
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Affiliation(s)
- Shuaijie Chen
- Department of Cardiology, Lishui Hospital, College of Medicine, Zhejiang University, Lishui, China
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Ruming Shen
- Department of Cardiology, Lishui Hospital, College of Medicine, Zhejiang University, Lishui, China
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Jiayi Shen
- Department of Cardiology, Lishui Hospital, College of Medicine, Zhejiang University, Lishui, China
| | - Lingchun Lyu
- Department of Cardiology, Lishui Hospital, College of Medicine, Zhejiang University, Lishui, China
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, College of Medicine, Zhejiang University, Lishui, China
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Xu T, Lin K, Cao M, Miao X, Guo H, Rui D, Hu Y, Yan Y. Patterns of global burden of 13 diseases attributable to lead exposure, 1990-2019. BMC Public Health 2023; 23:1121. [PMID: 37308890 DOI: 10.1186/s12889-023-15874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES Understanding the spatio-temporal patterns of the global burden of various diseases resulting from lead exposure is critical for controlling lead pollution and disease prevention. METHODS Based on the 2019 Global Burden of Disease (GBD) framework and methodology, the global, regional, and national burden of 13 level-three diseases attributable to lead exposure were analyzed by disease type, patient age and sex, and year of occurrence. Population attributable fraction (PAF), deaths and disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) obtained from the GBD 2019 database were used as descriptive indicators, and the average annual percentage change (AAPC) was estimated by a log-linear regression model to reflect the time trend. RESULTS AND CONCLUSIONS From 1990 to 2019, the number of deaths and DALYs resulting from lead exposure increased by 70.19% and 35.26%, respectively; however, the ASMR and ASDR decreased by 20.66% and 29.23%, respectively. Ischemic heart disease (IHD), stroke, and hypertensive heart disease (HHD) showed the highest increases in deaths; IHD, stroke, and diabetes and kidney disease (DKD) had the fastest-growing DALYs. The fastest decline in ASMR and ASDR was seen in stroke, with AAPCs of -1.25 (95% CI [95% confidence interval]: -1.36, -1.14) and -1.66 (95% CI: -1.76, -1.57), respectively. High PAFs occurred mainly in South Asia, East Asia, the Middle East, and North Africa. Age-specific PAFs of DKD resulting from lead exposure were positively correlated with age, whereas the opposite was true for mental disorders (MD), with the burden of lead-induced MD concentrated in children aged 0-6 years. The AAPCs of ASMR and ASDR showed a strong negative correlation with the socio-demographic index. Our findings showed that the global impact of lead exposure and its burden increased from 1990 to 2019 and varied significantly according to age, sex, region, and resulting disease. Effective public health measures and policies should be adopted to prevent and control lead exposure.
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Affiliation(s)
- Tongtong Xu
- Department of Preventive Medicine, School of Medicine, Shihezi University, No. 59, North 2nd Rd, Hong-Shan District, Shihezi, 832003, Xinjiang, China
| | - Kangqian Lin
- Department of Preventive Medicine, School of Medicine, Shihezi University, No. 59, North 2nd Rd, Hong-Shan District, Shihezi, 832003, Xinjiang, China
| | - Miao Cao
- Department of Preventive Medicine, School of Medicine, Shihezi University, No. 59, North 2nd Rd, Hong-Shan District, Shihezi, 832003, Xinjiang, China
| | - Xinlu Miao
- Department of Preventive Medicine, School of Medicine, Shihezi University, No. 59, North 2nd Rd, Hong-Shan District, Shihezi, 832003, Xinjiang, China
| | - Heng Guo
- Department of Preventive Medicine, School of Medicine, Shihezi University, No. 59, North 2nd Rd, Hong-Shan District, Shihezi, 832003, Xinjiang, China
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory for Prevention and Control of Crucial Emerging Infectious Diseases and Public, Health Security of The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China
| | - Dongsheng Rui
- Department of Preventive Medicine, School of Medicine, Shihezi University, No. 59, North 2nd Rd, Hong-Shan District, Shihezi, 832003, Xinjiang, China
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory for Prevention and Control of Crucial Emerging Infectious Diseases and Public, Health Security of The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China
| | - Yunhua Hu
- Department of Preventive Medicine, School of Medicine, Shihezi University, No. 59, North 2nd Rd, Hong-Shan District, Shihezi, 832003, Xinjiang, China.
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China.
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Shihezi, Xinjiang, China.
- Key Laboratory for Prevention and Control of Crucial Emerging Infectious Diseases and Public, Health Security of The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China.
| | - Yizhong Yan
- Department of Preventive Medicine, School of Medicine, Shihezi University, No. 59, North 2nd Rd, Hong-Shan District, Shihezi, 832003, Xinjiang, China.
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China.
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Shihezi, Xinjiang, China.
- Key Laboratory for Prevention and Control of Crucial Emerging Infectious Diseases and Public, Health Security of The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China.
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Zhang J, Wang X, Ma Z, Dang Y, Yang Y, Cao S, Ouyang C, Shi X, Pan J, Hu X. Associations of urinary and blood cadmium concentrations with all-cause mortality in US adults with chronic kidney disease: a prospective cohort study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:61659-61671. [PMID: 36933131 DOI: 10.1007/s11356-023-26451-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/10/2023] [Indexed: 05/10/2023]
Abstract
Epidemiological evidence for the relationship between cadmium exposure and mortality in specific chronic kidney disease (CKD) populations remains scarce. We aimed to explore the relationships between cadmium concentrations in urine and blood and all-cause mortality among CKD patients in the USA. This cohort study was composed of 1825 CKD participants from the National Health and Nutrition Examination Survey (NHANES) (1999-2014) who were followed up to December 31, 2015. All-cause mortality was ascertained by matching the National Death Index (NDI) records. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality in relation to urinary and blood cadmium concentrations by Cox regression models. During an average follow-up period of 82 months, 576 CKD participants died. Compared with the lowest quartiles, HRs (95% CIs) for all-cause mortality associated with the fourth weighted quartiles of urinary and blood cadmium concentrations were 1.75 (1.28 to 2.39) and 1.59 (1.17 to 2.15), respectively. Furthermore, the HRs (95% CIs) for all-cause mortality per ln-transformed IQR increment in cadmium concentrations in urine (1.15 μg/g UCr) and blood (0.95 μg/L) were 1.40 (1.21 to 1.63) and 1.22 (1.07 to 1.40), respectively. Linear concentration-response relationships between urinary and blood cadmium concentrations and all-cause mortality were also found. Our findings suggested that increased cadmium concentrations in both urine and blood significantly contributed to enhanced mortality risk in CKD patients, thus highlighting that efforts to reduce cadmium exposure may reduce mortality risk in high-risk populations with CKD.
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Affiliation(s)
- Jia Zhang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Xiao Wang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Zhibin Ma
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Ying Dang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Yaya Yang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Shuting Cao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Changping Ouyang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Xiaoru Shi
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Jinhua Pan
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China
| | - Xiaobin Hu
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu Province, China.
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Xing X, Xu M, Yang L, Shao C, Wang Y, Qi M, Niu X, Gao D. Association of selenium and cadmium with heart failure and mortality based on the National Health and Nutrition Examination Survey. J Hum Nutr Diet 2022. [DOI: 10.1111/jhn.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Xin Xing
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Min Xu
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Lijun Yang
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Congcong Shao
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Yuan Wang
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Mengyao Qi
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
| | - Xiaolin Niu
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
- Department of Cardiology, Meishan Brach of the Third Affiliated Hospital Yanan University School of Medical Meishan Sichuan China
| | - Dengfeng Gao
- Department of Cardiology, The Second Affiliated Hospital Xi'an Jiaotong University Xi'an Shaanxi China
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Zhang Y, Liu W, Zhang W, Cheng R, Tan A, Shen S, Xiong Y, Zhao L, Lei X. Association between blood lead levels and hyperlipidemiais: Results from the NHANES (1999-2018). Front Public Health 2022; 10:981749. [PMID: 36159291 PMCID: PMC9500574 DOI: 10.3389/fpubh.2022.981749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Background Research 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). Methods A 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. Results In 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. Conclusion The current study showed a positive association between blood lead levels and hyperlipidemia.
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Affiliation(s)
- Yangchang Zhang
- School of Public Health, Chongqing Medical University, Chongqing, China,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China,Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Weiwei Liu
- School of Public Health, Chongqing Medical University, Chongqing, China,Chongqing College of Traditional Chinese Medicine, Chongqing, China,Research Center for Medicine and Social Development, Chongqing, China
| | - Wei Zhang
- Chongqing College of Traditional Chinese Medicine, Chongqing, China
| | - Rui Cheng
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Andi Tan
- International Business School, Yunnan University of Finance and Economics, Kunming, China
| | - Shisi Shen
- The First School of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Yang Xiong
- West China Hospital, Sichuan University, Chengdu, China
| | - Limei Zhao
- Chongqing Jiangjin Central Hospital, Chongqing, China
| | - Xun Lei
- School of Public Health, Chongqing Medical University, Chongqing, China,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China,Research Center for Public Health Security, Chongqing Medical University, Chongqing, China,*Correspondence: Xun Lei
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