Higher Blood Lead Level Is Associated With Increased Likelihood of Abdominal Aortic Calcification

Klotho mediates the association between serum testosterone and severe abdominal aortic calcification: a cross-sectional study from the NHANES database

Severe abdominal aortic calcification (SAAC) is acknowledged as a significant contributor to cardiovascular morbidity and mortality, yet its relationship with sex steroid hormones remains unclear. Here, the unexplored link between serum sex steroid hormone levels and SAAC was investigated within the National Health and Nutrition Examination Survey (NHANES) cohort. This study utilized data from NHANES 2013-2014. SAAC was determined using the abdominal aortic calcification 24-point scale. Serum sex steroid hormones were categorized into quintiles 1-5 for analysis. Multivariable logistic regression and subgroup analyses were employed to investigate the potential relationship between serum sex steroid hormones and SAAC risk. Moreover, the Johnson-Neyman plot was applied to identify the presence of any threshold effects. Finally, to reveal the potential pathophysiological mechanism, mediation analyses were performed. A total of 1852 enrolled individuals were included, and the prevalence of SAAC stood at 8.00%. After adjusting for potential confounding factors, multivariate analysis suggested the association of higher level of serum testosterone with a reduced incidence of SAAC (AOR = 0.33, 95%CI:0.13-0.87, P = 0.0247 for quintile 5, P for trend = 0.025). Subgroup analyses demonstrated the negative associations were more significant in participants aged ≥ 60 (AOR = 0.20, 95%CI:0.07-0.56, P = 0.0023 for quintile 5) and non-hypertensive population (AOR = 0.29, 95%CI:0.09-0.96, P = 0.0436 for quintile 5). The restricted cubic spline curve indicated that among the non-hypertensive male population aged ≥ 60, there was a dose-response relationship between serum testosterone and SAAC risk. Furthermore, Johnson-Neyman plot showed that sex hormone binding globulin exhibited a threshold effect on the modulation of the association between serum testosterone and SAAC. Finally, mediation analysis identified the role of Klotho in mediating high levels of serum testosterone's association with SAAC. This study reported that serum testosterone was inversely associated with SAAC, and further highlighted the mediation effect of anti-ageing protein Klotho on that association. Our findings have positive implications for the prevention and treatment of SAAC.

Adjustment of the Framingham index by abdominal aortic calcification scores enables a more accurate prediction of long-term cardiac events in general population aged 40 years and above: evidence from NHANES 2013-2014

BACKGROUND

Abdominal aortic calcification (AAC) is considered as a strong predictor of cardiovascular disease (CVD) events. Our study aimed to investigate whether the predicted risk for cardiac death with the Framingham risk score (FRS) could be further improved with the addition of AAC score in general population aged ≥ 40 years.

METHODS

A total of 2971 participants aged ≥ 40 years in the National Health and Nutrition Examination Surveys (NHANES) 2013-2014 were followed up. The Spearman's rank correlation was performed to explore the correlation between the AAC score and FRS. the Kaplan-Meier method was used to make cumulative cardiac death curve. Predictors of cardiac death was identified by multivariate Cox regression. Additionally, the predictive value of FRS alone and combined with AAC score was estimated by comparing the area under the receiver-operating characteristic (ROC) curve (AUC) and calculating Integrated Discrimination Improvement (IDI).

RESULTS

During a median of 70.50 months (interquartile range 58.43-82.57 months), 49 (1.649%) experienced cardiac death in the follow-up. The FRS was positively associated with AAC score. Both FRS and AAC score were independent predictors of cardiac death (hazard ratio 1.216; 95%CI 1.135 to 1.302; p < 0.00001; 1.159; 95%CI 1.109 to 1.211; p < 0.00001; respectively). Furthermore, Kaplan-Meier analysis demonstrated increased risk of cardiac death with increasing AAC score (log-rank 54.548, p<0.0001). The predictive value of FRS significantly was improved by adding with AAC score [increase in AUC from 0.734 to 0.780, p < 0.0001; IDI = 0.007, p = 0.013 ].

CONCLUSIONS

AAC score is positively related with Framingham index, and FBS adjusted by AAC score further improved the prediction risk for cardiac death in general population aged ≥ 40 years.

The relationships between blood lead levels and nocturia prevalence in adults: A retrospective study

PURPOSE

The purpose of this study was to examine the association between blood lead levels and the prevalence of nocturia in American adults.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2020, focusing on individuals aged 20 years or older (n = 11,919). Blood lead levels were categorized into two groups (<2 µg/dL and ≥2 µg/dL), and the presence of nocturia was assessed based on questionnaire responses. We used multivariable logistic regression models to explore the association between blood lead levels and nocturia while adjusting for various covariates, including sex, ratio of family income to poverty (RIP), lipid profile, age, body mass index (BMI), race, citizenship, sleep trouble, diabetes, and hypertension. To verify whether certain covariates influence blood lead levels and the risk of nocturia, we conducted subgroup analyses.

RESULTS

Of the study participants, 31.70% reported experiencing nocturia. Individuals with higher blood lead levels (≥2 µg/dL) exhibited a higher likelihood of experiencing nocturia compared to those with lower levels (<2 µg/dL) in all three models (Model 1: OR 1.46, 95% CI 1.29-1.66, p < 0.0001; Model 2: OR 1.25, 95% CI 1.09-1.44, p = 0.002; Model 3: OR 1.22, 95%CI 1.06-1.41, p = 0.01). Subgroup analyses revealed that factors such as age, sex, sleep trouble, diabetes, hypertension, BMI, RIP, and race did not affect the association between blood lead levels and the risk of nocturia (P for interaction >0.05).

CONCLUSIONS

This study reported the correlation between blood lead levels and nocturia. We found that compared to blood lead levels below 2 µg/dL, when lead levels reached or exceeded 2 µg/dL, the risk of nocturia occurrence increased by 22%.

CLINICAL TRIAL REGISTRATION

This study is based on existing data from a public database and not from a specific clinical trial; hence, clinical registration information is not provided.

Burden of aortic aneurysm in Iran from 1990 to 2019: an analysis based on global burden of disease study

Background

Limited studies have been conducted on the epidemiology of aortic aneurysms in Iran. In this study, the authors aimed to comprehensively evaluate the burden and epidemiology of aortic aneurysms across various age groups, sexes, and provinces in Iran from 1990 to 2019.

Materials and methods

The authors used global burden of disease (GBD) study data in the current study. The authors retrieved data on the burden of aortic aneurysms across sexes and age groups at national and subnational levels from 1990 to 2019. The authors extracted mortality, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life year (DALY), numbers, rates, and age-standardized rates. Additionally, the authors extracted the burden of AA attributable to its risk factors, such as lead exposure, high systolic blood pressure, high dietary intake of sodium, and smoking.

Results

National ASDR (age-standardized DALY rate) was also observed to be reduced from 1990 [22.20 (17.46-26.86)] to 2019 [19.97 (17.98-21.98)]. However, the inclinations were evaluated to be slighter than the world (%change ASDR=-19.5%). In 2019, three leading risk factors yielding death in AA patients were smoking [ASMR attributable=0.73 (0.67-0.80)], high sodium intake [ASMR attributable=0.11 (0.03-0.27)], and lead exposure [ASMR attributable=0.04 (0.02-0.07)].

Conclusion

Mortality and DALYs due to AA both decreased slightly during the last three decades. Considering the role of smoking in the burden of AA in Iran, interventions targeting smoking cessation among high-risk groups, such as males, may be helpful to reduce the burden of AA in Iran in the coming years.

Combined exposure to multiple metals on abdominal aortic calcification: results from the NHANES study

Exposure to metals increases the risk of many diseases and has become a public health concern. However, few studies have focused on the effect of metal on abdominal aortic calcification (AAC), especially the combined effects of metal mixtures. In this study, we aim to investigate the combined effect of metals on AAC risk and determine the key components in the multiple metals. We tried to investigate the relationship between multiple metal exposure and AAC risk. Fourteen urinary metals were analyzed with five statistical models as follows: generalized linear regression, weighted quantile sum regression (WQS), quantile g-computation (Qgcomp), and Bayesian kernel machine regression (BKMR) models. A total of 838 participants were involved, of whom 241 (28.8%) had AAC. After adjusting for covariates, in multiple metal exposure logistic regression, cadmium (Cd) (OR = 1.364, 95% CI = 1.035-1.797) was positively associated with AAC risk, while cobalt (Co) (OR = 0.631, 95% CI = 0.438-0.908) was negatively associated with AAC risk. A significant positive effect between multiple metal exposure and AAC risk was observed in WQS (OR = 2.090; 95% CI = 1.280-3.420, P < 0.01), Qgcomp (OR = 1.522, 95% CI = 1.012-2.290, P < 0.05), and BKMR models. It was found that the positive association may be driven primarily by Cd, lead (Pb), uranium (U), and tungsten (W). Subgroups analysis showed the association was more significant in participants with BMI ≥ 25 kg/m2, abdominal obesity, drinking, and smoking. Our study shows that exposure to multiple metals increases the risk of AAC in adults aged ≥ 40 years in the USA and that Cd, Pb, U, and W are the main contributors. The association is stronger in participants who are obese, smoker, or drinker.

Federal Housing Assistance and Blood Lead Levels in a Nationally Representative US Sample Age 6 and Older: NHANES, 1999-2018

BACKGROUND

Federal housing assistance is an important policy tool to ensure housing security for low-income households. Less is known about its impact on residential environmental exposures, particularly lead.

OBJECTIVES

We conducted a quasi-experimental study to investigate the association between federal housing assistance and blood lead levels (BLLs) in a nationally representative US sample age 6 y and older eligible for housing assistance.

METHODS

We used the 1999-2018 National Health and Nutrition Examination Survey (NHANES) linked with US Department of Housing and Urban Development (HUD) administrative records to assess BLLs of NHANES participants with concurrent HUD housing assistance (i.e., current recipients, n = 3 , 0 71 ) and those receiving assistance within 2 y after the survey (i.e., pseudo-waitlist recipients, n = 1,235 ). We estimated BLL least squares geometric means (LSGMs), odds ratio (OR) for BLL ≥ 3.5 μ g / dL , and percent differences in LSGMs by HUD housing assistance status adjusting for age, sex, family income-to-poverty ratio, education, country of birth, race/ethnicity, region, and survey year. We also examined effect modification using interaction terms and stratified analyses by program type [i.e., public housing, multifamily, housing choice vouchers (HCV)], and race/ethnicity.

RESULTS

Current HUD recipients had a significantly lower LSGM [1.07 μ g / dL ; 95% confidence interval (CI): 1.02, 1.12] than pseudo-waitlist recipients (1.21   μ g / dL ; 95% CI: 1.14, 1.28), with an adjusted OR of 0.60 (95% CI: 0.42, 0.87) for BLL ≥ 3.5 μ g / dL . Some effect modification were observed: The protective association of HUD assistance on BLL was strongest among public housing (- 19.5 % LSGM; 95% CI: - 27.5 % , - 1 0 . 7 % ), multifamily (- 12.5 % LSGM; 95% CI: - 2 0 . 7 % , - 3.5 % ), and non-Hispanic White (- 2 0 . 6 % LSGM; 95% CI: - 29.8 % , - 1 0 . 3 % ) recipients. It was weaker to null among HCV (- 5.7 % LSGM; 95% CI: - 12.7 , 1.7%), non-Hispanic Black (- 1.6 % LSGM; 95% CI: - 8.1 % , 5.4%), and Mexican American (-12.5% LSGM; 95% CI: - 31.9 % , 12.5 % ) recipients.

DISCUSSION

Our research underscores the importance of social-structural determinants like federal housing assistance in providing affordable, stable, and healthy housing to very low-income households. More attention is needed to ensure housing quality and racial equity across HUD's three major housing assistance programs. https://doi.org/10.1289/EHP12645.

Association between dietary total choline and abdominal aorta calcification among older US adults: A cross-sectional study of the National Health and Nutrition Examination Survey

BACKGROUND

Numerous studies indicate a potential bidirectional association between dietary choline intake and its derivative, betaine, and subclinical atherosclerosis. However, little research has been conducted on the relationship between dietary choline and severe abdominal aortic calcification (SAAC).

METHODS

This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (2013-2014). Choline intake and food sources were measured using two 24-h dietary-recall interviews. The abdominal aortic calcification score was measured using a dual-emission x-ray absorptiometry scan. To assess the relationship between choline intake and SAAC, the study utilized restricted cubic spline and a multivariable logistic regression model.

RESULTS

Among the 2640 individuals included in the study, 10.9% had SAAC. After adjusting for all selected covariates, compared with the lowest quartile of dietary choline, the odds ratios of SAAC for the second-quartile, third-quartile, and fourth-quartile dietary choline intake were 0.63 (95% confidence interval [CI], 0.43-0.93), 0.63 (95% CI, 0.42-0.94), and 0.77 (95% CI, 0.5-1.16), respectively. The study found an L-shaped relationship between dietary choline and SAAC in the dose-response analysis. Subgroup analyses did not demonstrate any statistically significant interaction effects for any subgroup.

CONCLUSION

The study found that a higher intake of dietary choline is associated with a lower prevalence of SAAC. The dose-response analysis revealed an L-shaped relationship between dietary choline and SAAC. However, further studies are warranted to investigate the direct role of choline in the development of SAAC.

The estimated glomerular filtration rate was U-shaped associated with abdominal aortic calcification in US adults: findings from NHANES 2013-2014

Objectives

The high incidence of abdominal aortic calcification (AAC) is well-documented in individuals with severe renal function decline. However, there is limited research on the historical relationship between estimated glomerular filtration rate (eGFR) and the risk of AAC occurrence in the general population undergoing routine medical examinations. The main objective of this study was to investigate the historical relationship between eGFR and AAC in the general population of the United States.

Methods

We performed a cross-sectional study using the National Health and Nutrition Examination Survey 2013-2014 database. Weighted multivariate linear regression models were used to estimate the associations of eGFR with AAC score. Smooth curve fitting and two-piecewise linear regression were employed to explore the potential non-linear relationship.

Results

A total of 2,978 participant (48.22% were male) aged 40-80 years were included in this study. The fully-adjusted model demonstrated a negative correlation between eGFR and AAC score (β = -0.015, 95% CI: -0.023 to -0.006). However, when applying the smooth curve fitting method, a U-shaped relationship was identified, and the inflection point was calculated at 76.43 ml/min/1.73 m2 using the two-piecewise linear regression model.

Conclusions

There was a U-shaped association between eGFR and AAC score in general US adults, with an inflection point at about 76.43 ml/min/1.73 m2.

Association between urinary biomarkers of polycyclic aromatic hydrocarbons and severe abdominal aortic calcification in adults: data from the National Health and Examination Nutrition Survey

OBJECTIVE

Recent studies have found that polycyclic aromatic hydrocarbons (PAHs) exposure may increase the risk of cardiovascular disease. The present study aimed to explore the association between PAHs exposure and severe abdominal aortic calcification (AAC) in adults.

METHODS

Data were collected from the 2013-2014 National Health and Nutrition Examination Survey. PAHs exposure was analyzed from urinary mono hydroxylated metabolites of PAHs. Logistic regression models and subgroup analysis were performed to explore the association of PAHs exposure with severe AAC prevalence.

RESULTS

A total of 1,005 eligible individuals were recruited into the study. After adjusting for confounding factors, those with the highest quartiles of 1-hydroxynaphthalene (1-NAP: OR 2.19, 95% CI 1.03-4.68, P_{for trend} < 0.001), 2-hydroxynaphthalene (2-NAP: OR 2.22, 95% CI 1.04-4.64, P_{for trend} < 0.001) and 1-hydroxypyrene (1-PYR: OR 2.15, 95% CI 1.06-4.33, P_{for trend} < 0.001) were associated with an increased prevalence of severe AAC in the adults compared to those who in the lowest quartile.

CONCLUSION

This study found that urinary 1-NAP, 2-NAP and 1-PYR were positively associated with severe AAC prevalence in adults.

Exposure to perchlorate, nitrate, and thiocyanate and the prevalence of abdominal aortic calcification

Perchlorate, nitrate, and thiocyanate are reported to affect human health. However, it is unclear about the associations between exposure to these chemicals and abdominal aortic calcification (AAC). A total of 959 individuals were included in a large representative survey. Urinary levels of perchlorate, nitrate, and thiocyanate were measured by ion chromatography coupled with electrospray tandem mass spectrometry. AAC was diagnosed based on dual-energy X-ray absorptiometry (DXA). There were 276 (28.8%) cases of AAC among the participants. The level of urinary nitrate was significantly lower in AAC patients compared with non-AAC patients (36.4 mg/L [20.6, 59.5] vs. 42.4 [23.8, 68.3]; P = 0.013). In multivariable-adjusted logistic regression models, urinary nitrate was associated with the prevalence of AAC. Compared with the lowest quartile, the odds ratios (95% confidence intervals) across increasing quartiles were 1.06 (0.69-1.61; P = 0.799), 0.64 (0.41-1.00; P = 0.049) and 0.74 (0.47-1.15; P = 0.180). Restricted cubic splines suggested that urinary nitrate ranging between 43.7 and 115.4 mg/L was associated with a lower risk of AAC. Moderate exposure to nitrate was associated with a lower risk of AAC.

The association between weight-adjusted-waist index and abdominal aortic calcification in adults aged ≥ 40 years: results from NHANES 2013-2014

The negative effects of obesity on the cardiovascular health have drawn much attention. Weight-adjusted-waist index (WWI) has been proved to reflect weight-independent centripetal obesity. However, the association between WWI and abdominal aortic calcification (AAC) has not been reported before. Using data from National Health and Nutrition Examination Survey 2013-2014, we aimed to determine the relationship of WWI and AAC in adults aged ≥ 40 years. WWI was determined by dividing waist circumference by the square root of weight. AAC was measured by dual-energy X-ray absorptiometry and quantified by Kauppila scores. Severe AAC (SAAC) was defined as an AAC score > 6. We utilized weighed multivariable logistic regression and generalized additive model to explore the independent association between WWI and AAC. Threshold effects were further calculated by two-piecewise linear regression model. 3082 participants were enrolled in our analysis, of which 48.2% were male. WWI was positively associated with AAC scores (β = 0.34, 95% CI 0.05-0.63) and exhibited a nonlinear relationship with SAAC. On the left of the breakpoint (WWI = 11.11), WWI and SAAC were positively associated (OR = 2.86, 95% CI 1.40-5.84), while no such relationship was found on the right (OR = 1.07, 95% CI 0.77-1.48). Our findings indicated that WWI may serve as a simple biomarker of AAC in US adults aged ≥ 40 years.

Higher visceral adiposity index is associated with increased likelihood of abdominal aortic calcification

BACKGROUND

The negative effects of visceral adiposity accumulation on cardiovascular health have drawn much attention. However, the association between the Visceral Adiposity Index (VAI) and Abdominal Aortic Calcification (AAC) has never been reported before. The authors aimed to investigate the association between the VAI and AAC in US adults.

METHODS

Cross-sectional data were derived from the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) of participants with complete data of VAI and AAC scores. Weighted multivariable regression and logistic regression analysis were conducted to explore the independent relationship between VAI and AAC. Subgroup analysis and interaction tests were also performed.

RESULTS

A total of 2958 participants were enrolled and participants in the higher VAI tertile tended to have a higher mean AAC score and prevalence of severe AAC. In the fully adjusted model, a positive association between VAI and AAC score and severe AAC was observed (β = 0.04, 95% CI 0.01‒0.08; OR = 1.04, 95% CI 1.01‒1.07). Participants in the highest VAI tertile had a 0.41-unit higher AAC score (β = 0.41, 95% CI 0.08‒0.73) and a significantly 68% higher risk of severe AAC than those in the lowest VAI tertile (OR = 1.68, 95% CI 1.04‒2.71). Subgroup analysis and interaction tests indicated that there was no dependence for the association of VAI and AAC.

CONCLUSION

Visceral adiposity accumulation evaluated by the VAI was associated with a higher AAC score and an increased likelihood of severe AAC.