Colicino Elena, Hazeltine Danielle B, Schneider Kelly M, Zilverstand Anna, Bachi Keren, Alia-Klein Nelly, Goldstein Rita Z, Todd Andy C, Horton Megan K
Department of Environmental Medicine and Public Health, New York, NY, USA.
Department of Psychiatry, New York, NY, USA.
Environ Dis. 2019 Jul-Sep;4(3):75-80. doi: 10.4103/ed.ed_21_19. Epub 2019 Sep 27.
High blood pressure (BP) is associated independently with cocaine use and lead exposure. It is not known whether cocaine use and lead exposure act jointly to disrupt cardiovascular health.
To determine whether cocaine use modifies the association between cumulative lead levels and elevated BP.
We measured cumulative tibia lead levels in 35 adults: 20 with cocaine use disorder (CUD) and 15 non-CUD controls using K-shell X-ray fluorescence. Generalized estimating equation regression determined associations between log-transformed lead and BP (systolic, diastolic, and mean arterial pressure) and assessed the modifying association of cocaine use (as addiction severity) on the lead-BP relationship, adjusting for age, sex, smoking, and education. Sensitivity analyses included correction for potential selection bias.
Cases and controls differed by sex (%male: 90% vs. 67%), age (50.7 vs. 39.9 years), education (12.8 vs. 14.4 years), and tibia lead (3.50 vs. 2.35 μg/g). Lead was positively associated with systolic ( = 0.01) and diastolic BP ( = 0.01). We observed an interaction between lead and addiction severity on BP ( values for systolic BP: 0.01, diastolic BP: 0.003, and mean arterial BP: <0.0001); the association was stronger among individuals with more severe cocaine addiction: Systolic BP: Est.: 17.89, 95% confidence interval (CI): 9.52; 26.26, diastolic BP Est.: 17.89, 95% CI: 7.33; 13.79, mean arterial BP: Est.: 13.09, 95% CI: 10.34; 15.83.
Lead was adversely associated with BP. This association was strongest among individuals with more severe cocaine addiction. The results from this small pilot study suggest that the interaction between lead and cocaine should be considered in studies of substance abuse-related health outcomes.
高血压与可卡因使用及铅暴露独立相关。目前尚不清楚可卡因使用和铅暴露是否共同作用破坏心血管健康。
确定可卡因使用是否改变累积铅水平与血压升高之间的关联。
我们使用K壳层X射线荧光法测量了35名成年人的胫骨累积铅水平：20名患有可卡因使用障碍（CUD）者和15名非CUD对照者。广义估计方程回归确定了对数转换后的铅与血压（收缩压、舒张压和平均动脉压）之间的关联，并评估了可卡因使用（作为成瘾严重程度）对铅-血压关系的修正关联，同时对年龄、性别、吸烟和教育程度进行了校正。敏感性分析包括对潜在选择偏倚的校正。
病例组和对照组在性别（男性比例：90%对67%）、年龄（50.7岁对39.9岁）、教育程度（12.8年对14.4年）和胫骨铅含量（3.50μg/g对2.35μg/g）方面存在差异。铅与收缩压（P = 0.01）和舒张压（P = 0.01）呈正相关。我们观察到铅与成瘾严重程度在血压方面存在交互作用（收缩压P值：P = 0.01，舒张压P值：P = 0.003，平均动脉压P值：P < 0.0001）；在可卡因成瘾更严重的个体中，这种关联更强：收缩压：估计值：17.89，95%置信区间（CI）：9.52；26.26，舒张压估计值：17.89，95%CI：7.33；13.79，平均动脉压：估计值：13.09，95%CI：10.34；15.83。
铅与血压呈负相关。这种关联在可卡因成瘾更严重的个体中最强。这项小型试点研究的结果表明，在与药物滥用相关的健康结局研究中应考虑铅与可卡因之间的相互作用。
