J Am Heart Assoc. 2023 Jul 4;12(13):e029852. doi: 10.1161/JAHA.123.029852. Epub 2023 Jun 12.
Exposure to environmental pollutants is linked to increased risk of cardiovascular disease. Beyond the extensive evidence for particulate air pollution, accumulating evidence supports that exposure to nonessential metals such as lead, cadmium, and arsenic is a significant contributor to cardiovascular disease worldwide. Humans are exposed to metals through air, water, soil, and food and extensive industrial and public use. Contaminant metals interfere with critical intracellular reactions and functions leading to oxidative stress and chronic inflammation that result in endothelial dysfunction, hypertension, epigenetic dysregulation, dyslipidemia, and changes in myocardial excitation and contractile function. Lead, cadmium, and arsenic have been linked to subclinical atherosclerosis, coronary artery stenosis, and calcification as well as to increased risk of ischemic heart disease and stroke, left ventricular hypertrophy and heart failure, and peripheral artery disease. Epidemiological studies show that exposure to lead, cadmium, or arsenic is associated with cardiovascular death mostly attributable to ischemic heart disease. Public health measures reducing metal exposure are associated with reductions in cardiovascular disease death. Populations of color and low socioeconomic means are more commonly exposed to metals and therefore at greater risk of metal-induced cardiovascular disease. Together with strengthening public health measures to prevent metal exposures, development of more sensitive and selective measurement modalities, clinical monitoring of metal exposures, and the development of metal chelation therapies could further diminish the burden of cardiovascular disease attributable to metal exposure.
暴露于环境污染物与心血管疾病风险增加有关。除了大量证据表明细颗粒物空气污染外，越来越多的证据支持暴露于非必需金属（如铅、镉和砷）是全球心血管疾病的一个重要因素。人类通过空气、水、土壤和食物以及广泛的工业和公共用途接触金属。污染物金属会干扰关键的细胞内反应和功能，导致氧化应激和慢性炎症，从而导致内皮功能障碍、高血压、表观遗传失调、血脂异常以及心肌兴奋和收缩功能的改变。铅、镉和砷与亚临床动脉粥样硬化、冠状动脉狭窄和钙化以及缺血性心脏病和中风风险增加、左心室肥厚和心力衰竭以及外周动脉疾病有关。流行病学研究表明，暴露于铅、镉或砷与心血管死亡有关，主要归因于缺血性心脏病。减少金属暴露的公共卫生措施与心血管疾病死亡人数的减少有关。有色人种和社会经济地位较低的人群更常接触金属，因此患金属引起的心血管疾病的风险更高。除了加强预防金属暴露的公共卫生措施外，开发更敏感和选择性的测量方式、临床监测金属暴露以及开发金属螯合疗法，可以进一步减轻归因于金属暴露的心血管疾病负担。
