Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Non-Profit Research Association Alliance for the Promotion of Preventive Medicine.
J Hypertens. 2024 Aug 1;42(8):1322-1330. doi: 10.1097/HJH.0000000000003713. Epub 2024 Mar 14.
We undertook time-stratified analyses of the National Health and Nutrition Examination Survey in the US to assess time trends (1999-2020) in the associations of blood lead (BL) with blood pressure, mortality, the BL-associated population attributable fraction (PAF).
Vital status of participants, 20-79 years old at enrolment, was ascertained via the National Death Index. Regressions, mediation analyses and PAF were multivariable adjusted and standardized to 2020 US Census data.
In time-stratified analyses, BL decreased from 1.76 μg/dl in 1999-2004 to 0.93 μg/dl in 2017-2020, while the proportion of individuals with BL < 1 μg/dl increased from 19.2% to 63.0%. Total mortality was unrelated to BL (hazard ratio (HR) for a fourfold BL increment: 1.05 [95% confidence interval, CI: 0.93-1.17]). The HR for cardiovascular death was 1.44 (1.01-2.07) in the 1999-2000 cycle, but lost significance thereafter. BL was directly related to cardiovascular mortality, whereas the indirect BL pathway via BP was not significant. Low socioeconomic status (SES) was directly related to BL and cardiovascular mortality, but the indirect SES pathway via BL lost significance in 2007-2010. From 1999-2004 to 2017-2020, cardiovascular PAF decreased ( P < 0.001) from 7.80% (0.17-14.4%) to 2.50% (0.05-4.68%) and number of lead-attributable cardiovascular deaths from 53 878 (1167-99 253) to 7539 (160-14 108).
Due to implementation of strict environmental policies, lead exposure is no longer associated with total mortality, and the mildly increased cardiovascular mortality is not associated with blood lead via blood pressure in the United States.
我们在美国国家健康和营养调查中进行了时间分层分析，以评估血液铅（BL）与血压、死亡率以及与 BL 相关的人群归因分数（PAF）之间关联的时间趋势（1999-2020 年）。
通过国家死亡指数确定了参与者的生存状态，这些参与者在登记时年龄为 20-79 岁。回归、中介分析和 PAF 采用多变量调整，并根据 2020 年美国人口普查数据进行标准化。
在时间分层分析中，BL 从 1999-2004 年的 1.76μg/dl 下降到 2017-2020 年的 0.93μg/dl，而 BL<1μg/dl 的个体比例从 19.2%增加到 63.0%。总死亡率与 BL 无关（BL 增加四倍的危害比（HR）：1.05 [95%置信区间，CI：0.93-1.17]）。心血管死亡的 HR 在 1999-2000 周期为 1.44（1.01-2.07），但此后失去意义。BL 与心血管死亡率直接相关，而通过血压的 BL 间接途径则不显著。低社会经济地位（SES）与 BL 和心血管死亡率直接相关，但 BL 间接 SES 途径在 2007-2010 年失去意义。从 1999-2004 年到 2017-2020 年，心血管 PAF 从 7.80%（0.17-14.4%）降至 2.50%（0.05-4.68%）（P<0.001），归因于铅的心血管死亡人数从 53878（1167-99253）降至 7539（160-14108）。
由于实施了严格的环境政策，铅暴露不再与总死亡率相关，在美国，轻度增加的心血管死亡率与血压无关。
