Deng Lili, Li Qinhong, Li Hongyan, Li Bin, Cheng Zugen, Xiao Ying
Department of Cardiology, Kunming Children's Hospital, Kunming, China.
Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Front Cardiovasc Med. 2025 Aug 12;12:1638747. doi: 10.3389/fcvm.2025.1638747. eCollection 2025.
BACKGROUND: Atrial fibrillation and flutter (AF/AFL) are increasingly recognized as major contributors to global cardiovascular morbidity and mortality. Emerging evidence implicates environmental lead exposure as a modifiable risk factor for AF/AFL, yet the global burden and trends of AF/AFL attributable to lead exposure remain poorly characterized. METHODS: We used data from the Global Burden of Disease Study 2021 to estimate mortality, disability-adjusted life years (DALYs), and temporal trends in AF/AFL attributable to lead exposure from 1990 to 2021, with projections to 2030. Analyses were stratified by age, sex, and Socio-demographic Index (SDI) quintiles. Population-attributable fractions were calculated using comparative risk assessment methodology. Trend analyses utilized Joinpoint regression, and projections applied BAPC models. FINDINGS: Between 1990 and 2021, the global burden of AF/AFL attributable to lead exposure increased substantially. The number of lead-attributable AF/AFL deaths rose by 264.9%, and DALYs increased by 179.3%. Age-standardized rates for mortality and DALYs rose by 30.7% and 16.3%, respectively. The highest attributable burden occurred in older adults (≥60 years) and low-SDI regions, where lead exposure remains pervasive. Males consistently exhibited higher AF/AFL mortality and DALY rates than females, although the sex gap is narrowing. A significant negative correlation was observed between SDI and both mortality ( = -0.53, < 0.001) and DALY rates ( = -0.53, < 0.001) for lead-attributable AF/AFL. Projections indicate a continued rise in global AF/AFL burden linked to lead exposure in the absence of further mitigation efforts. INTERPRETATION: Lead exposure is an important, preventable contributor to the rising global burden of AF/AFL, particularly among older adults and populations in low-SDI regions. Mechanistically, lead may increase AF/AFL risk through both direct myocardial effects and the amplification of established cardiovascular risk factors, notably hypertension. Our findings support urgent global policy action to reduce environmental lead exposure as an integral strategy for cardiovascular and arrhythmia prevention.
背景：心房颤动和心房扑动（AF/AFL）日益被视为全球心血管疾病发病率和死亡率的主要促成因素。新出现的证据表明，环境铅暴露是AF/AFL的一个可改变的风险因素，但全球范围内因铅暴露导致的AF/AFL负担和趋势仍未得到充分描述。 方法：我们使用了《2021年全球疾病负担研究》的数据，来估计1990年至2021年因铅暴露导致的AF/AFL的死亡率、伤残调整生命年（DALYs）和时间趋势，并预测到2030年。分析按年龄、性别和社会人口指数（SDI）五分位数进行分层。使用比较风险评估方法计算人群归因分数。趋势分析采用Joinpoint回归，预测应用BAPC模型。 研究结果：1990年至2021年期间，因铅暴露导致的全球AF/AFL负担大幅增加。铅归因的AF/AFL死亡人数增加了264.9%，DALYs增加了179.3%。年龄标准化死亡率和DALYs率分别上升了30.7%和16.3%。最高的归因负担出现在老年人（≥60岁）和低SDI地区，这些地区铅暴露仍然普遍存在。男性的AF/AFL死亡率和DALY率一直高于女性，尽管性别差距正在缩小。观察到SDI与铅归因的AF/AFL的死亡率（r = -0.53，p < 0.001）和DALY率（r = -0.53，p < 0.001）之间存在显著负相关。预测表明，如果不进一步采取缓解措施，与铅暴露相关的全球AF/AFL负担将继续上升。 解读：铅暴露是全球AF/AFL负担上升的一个重要的、可预防的因素，特别是在老年人和低SDI地区的人群中。从机制上讲，铅可能通过直接的心肌效应和对已有的心血管危险因素（尤其是高血压）的放大作用来增加AF/AFL的风险。我们的研究结果支持全球采取紧急政策行动，减少环境铅暴露，将其作为心血管疾病和心律失常预防的一项整体战略。
J Health Popul Nutr. 2025-8-28
BMC Musculoskelet Disord. 2025-7-1
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