Møller L F, Kristensen T S
Institut for Social Medicin, Københavns Universitet.
Ugeskr Laeger. 1993 Oct 4;155(40):3203-7.
Many epidemiological and animal experiment studies support the hypothesis of there being a causal association between lead exposure and increased blood pressure/cardiovascular disease. This study includes 1,052 men and women from Copenhagen County, Denmark, who were examined in 1976 and 1981; in 1987, only the men were examined. Blood lead fell by approximately 40% for the men during the 11-year period and by approximately 30% for the women during the first 5-year period. There was a univariate association between systolic blood pressure and blood lead for both sexes in 1976, but it disappeared at the following examinations. The authors found a significant univariate association between changes in blood lead and changes in systolic blood pressure from 1976 to 1987 in the males. All participants taking part in the study in 1976 were followed with respect to hospital admissions and deaths throughout a follow-up period lasting 14 years. There was a significant univariate association between blood lead levels in 1976 and total mortality, coronary heart disease, and cardiovascular disease. However, with regard to coronary heart disease and cardiovascular disease, the association disappeared when controlling for confounders. Blood lead was a significant predictor of total mortality after control for relevant confounders. This study supports the hypothesis of there being a weak causal association between blood lead and blood pressure, total mortality, coronary heart disease, and cardiovascular disease. The importance of this association is very modest for the individual, but the population attributable risk may be considerable.
许多流行病学和动物实验研究支持铅暴露与血压升高/心血管疾病之间存在因果关联的假说。本研究纳入了丹麦哥本哈根郡的1052名男性和女性,他们在1976年和1981年接受了检查;1987年,仅对男性进行了检查。在这11年期间,男性的血铅水平下降了约40%,在前5年期间,女性的血铅水平下降了约30%。1976年,收缩压与血铅之间在两性中均存在单变量关联,但在随后的检查中这种关联消失了。作者发现,1976年至1987年男性的血铅变化与收缩压变化之间存在显著的单变量关联。对所有1976年参与研究的参与者在长达14年的随访期内进行了住院和死亡情况的跟踪。1976年的血铅水平与总死亡率、冠心病和心血管疾病之间存在显著的单变量关联。然而,对于冠心病和心血管疾病,在控制混杂因素后这种关联消失了。在控制了相关混杂因素后,血铅是总死亡率的显著预测因素。本研究支持血铅与血压、总死亡率、冠心病和心血管疾病之间存在微弱因果关联的假说。这种关联对个体的重要性非常小,但人群归因风险可能相当大。