ArticleThe Science of the total environment2024
Do we underestimate risk of cardiovascular mortality due to lead exposure?
Article in The Science of the total environment, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Metallomic Dysregulation and Cardiovascular Disease: Essential Trace Elements, Non-essential Metal Exposure, and Heart Failure Risk: A Systematic Review.Cardiovascular toxicology · 2026Pooled it
- Exposure to lead and incidence of Alzheimer's disease and all-cause dementia in the United States.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- A Narrative Review of Metallomic Studies: Revealing the Toxic Metal Burden in Tobacco Smokers.International journal of molecular sciences · 2025Review
- Association of urinary metal exposure with H. pylori seropositivity and mortality in the U.S. Population: NHANES 1999-2000 analysis.BMC gastroenterology · 2025Article
- Global Burden of Disease from Environmental Factors.Annual review of public health · 2025Review
- Use of biomarkers of metals to improve prediction performance of cardiovascular disease mortality.Environmental health : a global access science source · 2024Article
- Invited Perspective: Protect and Serve-The Potential Role of Folate in Lead Risk Reduction.Environmental health perspectives · 2024Article
- Trends in urine lead and associated mortality in US adults: NHANES 1999-2018.Frontiers in nutrition · 2024Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundStudies using data from the National Health and Nutrition Examination Survey-III (NHANES-III) have demonstrated significant prospective associations between blood lead levels and increased mortality. Bone lead represents cumulative lead burden and thus is a better biomarker for assessing chronic impacts, but its in vivo assessment requires special K-x-ray fluorescence (KXRF) instrumentation. Our team recently developed an algorithm predicting bone lead levels from a combination of blood lead levels, age and other socioeconomic and behavioral variables. We examined the associations of our algorithm-estimated bone lead levels and mortality in NHANES-III.
methodsWe included 11,628 adults followed up to December 31, 2019. Estimated tibia lead and patella lead levels were calculated using our prediction algorithms. We used survey-weighted Cox proportional hazards models to compute hazard ratios (HRs) and 95 % confidence intervals (CIs).
resultsDuring the median follow-up of 26.8 years, 4900 participants died (mortality rate = 1398 per 100,000 adults/year). Geometric means (95 % CIs) of blood lead, predicted tibia lead, and predicted patella lead were 2.69 μg/dL (2.54, 2.84), 6.73 μg/g (6.22, 7.25), and 16.3 μg/g (15.9, 16.8), respectively. The associations for all-cause mortality were similar between blood lead and bone lead. However, the associations for cardiovascular mortality were much greater with predicted bone lead markers compared to blood lead: for comparing participants at the 90th vs. 10th percentiles of exposure, HR = 3.32 (95 % CI: 1.93-5.73) for tibia lead, 2.42 (1.56-3.76) for patella lead, 1.63 (1.25-2.14) for blood lead. The population attributable fractions for cardiovascular disease mortality if everyone's lead concentrations were declined to the 10th percentiles were 45.8 % (95 % CI: 28.1-59.4) for tibia lead, 33.1 % (18.1-45.8) for patella lead, and 22.8 % (10.4-33.8) for blood lead.
conclusionsThese findings suggest that risk assessment for cardiovascular mortality based on blood lead levels may underestimate the true mortality risk of lead exposure.
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