Adrian Ruiz-Hernandez1,2, Ana Navas-Acien3,4,5, Roberto Pastor-Barriuso6,7, Ciprian M Crainiceanu8, Josep Redon1,2,9, Eliseo Guallar3,5,10, Maria Tellez-Plaza2,4. 1. Department of Internal Medicine, Hospital Clinic of Valencia, Valencia, Spain. 2. Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research Hospital Clinic of Valencia INCLIVA, Valencia, Spain. 3. Welch Center for Prevention, Epidemiology and Clinical Research. 4. Environmental Health Sciences. 5. Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 6. National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain. 7. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain. 8. Department of Biostatistics, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 9. Consortium for Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, Madrid, Spain. 10. Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Abstract
Background: Lead and cadmium exposures have markedly declined in the USA following the implementation of large-scale public health policies and could have contributed to the unexplained decline in cardiovascular mortality in US adults. We evaluated the potential contribution of lead and cadmium exposure reductions to explain decreasing cardiovascular mortality trends occurring in the USA from 1988-94 to 1999-2004. Methods: Prospective study in 15 421 adults ≥40 years old who had participated in the National Health and Nutrition Examination Survey 1988-94 or 1999-2004. We estimated the amount of change in cardiovascular mortality over time that can be independently attributed to the intermediate pathway of changes in blood lead and urine cadmium concentrations. Results: There was a 42.0% decrease in blood lead and a 31.0% decrease in urine cadmium concentrations. The cardiovascular mortality rate ratio [95% confidence intervals (CIs)] associated with a doubling of metal levels was 1.19 (1.07, 1.31) for blood lead and 1.20 (1.09, 1.32) for urine cadmium. The absolute reduction in cardiovascular deaths comparing 1999-2004 to 1988-94 was 230.7 deaths/100 000 person-years, in models adjusted for traditional cardiovascular risk factors. Among these avoided deaths, 52.0 (95% CI 8.4, 96.7) and 19.4 (4.3, 36.4) deaths/100 000 person-years were attributable to changes in lead and cadmium, respectively. Conclusions: Environmental declines in lead and cadmium exposures were associated with reductions in cardiovascular mortality in US adults. Given the fact that lead and cadmium remain associated with cardiovascular disease at relatively low levels of exposure, prevention strategies that further minimize exposure to lead and cadmium may be needed.
Background: Lead and cadmium exposures have markedly declined in the USA following the implementation of large-scale public health policies and could have contributed to the unexplained decline in cardiovascular mortality in US adults. We evaluated the potential contribution of lead and cadmium exposure reductions to explain decreasing cardiovascular mortality trends occurring in the USA from 1988-94 to 1999-2004. Methods: Prospective study in 15 421 adults ≥40 years old who had participated in the National Health and Nutrition Examination Survey 1988-94 or 1999-2004. We estimated the amount of change in cardiovascular mortality over time that can be independently attributed to the intermediate pathway of changes in blood lead and urine cadmium concentrations. Results: There was a 42.0% decrease in blood lead and a 31.0% decrease in urine cadmium concentrations. The cardiovascular mortality rate ratio [95% confidence intervals (CIs)] associated with a doubling of metal levels was 1.19 (1.07, 1.31) for blood lead and 1.20 (1.09, 1.32) for urine cadmium. The absolute reduction in cardiovascular deaths comparing 1999-2004 to 1988-94 was 230.7 deaths/100 000 person-years, in models adjusted for traditional cardiovascular risk factors. Among these avoided deaths, 52.0 (95% CI 8.4, 96.7) and 19.4 (4.3, 36.4) deaths/100 000 person-years were attributable to changes in lead and cadmium, respectively. Conclusions: Environmental declines in lead and cadmium exposures were associated with reductions in cardiovascular mortality in US adults. Given the fact that lead and cadmium remain associated with cardiovascular disease at relatively low levels of exposure, prevention strategies that further minimize exposure to lead and cadmium may be needed.
Authors: R Cooper; J Cutler; P Desvigne-Nickens; S P Fortmann; L Friedman; R Havlik; G Hogelin; J Marler; P McGovern; G Morosco; L Mosca; T Pearson; J Stamler; D Stryer; T Thom Journal: Circulation Date: 2000-12-19 Impact factor: 29.690
Authors: Maria Tellez-Plaza; Ana Navas-Acien; Ciprian M Crainiceanu; A Richey Sharrett; Eliseo Guallar Journal: Am J Epidemiol Date: 2010-08-06 Impact factor: 4.897
Authors: Gervasio A Lamas; Christine Goertz; Robin Boineau; Daniel B Mark; Theodore Rozema; Richard L Nahin; Lauren Lindblad; Eldrin F Lewis; Jeanne Drisko; Kerry L Lee Journal: JAMA Date: 2013-03-27 Impact factor: 56.272
Authors: Yan Borné; Lars Barregard; Margaretha Persson; Bo Hedblad; Björn Fagerberg; Gunnar Engström Journal: BMJ Open Date: 2015-06-15 Impact factor: 2.692
Authors: Denisse Diaz; Francisco Ujueta; Gisell Mansur; Gervasio A Lamas; Ana Navas-Acien; Ivan A Arenas Journal: Curr Environ Health Rep Date: 2021-03-23
Authors: Katie M O'Brien; Alexandra J White; Brian P Jackson; Margaret R Karagas; Dale P Sandler; Clarice R Weinberg Journal: Am J Epidemiol Date: 2019-04-01 Impact factor: 4.897
Authors: Katie M O'Brien; Alexandra J White; Brian P Jackson; Margaret R Karagas; Dale P Sandler; Clarice R Weinberg Journal: Am J Epidemiol Date: 2019-11-01 Impact factor: 4.897
Authors: Katie M O'Brien; Alexandra J White; Dale P Sandler; Brian P Jackson; Margaret R Karagas; Clarice R Weinberg Journal: Epidemiology Date: 2019-01 Impact factor: 4.822
Authors: Yuexia Li; Cheng Chen; Liping Lu; Wenzhi Guo; Lisa B VanWagner; James M Shikany; Shuijun Zhang; Ka Kahe Journal: Dig Dis Sci Date: 2021-02-25 Impact factor: 3.199
Authors: Maria Grau-Perez; V Saroja Voruganti; Poojitha Balakrishnan; Karin Haack; Walter Goessler; Nora Franceschini; Josep Redón; Shelley A Cole; Ana Navas-Acien; Maria Tellez-Plaza Journal: Environ Pollut Date: 2021-02-11 Impact factor: 8.071