Blood lead below 0.48 μmol/L (10 μg/dL) and mortality among US adults
Blood lead below 0.48 μmol/L (10 μg/dL) and mortality among US adults
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DOI：
10.1161/circulationaha.106.628321
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发表时间：
2006-09-26
期刊：
影响因子：
37.8
通讯作者：
Guallar, Eliseo
中科院分区：
文献类型：
--
作者：
Menke, Andy;Muntner, Paul;Guallar, Eliseo
背景——成人血铅水平高于0.48 μ mol/L （10 μ g/dL）与心血管、癌症和全因死亡风险增加有关。本研究的目的是确定美国普通人群中低于0.48 μ mol/L的血铅水平与死亡率之间的关系。方法和结果-在1988年至1994年招募的第三次全国健康和营养检查调查的13 946名成年参与者的全国代表性样本中测量了血铅水平，并对全因和特定原因死亡率进行了长达12年的随访。研究参与者的几何平均血铅水平为0.12 μ mol/L （2.58 μ g/dL）。多因素调整后，血铅最高分位数（>= 0.17 mu mol/L [>= 3.62 mu g/dL]）与最低分位数（< 0.09 mu mol/L [< 1.94 mu g/dL]）的参与者的全因死亡率风险比（95% CI）为1.25(1.04至1.51，p趋势跨分位数=0.002)，心血管死亡率风险比为1.55（1.08至2.24，p趋势跨分位数=0.003）。血铅水平与心肌梗死和脑卒中死亡率均有显著相关性，且在血铅水平为> ~ 0.10 μ mol/L （>= 2 μ g/dL）时相关性显著。在这一暴露范围内，血铅与癌症死亡率之间没有关联。结论：血铅水平与全因死亡率和心血管死亡率增加之间的关联在比先前报道的低得多的血铅水平下被观察到。尽管过去30年来血铅水平显著下降，但环境铅暴露仍然是普通人群心血管死亡率的一个重要决定因素，构成了一个重大的公共卫生问题。
Background - Blood lead levels above 0.48 mu mol/L (10 mu g/dL) in adults have been associated with increased risk of cardiovascular, cancer, and all-cause mortality. The objective of the present study was to determine the association between blood lead levels below 0.48 mu mol/L and mortality in the general US population.Methods and Results - Blood lead levels were measured in a nationally representative sample of 13 946 adult participants of the Third National Health and Nutrition Examination Survey recruited in 1988 to 1994 and followed up for up to 12 years for all-cause and cause-specific mortality. The geometric mean blood lead level in study participants was 0.12 mu mol/L (2.58 mu g/dL). After multivariate adjustment, the hazard ratios (95% CI) for comparisons of participants in the highest tertile of blood lead (>= 0.17 mu mol/L [>= 3.62 mu g/dL]) with those in the lowest tertile (< 0.09 mu mol/L [< 1.94 mu g/dL]) were 1.25 (1.04 to 1.51; P-trend across tertiles=0.002) for all-cause mortality and 1.55 (1.08 to 2.24; P-trend across tertiles=0.003) for cardiovascular mortality. Blood lead level was significantly associated with both myocardial infarction and stroke mortality, and the association was evident at levels > 0.10 mu mol/L (>= 2 mu g/dL). There was no association between blood lead and cancer mortality in this range of exposure.Conclusions - The association between blood lead levels and increased all-cause and cardiovascular mortality was observed at substantially lower blood lead levels than previously reported. Despite the marked decrease in blood lead levels over the past 3 decades, environmental lead exposures remain a significant determinant of cardiovascular mortality in the general population, constituting a major public health problem.