Allostatic load amplifies the effect of blood lead levels on elevated blood pressure among middle-aged U.S. adults: a cross-sectional study.
Allostatic load amplifies the effect of blood lead levels on elevated blood pressure among middle-aged U.S. adults: a cross-sectional study.
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DOI：
10.1186/1476-069x-12-64
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发表时间：
2013-08-16
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影响因子：
--
通讯作者：
Morello-Frosch R
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文献类型：
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作者：
Zota AR;Shenassa ED;Morello-Frosch R
科学家和监管机构一直在努力了解慢性压力暴露导致的生理失调是否以及如何可能增加对有毒物质暴露的不良健康影响的脆弱性。我们进行了一项横断面研究，以确定非稳态负荷（AL），一个复合措施的生理反应，慢性暴露于压力，放大铅暴露对血压的影响，在中年人。我们分析了1999- 2008年全国健康和营养检查调查中8，194名美国成年人（40-65岁）的全国代表性样本中血铅水平与血压之间的关系。结局为收缩压（≥ 140 mm Hg）和舒张压（≥ 90 mm Hg）升高。AL被定义为七个组成部分的综合评分，反映了心血管、炎症和内分泌系统的失调。Logistic回归模型显示高AL组血铅五分位数与收缩压升高呈线性剂量反应关系（p = 0.03），但低AL组无此关系（p = 0.24）。同样，高AL组的铅暴露与舒张压升高之间的关系比低AL组更强。在高AL组中，与最低五分位数相比，第四和第五分位数的血压升高几率显著升高[OR = 1.92，（95%CI，1.07，3.47）和OR =2.28（95%CI，1.33，3.91）]。在低AL组中，尽管有线性趋势的证据（p =0.03），但五分位效应与参考组无显著差异。对于收缩压或舒张压模型，导联与AL的相互作用项均无统计学显著性。结果表明，较高的AL可能会放大铅对血压的不良影响。未来的研究应评估累积暴露于环境和社会压力的监管决策的影响。
Scientists and regulators have sought to understand whether and how physiologic dysregulation due to chronic stress exposure may enhance vulnerability to the adverse health effects of toxicant exposures. We conducted a cross-sectional study to determine whether allostatic load (AL), a composite measure of physiologic response to chronic exposure to stress, amplifies the effect of lead exposure on blood pressure among middle-aged adults. We analyzed associations between blood lead levels and blood pressure in a nationally representative sample of 8,194 U.S. adults (aged 40-65 years) participating in the National Health and Nutritional Examination Survey, 1999--2008. Outcomes were elevated systolic (≥ 140 mm Hg) and diastolic (≥ 90 mm Hg) blood pressure. AL was defined as the aggregate score of seven components, reflecting dysregulation of the cardiovascular, inflammatory, and endocrine systems. Logistic regression models showed a linear dose-response relationship for quintiles of blood lead and elevated systolic blood pressure in the high AL group (p = 0.03) but not the low AL group (p = 0.24). Similarly, the relationship between lead exposure and elevated diastolic blood pressure was stronger among the high AL group than the low AL group. Within the high AL group, the fourth and fifth quintiles had significantly elevated odds of elevated blood pressure compared to lowest quintile [OR = 1.92, (95% CI, 1.07, 3.47) and OR =2.28 (95% CI, 1.33, 3.91), respectively]. In the low AL group, none of the quintile effects were significantly different than the referent group although there was evidence of a linear trend (p =0.03). The lead by AL interaction term was not statistically significant for either systolic or diastolic blood pressure models. Results suggest that higher AL may amplify the adverse effects of lead on blood pressure. Future research should assess the implications of cumulative exposures to environmental and social stressors for regulatory decision-making.