Environmental heavy metals and risk of ischemic heart disease and stroke in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

项目总结 环境退化和接触重金属(个人往往难以控制)可能 对心血管疾病(CVD)的发展有直接影响，已成为最严重的 在全球范围内，个人和人口健康都面临着紧迫的死敌。最近的研究提供了具有挑衅性的 将环境暴露于重金属与糖尿病和高血压风险增加联系起来的证据，这 都是强烈的心血管疾病危险因素。相比之下，前瞻性队列研究表明，较高水平的饮食和 血清中必需微量元素与较低的心血管疾病风险直接相关，补充这些金属元素可能 通过减轻有毒金属对心血管系统的影响，有潜在的好处。然而，很少有人 研究直接和全面地调查了接触多种金属，特别是它们的联合影响。 对心血管疾病风险(包括中风)的影响。正在进行的巴西成人健康纵向研究(葡萄牙语， 巴西ELSA)，这是在南部建立的唯一大型前瞻性研究 美国专门研究心脏代谢健康的风险因素，这是一个独特的研究资源 多种金属暴露的作用及其与饮食中微量元素的相互作用在影响心血管疾病风险中的作用。在… 在圣保罗的Elsa-Brasil现场，4428名无心血管疾病的参与者完成了1)体检； 2)临床化验；3)面谈；4)采集血液和尿液样本；5)CT 检查以量化冠状动脉钙化(CAC)评分。到目前为止，共有466例心血管事件(~150例中风) 在为期10年的后续行动中，在Elsa-Brasil队列中对案件进行了裁决。在当前的应用程序目标中 为了进行调查，我们将利用这些特殊的资源和大量的时间和精力投资，通过 ELSA-Brasil研究人员在过去十年中以最具成本效益和最及时的方式进行调查， 金属在CVD发展中的作用。具体地说，当前的应用程序旨在利用这一正在进行的 前瞻性队列研究不仅确定重金属暴露是否会增加CAC评分和心血管疾病 不仅要确定人体内必需金属的最佳摄入量，而且要确定可降低有毒金属引起的心血管疾病风险的最佳人体水平。 如果存在拮抗效应，且可减少有毒金属影响的最佳人体必需金属水平为 如果得到证实，这项工作将导致简单、安全、容易获得、可接受和高度负担得起的营养 对心血管疾病预防的干预将在世界范围内具有临床和公共卫生意义。

PROJECT SUMMARY Environmental degradation and exposure to heavy metals (over which individuals often have little control) may have a direct impact on cardiovascular diseases (CVD) development, which have become one of the most pressing nemesis for individual- and population-health globally. Recent studies have provided provocative evidence linking environmental exposure to heavy metals to increased risk of diabetes and hypertension, which are strong CVD risk factors. In contrast, prospective cohort studies have shown that higher levels of dietary and serum essential trace metals are directly associated with lower CVD risk and that supplementation of which may have potential benefits by mitigating the effects of toxic metals on the cardiovascular system. However, very few studies have directly and comprehensively investigated exposure to multiple metals particularly their joint effects on affecting CVD risk (including stroke). The ongoing Brazilian Longitudinal Study of Adult Health (in Portuguese, ‘Estudo Longitudinal de Sau´ de do Adulto’, ELSA-Brasil), the only large prospective study established in South America to specifically investigate risk factors for cardiometabolic health, represents a unique resource to study the roles of multiple metal exposures and their interactions with dietary trace elements in affecting CVD risk. At baseline, 4,428 CVD-free participants at the ELSA-Brasil site in Sao Paulo completed 1) physical examinations; 2) clinical laboratory tests; 3) in-person interviews; 4) collections of blood and urine samples; and 5) a CT examination to quantify coronary artery calcium (CAC) score. To date, a total of 466 incident CVD (~150 stroke) cases have been adjudicated in the ELSA-Brasil cohort in the 10-year follow up. ln the current application aims to investigate, we will leverage these exceptional resources and the substantial investment of time and effort by ELSA-Brasil study investigators over the past ten years to investigate, in a most cost-efficient and timely manner, the roles of metals playing in CVD development. Specifically, the current application aims to utilize this ongoing prospective cohort study to not only determine whether heavy metal exposures increase CAC score and CVD risk, but also identify the optimal body levels of essential metals that could mitigate CVD risk from toxic metals. If antagonistic effects exist and optimal body levels of essential metals that could reduce toxic metal impacts are confirmed, this work would lead to simple, safe, readily-available, acceptable and highly-affordable nutritional intervention for CVD prevention that will have both clinical and public health significance worldwide.