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Abstract
This study explores the combined effect of lead (Pb) exposure and an index of chronic physiological stress on cardiovascular disease mortality using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2008 linked to 1999–2014 National Death Index data. Chronic physiological stress was measured using the allostatic load (AL) index, which was formed by analyzing markers from the cardiovascular, inflammatory, and metabolic systems, with Pb levels, assessed using blood lead levels (BLL). The dataset was analyzed with statistical techniques to explore (a) the relationship between Pb exposure and AL, and (b) the combined role of Pb and AL on cardiovascular disease mortality. Results indicated that AL was more elevated in those with BLLs above the 50th percentile in the US population and that those with elevated AL were more likely to have high BLL. Finally, the interaction of AL and BLL significantly increased the likelihood of cardiovascular disease mortality. These findings highlight the need for considering the totality of exposures experienced by populations to build holistic programs to prevent Pb exposure and reduce stressors to promote optimal health outcomes and reduce cardiovascular mortality risk.
Highlights
In the US population, cardiovascular diseases are the leading cause of mortality [1].Numerous epidemiological studies have linked lead (Pb) exposure with adverse cardiovascular disease outcomes [2,3,4,5]
This study examined the association between blood lead levels (BLL) and allostatic load (AL), and the combined effect of BLL and AL on cardiovascular disease mortality in adults using data from the National
We explored the association of cardiovascular disease mortality risk with BLL, AL, and the interaction of AL and BLL (AL X BLL) using cox proportional hazard ratios
Summary
In the US population, cardiovascular diseases are the leading cause of mortality [1]. Numerous epidemiological studies have linked lead (Pb) exposure with adverse cardiovascular disease outcomes [2,3,4,5]. According to the Centers for Disease Control and Prevention (CDC), any exposure to Pb can induce disease and dysfunction in children [6]. The US Centers for Disease Control and Prevention (CDC) have concluded that no Pb exposure level is safe for adults as adverse health outcomes have been documented at all exposure concentrations [6,16]. Race is a critical factor in Pb exposure risk in the United States, with environmental inequities leaving Black populations disproportionately exposed. Owing in part to environmental racism, social and environmental conditions such as residential location, education, and employment have historically led to greater exposure in minority populations to environ-
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