MON-036 Lead Exposure Is Related to Macro- and Microvascular Diabetic Complications

Abstract

Background Lead, is one of the world’s highest-volume heavy metals in use today and remains ubiquitous in natural environment. High blood lead level (BLL) was associated with cardiovascular disease (CVD) and decline in renal function in general population. Considering CVD and diabetic kidney disease (DKD) has become top 2 in diabetic mortality rate, studies about their association with BLL in diabetic individuals were rather limited. We aimed to investigate whether higher BLL exposure associates with CVD and DKD in diabetic adults. We believe that this field of work may enable us to identify a novel risk factor for diabetic vascular complications. Methods 4,234 diabetic participants were enrolled from seven communities in Shanghai, China in 2018. Macrovascular measurements including common carotid artery (CCA) plaque and diameter were detected by ultrasound. CVD was defined as a composite measure including previous diagnosis of coronary heart disease, myocardial infarction, or stroke , which were recorded in the registration platform. DKD were defined according to ADA statement and KDOQI recommendation. Results Compared with first quartile, Odds ratios (ORs) (95% CI) of CCA plaque ranging from none to bilateral in ordinal regression associated with BLL was 1.23 (1.04, 1.46) for the fourth BLL quartile and the odds of having CVD was significantly increased 47% for participants in the fourth quartile (OR 1.47, 95% CI 1.22, 1.78) (P for trend <0.001). For DKD, the fourth BLL quartile increased the odds of DKD based on two definitions (ACR ≥30mg/g or eGFR <60 ml/min per 1.73 m2; ACR ≥300mg/g or ACR 30-299mg/g plus eGFR ≥30ml/min per 1.73 m2) by 55% (OR 1.55; 95%CI 1.25, 1.93) and 44% (OR 1.44; 95%CI 1.15, 1.80), respectively, compared with the first quartile. In non-diabetic participants, the association of BLL with CVD and eGFR was insignificant. Conclusions BLL was positively associated with CCA plaque, CVD and DKD in the Chinese middle-aged and elderly with diabetes and these associations were more prone to affect diabetic but not non-diabetic participants. Lead exposure is probably a major new modifiable risk factor for diabetic vascular complications, which suggest reducing lead exposure may be critical for primary or even secondary intervention.