BACKGROUND Most absorbed lead ends up in the bone, where it can be measured as a biomarker of cumulative exposure, elevations of which have been shown to predict a higher risk of coronary heart disease (CHD). Knowledge about the role of dietary patterns is critical to the development of effective interventions for the cardiovascular toxicity of cumulative lead exposure. METHODS 594 men, free of CHD at baseline, were followed from August 1991 to June 2011 in the Normative Aging Study. Bone lead concentrations were measured by K-shell-X-ray fluorescence. Dietary patterns were identified using principal components analysis. Two dietary patterns were identified: a 'prudent' pattern characterized by high intake of fruit, vegetables, legumes, tomatoes, poultry, and seafood; and a 'Western' pattern, with high intake of red meat, processed meat, refined grains, high-fat dairy products, high-energy drinks, fries, butter and eggs. Cox proportional hazard models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CHD. Effect modification on the multiplicative scale was examined through cross-product interaction terms. RESULTS 137 men developed incident CHD events during 5071 person-years of follow-up. After adjusting for age, body mass index, total energy intake, smoking status, total cholesterol to high-density lipoprotein ratio, education and occupation, an HR of incident CHD was 1.64 (95% CI: 1.27-2.11) with each doubling in patella lead concentration in the low prudent diet group (< median prudent score); and the HR decreased to 1.07 (95% CI: 0.86-1.34) in the high prudent diet (≥ median prudent score) (p-for-interaction = 0.01), suggesting protective effects of prudent diet against lead-related CHD. By contrast, the association between tibia lead and CHD was non-significantly larger in the low Western diet group (HR = 1.43, 95% CI: 1.14-1.80) compared with the high Western diet group (HR = 1.08, 95% CI: 0.86-1.34) (p-for-interaction = 0.06). No significant effect modifications were detected by Western diet in the patella lead-CHD association and by prudent diet in the tibia lead-CHD association. CONCLUSIONS Prudent diet may reduce the risk of development of CHD in relation to patella lead. However, these findings need to be interpreted with caution, given the modest sample size.

中文翻译：

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中年男子的饮食习惯，骨铅和冠心病的发病率。

背景技术大多数吸收的铅最终都在骨骼中，可以将其作为累积暴露的生物标志物进行测量，其升高已显示出预示着冠心病（CHD）的更高风险。关于饮食模式的作用的知识对于开发有效的干预措施来累积铅暴露的心血管毒性至关重要。方法1991年8月至2011年6月在规范老龄化研究中追踪了594名基线时无冠心病的男性。骨铅浓度通过K-shell-X射线荧光测量。使用主成分分析确定饮食模式。确定了两种饮食模式：以大量摄入水果，蔬菜，豆类，西红柿，家禽和海鲜为特征的“谨慎”模式；以及“西方”模式，大量摄入红肉，加工肉，精制谷物，高脂乳制品，高能饮料，薯条，黄油和鸡蛋。使用Cox比例风险模型计算事故冠心病的风险比（HRs）和95％置信区间（CIs）。通过跨产品交互作用项，研究了乘数尺度上的效果修正。结果137名男性在5071人-年的随访期间发生了冠心病事件。在调整了年龄，体重指数，总能量摄入量，吸烟状况，总胆固醇与高密度脂蛋白的比率，教育程度和职业之后，CHD事件的HR为1.64（95％CI：1.27-2.11），each骨每增加一倍低审慎饮食组中的铅浓度（<审慎中位数）；在高审慎饮食（≥审慎中位数）中，HR降至1.07（95％CI：0.86-1.34）（交互作用p = 0.01），表明谨慎饮食对铅相关冠心病的保护作用。相比之下，低西饮食组（HR = 1.43，95％CI：1.14-1.80）与高西饮食组（HR = 1.08，95％CI ：）相比，胫骨铅与冠心病之间的相关性无统计学意义。 0.86-1.34）（互动p = 0.06）。Western骨铅-CHD关联的西方饮食和胫骨铅-CHD关联的谨慎饮食均未发现明显的效果改变。结论谨慎饮食可降低CH骨铅导致冠心病的风险。但是，鉴于样本量适中，需要谨慎解释这些发现。43、95％CI：1.14-1.80）与高西饮食组（HR = 1.08，95％CI：0.86-1.34）（互动对= 0.06）。Western骨铅-CHD关联的西方饮食和胫骨铅-CHD关联的谨慎饮食均未发现明显的效果改变。结论谨慎饮食可降低CH骨铅导致冠心病的风险。但是，鉴于样本量适中，需要谨慎解释这些发现。43、95％CI：1.14-1.80）与高西饮食组（HR = 1.08，95％CI：0.86-1.34）（互动对= 0.06）。Western骨铅-CHD关联的西方饮食和胫骨铅-CHD关联的谨慎饮食均未发现明显的效果改变。结论谨慎饮食可降低CH骨铅导致冠心病的风险。但是，鉴于样本量适中，需要谨慎解释这些发现。