Abstract

Background:

Lead exposure is a risk factor for increased blood pressure and cardiovascular disease, even when blood lead levels (BLLs) are within the normal range.

Objective:

This study aimed to investigate the association between BLL and coronary artery stenosis (CAS) in asymptomatic adults using 128-slice dual-source coronary computed tomography (CT) angiography.

Methods:

We analyzed medical records data from 2,193 adults (1,461 men and 732 women) who elected to complete a screening health examination, coronary CT angiography, and BLL measurement during 2011–2018 and had no history of CAS symptoms, cardiovascular disease, or occupational exposure to lead. Logistic regression models were used to estimate associations between moderate-to-severe CAS ($\ge 25\%$ stenosis) and a $1\text{-}\mathrm{\mu }\mathrm{g}/\text{dL}$ increase in blood lead, with and without adjustment for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, regular exercise, smoking status, and alcohol drinking.

Results:

BLLs ranged from $0.12\text{\hspace{0.17em}to\hspace{0.17em}}10.14\mathrm{\mu }\mathrm{g}/\text{dL}$, with an arithmetic mean of $2.71\pm 1.26\mathrm{\mu }\mathrm{g}/\text{dL}$. The arithmetic mean was higher for men than for women ($2.98\pm 1.26\mathrm{\mu }\mathrm{g}/\text{dL}$ vs. $2.18\pm 1.08\mathrm{\mu }\mathrm{g}/\text{dL}$, $p<0.001$) and higher in the moderate-to-severe CAS group than in the no-CAS or $<25\%$ stenosis group ($3.02\pm 1.44\mathrm{\mu }\mathrm{g}/\text{dL}$ vs. $2.67\pm 1.23\mathrm{\mu }\mathrm{g}/\text{dL}$, $p<0.001$). Moderate-to-severe CAS was significantly associated with BLL before and after adjustment, with an adjusted odds ratio for a $1\text{-}\mathrm{\mu }\mathrm{g}/\text{dL}$ increase in BLL of 1.14 (95% CI: 1.02, 1.26), $p=0.017$.

Conclusions:

BLL was positively associated with the prevalence of moderate-to-severe CAS in Korean adults who completed an elective screening examination for early cardiovascular disease, 94% of whom had a BLL of $<5\mathrm{\mu }\mathrm{g}/\text{dL}$. More efforts and a strict health policy are needed to further reduce BLLs in the general population. https://doi.org/10.1289/EHP7351

中文翻译：

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血铅水平与冠状动脉血管造影术测量冠状动脉狭窄之间的关联

摘要

背景：

铅暴露是导致血压升高和心血管疾病的危险因素，即使血铅水平（BLLs）在正常范围内也是如此。

客观的：

这项研究旨在调查无症状成人中BLL与冠状动脉狭窄（CAS）之间的关联，使用128层双源冠状动脉计算机断层扫描（CT）血管造影。

方法：

我们分析了2011-2018年期间选择完成筛查健康检查，冠状动脉CT血管造影和BLL测量的2193名成年人（1 461名男性和732名女性）的病历数据，这些患者没有CAS症状，心血管疾病或职业病史带领。使用Logistic回归模型估计中度至重度CAS（$\ge 25％$ 狭窄）和 $\mathrm{1个}\text{--}\mathrm{\mu }\mathrm{G}/\text{dL}$ 血铅增加，并根据年龄，性别，高血压，糖尿病，血脂异常，体重指数，定期运动，吸烟状况和饮酒情况进行调整。

结果：

BLL的范围从 $0.12\text{\hspace{0.17em}到\hspace{0.17em}}10.14\mathrm{\mu }\mathrm{G}/\text{dL}$，其算术平均值为 $2.71\pm 1.26\mathrm{\mu }\mathrm{G}/\text{dL}$。男性的算术平均值高于女性（$2.98\pm 1.26\mathrm{\mu }\mathrm{G}/\text{dL}$ 与 $2.18\pm 1.08\mathrm{\mu }\mathrm{G}/\text{dL}$， $p<0.001$），并且在中度至重度CAS组中的数字高于无CAS或 $<25％$ 狭窄组（$3.02\pm 1.44\mathrm{\mu }\mathrm{G}/\text{dL}$ 与 $2.67\pm 1.23\mathrm{\mu }\mathrm{G}/\text{dL}$， $p<0.001$）。中度至重度CAS调整前后与BLL显着相关，调整后的比值比为$\mathrm{1个}\text{--}\mathrm{\mu }\mathrm{G}/\text{dL}$ BLL增加1.14（95％CI：1.02，1.26）， $p=0.017$。

结论：

BLL与韩国成年人中中重度CAS的患病率呈正相关，韩国成年人完成了早期心血管疾病的选择性筛查，其中94％的BLL为 $<5\mathrm{\mu }\mathrm{G}/\text{dL}$。需要进一步的努力和严格的卫生政策，以进一步减少普通人群的BLL。https://doi.org/10.1289/EHP7351