Exposure to multiple metals and the risk of hypertension in adults: A prospective cohort study in a local area on the Yangtze River, China

Zhong, Qi; Wu, Hua-bing; Niu, Qin-shan; Jia, Pingping; Qin, Qirong; Wang, Xiaodong; He, Jiaxue; Yang, Wenqiang; Huang, Fen

doi:10.1016/j.envint.2021.106538

Cited by 49 publications

(36 citation statements)

References 55 publications

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“…Possible reasons for these discrepancies include differences in population demographics, exposure patterns and levels, mixture components, study designs, biospecimens measured, the timing of exposure and outcome assessment, population-specific unmeasured confounding, CVD outcome definitions, and the statistical approaches used [69]. The majority of studies were either cross-sectional in design (n = 13) [39,[42][43][44][45][46][47][49][50][51][52][53][54] or prospective cohort studies (n = 10) [38,[55][56][57][58][59][60][61][62][63]. Cardiovascular outcomes and risk factors were categorized into four groups: (i) blood pressure (BP) and hypertension, (ii) preeclampsia, (iii) dyslipidemia and serum lipid markers, and (iv) clinical CVD outcomes, including stroke, coronary heart disease (CHD), and myocardial infarction (MI).…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies were either cross-sectional in design ( n = 13) [ 39 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 ] or prospective cohort studies ( n = 10) [ 38 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. Cardiovascular outcomes and risk factors were categorized into four groups: (i) blood pressure (BP) and hypertension, (ii) preeclampsia, (iii) dyslipidemia and serum lipid markers, and (iv) clinical CVD outcomes, including stroke, coronary heart disease (CHD), and myocardial infarction (MI).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies meeting our inclusion criteria, all conducted in adults, have investigated impacts of metal mixtures on hypertension. Of these, only one prospective study by Zhong et al [59] has investigated metal mixture impacts on hypertension. This study was conducted in the Wanjiang Cohort, which follows adults living along the Yangtze River in ), were examined in relation to hypertension using a 2-stage approach.…”

Section: Blood Pressure and Hypertensionmentioning

confidence: 99%

“…Figure 1. Flow chart of literature review and study selection for papers published between 1998 through 1 October 2021.The majority of studies were either cross-sectional in design (n = 13)[39,[42][43][44][45][46][47][49][50][51][52][53][54] or prospective cohort studies (n = 10)[38,[55][56][57][58][59][60][61][62][63]. Cardiovascular outcomes and risk factors were categorized into four groups: (i) blood pressure (BP) and hypertension, (ii) preeclampsia, (iii) dyslipidemia and serum lipid markers, and (iv) clinical CVD outcomes, including stroke, coronary heart disease (CHD), and myocardial infarction (MI).…”

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confidence: 99%

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Exposure to Metal Mixtures in Association with Cardiovascular Risk Factors and Outcomes: A Scoping Review

Yim

Wang

Howe

et al. 2022

Toxics

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Since the National Institute of Environmental Health Sciences (NIEHS) declared conducting combined exposure research as a priority area, literature on chemical mixtures has grown dramatically. However, a systematic evaluation of the current literature investigating the impacts of metal mixtures on cardiovascular disease (CVD) risk factors and outcomes has thus far not been performed. This scoping review aims to summarize published epidemiology literature on the cardiotoxicity of exposure to multiple metals. We performed systematic searches of MEDLINE (PubMed), Scopus, and Web of Science to identify peer-reviewed studies employing statistical mixture analysis methods to evaluate the impact of metal mixtures on CVD risk factors and outcomes among nonoccupationally exposed populations. The search was limited to papers published on or after 1998, when the first dedicated funding for mixtures research was granted by NIEHS, through 1 October 2021. Twenty-nine original research studies were identified for review. A notable increase in relevant mixtures publications was observed starting in 2019. The majority of eligible studies were conducted in the United States (n = 10) and China (n = 9). Sample sizes ranged from 127 to 10,818. Many of the included studies were cross-sectional in design. Four primary focus areas included: (i) blood pressure and/or diagnosis of hypertension (n = 15), (ii) risk of preeclampsia (n = 3), (iii) dyslipidemia and/or serum lipid markers (n = 5), and (iv) CVD outcomes, including stroke incidence or coronary heart disease (n = 8). The most frequently investigated metals included cadmium, lead, arsenic, and cobalt, which were typically measured in blood (n = 15). The most commonly utilized multipollutant analysis approaches were Bayesian kernel machine regression (BKMR), weighted quantile sum regression (WQSR), and principal component analysis (PCA). To our knowledge, this is the first scoping review to assess exposure to metal mixtures in relation to CVD risk factors and outcomes. Recommendations for future studies evaluating the associations of exposure to metal mixtures with risk of CVDs and related risk factors include extending environmental mixtures epidemiologic studies to populations with wider metals exposure ranges, including other CVD risk factors or outcomes outside hypertension or dyslipidemia, using repeated measurement of metals to detect windows of susceptibility, and further examining the impacts of potential effect modifiers and confounding factors, such as fish and seafood intake.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Blood Pressure and Hypertensionmentioning

confidence: 99%

mentioning

confidence: 99%

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Exposure to Metal Mixtures in Association with Cardiovascular Risk Factors and Outcomes: A Scoping Review

Yim

Wang

Howe

et al. 2022

Toxics

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“…Furthermore, previous studies have found that Cd induces the expression of various pro-atherogenic adhesion molecules on the surface of endothelial cells, thereby facilitating adhesion and migration of immune cells into the vessel wall [7]. Elevated uCd levels were associated with 11% higher risk of stroke (median 0.44 µg/g creatinine versus median 0.10 µg/g creatinine) [1], and 49% higher risk of hypertension (≥5.22 µg/g creatinine versus <1.15 µg/g creatinine) [8]. Moreover, a meta-analysis showed the highest level of urinary Cd increased the risk of mortality from all-cause and cardiovascular disease (CVD) by 44% and 57%, respectively [9].…”

Section: Introductionmentioning

confidence: 99%

Trends in Urinary and Blood Cadmium Levels in U.S. Adults with or without Comorbidities, 1999–2018

Yang

2022

Nutrients

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Although cadmium (Cd) exposure has been declining in the United States (U.S.) over the years, the level of exposure for people with pre-existing comorbidities is unclear. This study characterized the trends of blood Cd levels (bCd) (n = 44,498) and urinary Cd levels (uCd) (n = 15,107) by pre-existing comorbidities among adults participating in the U.S. National Health and Nutrition Examination Survey. We calculated age- and sex-standardized annual geometric mean (GM) levels, and used aJoinpoint regression model to examine the trends over time. The GM levels of bCd declined from 1999–2000 to 2017–2018 survey cycles (from 0.49 to 0.33 μg/L), while women and current smokers had higher levels. Participants with comorbidities had higher bCd and declined over time: cardiovascular disease (CVD) (0.50 to 0.42 μg/L), hypertension (0.49 to 0.35 μg/L), chronic kidney disease (CKD) (0.54 to 0.37 μg), and cancer (0.57 to 0.38 μg) versus those without these comorbidities. We observed the similar pattern of changes for uCd and participants with CVD, CKD, and cancer had higher levels. To conclude, the trend in urinary and blood Cd levels in U.S adults decreased in the past 20 years, and the levels varied by sex, smoking status, and comorbidities.

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Effect of exposures to multiple metals on blood pressure and hypertension in the elderly: a community-based study

Hu,

Xiao,

Shen

et al. 2023

Biometals

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Exposure to multiple metals and the risk of hypertension in adults: A prospective cohort study in a local area on the Yangtze River, China

Cited by 49 publications

References 55 publications

Exposure to Metal Mixtures in Association with Cardiovascular Risk Factors and Outcomes: A Scoping Review

Exposure to Metal Mixtures in Association with Cardiovascular Risk Factors and Outcomes: A Scoping Review

Trends in Urinary and Blood Cadmium Levels in U.S. Adults with or without Comorbidities, 1999–2018

Effect of exposures to multiple metals on blood pressure and hypertension in the elderly: a community-based study

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