Metal biomarker mixtures and blood pressure in the United States: cross-sectional findings from the 1999-2006 National Health and Nutrition Examination Survey (NHANES)

Abstract

Background The objective of this study was to identify conditional relationships between multiple metal biomarkers that predict systolic and diastolic blood pressure in the non-institutionalized United States adult population below the age of 60. Methods We used inorganic exposure biomarker data and blood pressure data from three cycles (1999–2004) of the National Health and Nutrition Examination Survey (NHANES) to construct regression trees for blood pressure among adults ages 20–60 (adjusted for age, sex, body mass index, race, and smoking status) to identify predictors of systolic (SBP) and diastolic blood pressure (DBP). We also considered relationships among non-Hispanic black, Mexican-American, and white adults separately. Results The following metal exposure biomarkers were conditionally predictive of SBP and/or DBP in the full sample: antimony (Sb), barium (Ba), cadmium (Cd), cesium (Cs), lead (Pb), tungsten (W) and molybdenum (Mo). The highest average SBP (> 120 mmHg) was observed among those with low Sb (≤ 0.21 μg/dL) high Cd (> 0.22 μg/g creatinine) and high Pb (> 2.55 μg/dL) biomarkers. Those with the highest average DBP had high urinary W levels (> 0.10 μg/g creatinine) in combination with either urinary Sb > 0.17 μg/g creatinine or those with urinary Sb ≤ 0.17 μg/g creatinine, but with high blood Pb levels (> 1.35 μg/dL). Predictors differed by ethnicity, with Cd as the main predictor of SBP among non-Hispanic black adults, and Pb not selected by the algorithm as a predictor of SBP among non-Hispanic white adults. Conclusions Combinations of metal biomarkers have different apparent relationships with blood pressure. Additional research in toxicological experimental models and in epidemiological studies is warranted to evaluate the suggested possible toxicological interactions between Sb, Cd, and Pb; and between W, Sb, and Pb; for cardiovascular (e.g., blood pressure) health. We also think future epidemiological research on inorganic exposure sets in relation to health outcomes like blood pressure might benefit from stratification by race and ethnicity.

Inverse Association of Plasma Molybdenum with Metabolic Syndrome in a Chinese Adult Population: A Case-Control Study

“…A recent report indicated that one-third of Chinese adults had MetS due to the rapid socio-economic growth within a short time [8]. Growing evidence suggested that essential elements might impact the onset and progression of MetS [9][10][11][12].…”

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

“…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).…”

“…Ten studies were conducted in the USA, followed by 9 in China ( Table 2 ). While 6 out of the 10 USA studies were based on NHANES data [ 42 , 43 , 44 , 45 , 46 , 47 ], none were excluded as they focused on unique combinations of metal components, evaluated different CVD-related outcomes, or used different mixtures analysis methods. Sample sizes ranged between 127 (a panel study of adults in China [ 48 ]) to 10,818 (a cross-sectional study conducted in the USA NHANES [ 43 ]).…”

“…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).…”

“…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).…”