- Full (HTML) - Full (PDF) - Related EHP Articles - PubMed:Related Articles - PubMed:Citation - Cited in PMC - Purchase This Issue

Ana Navas-Acien,¹ Eliseo Guallar,^2,3 Ellen K. Silbergeld,¹ and Stephen J. Rothenberg^4,5

¹Department of Environmental Health Sciences, and ²Departments of Epidemiology and Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; ³Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; ⁴Centro de Investigación y de Estudios Avanzados – Instituto Politécnico Nacional (CINVESTAV-IPN), Mérida, Yucatán, México; ⁵Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México

Abstract
Objective: This systematic review evaluates the evidence on the association between lead exposure and cardiovascular end points in human populations.

Methods: We reviewed all observational studies from database searches and citations regarding lead and cardiovascular end points.

Results: A positive association of lead exposure with blood pressure has been identified in numerous studies in different settings, including prospective studies and in relatively homogeneous socioeconomic status groups. Several studies have identified a dose–response relationship. Although the magnitude of this association is modest, it may be underestimated by measurement error. The hypertensive effects of lead have been confirmed in experimental models. Beyond hypertension, studies in general populations have identified a positive association of lead exposure with clinical cardiovascular outcomes (cardiovascular, coronary heart disease, and stroke mortality ; and peripheral arterial disease) , but the number of studies is small. In some studies these associations were observed at blood lead levels < 5 µg/dL.

Conclusions: We conclude that the evidence is sufficient to infer a causal relationship of lead exposure with hypertension. We conclude that the evidence is suggestive but not sufficient to infer a causal relationship of lead exposure with clinical cardiovascular outcomes. There is also suggestive but insufficient evidence to infer a causal relationship of lead exposure with heart rate variability.

Public Health Implications: These findings have immediate public health implications. Current occupational safety standards for blood lead must be lowered and a criterion for screening elevated lead exposure needs to be established in adults. Risk assessment and economic analyses of lead exposure impact must include the cardiovascular effects of lead. Finally, regulatory and public health interventions must be developed and implemented to further prevent and reduce lead exposure.

Key words: atherosclerosis, blood pressure, cardiovascular disease, heart rate variability, hypertension, lead, systematic review. Environ Health Perspect 115:472–482 (2007) . doi:10.1289/ehp.9785 available via http://dx.doi.org/ [Online 22 December 2006]

This article is part of the mini-monograph "Lead Exposure and Health Effects in Adults: Evidence, Management, and Implications for Policy."

Address correspondence to S. Rothenberg, Departamento, Ecología Humana, Centro de Investigación y de Estudios Avanzados—Instituto Politécnico Nacional (CINVESTAV-IPN) , Carretera Antigua a Progreso km 6, 97310 Mérida, Yucatán, México. Telephone: 52 999 124 2109. Fax: 52 739 395 0662. E-mail: srothenberg@mda.cinvestav.mx

We thank J.M. Samet for his comments to a previous version of this manuscript.

A.N-A. was supported by grant P30 ES 03819 from the National Institute of Environmental Health Sciences Center in Urban Environmental Health.

The authors declare they have no competing financial interests.

Received 3 October 2006 ; accepted 20 December 2006.