Effect of lead on cardiac parasympathetic function

Exploring the Link Between the Serum/Blood Levels of Heavy Metals (Pb, As, Cd, and Cu) and 2 Novel Biomarkers of Cardiovascular Stress (Growth Differentiation Factor 15 and Soluble Suppression of Tumorigenicity 2) in Copper Smelter Workers

OBJECTIVE

Studying the association between the occupational exposure to Pb, As, Cd, and Cu with the serum levels of 2 novel biomarkers of cardiovascular stress; growth differentiation factor 15 and soluble suppression of tumorigenicity 2, in some Egyptian Cu smelter workers.

METHODS

Forty-one exposed workers and 41 administrative controls were clinically evaluated. Serum/blood levels of heavy metals and biomarkers were measured for both groups.

RESULTS

The smelter workers showed significantly elevated levels of heavy metals and biomarkers compared with controls. The elevated serum levels of both biomarkers were significantly and positively correlated with each other, the levels of heavy metals, and the duration of employment of the exposed workers.

CONCLUSIONS

There was a significant association between the levels of heavy metals and both biomarkers among the smelter workers. Further prospective studies should be performed.

Longitudinal association of early childhood lead exposure and adolescent heart rate variability: influence of parental education

Lead exposure has been shown to dysregulate physiological stress responses. However, few studies have investigated the effect of lead exposure on later heart rate variability (HRV), an indicator of a stress response, in large samples of children. Furthermore, the interaction between social environmental factors and lead exposure in childhood, which commonly co-occur, remains understudied. This study examined relationships between childhood lead exposure and early adolescent physiological stress responses at different levels of parental education. Participants were 406 children from Jintan, China. Blood lead levels (BLLs) and parental education data were collected at 3-5 years of age, and HRV outcomes assessed at 12 years via frequency domain measures (LF/HF ratio) collected during an induced stress test. Results show a significant interaction between parental education and BLLs at 3-5 years. This relationship was found to be most consistent for the interaction between BLLs and mother's years of education for both the planning (β = 0.12, p = 0.046) and speaking (β = 0.11, p = 0.043) phase of the stress task, suggesting that increasing years of mother's education may enhance the deleterious influence of lead exposure on the HRV frequency measure, LF/HF ratio. This research highlights the complexity in lead exposure induced outcomes.

Early childhood lead exposure and adolescent heart rate variability: A longitudinal cohort study

Lead is a known neurotoxicant with many detrimental health effects, including neurocognitive deficits and cardiovascular and metabolic disorders. However, few studies have tested the association between lead exposure and the physiological stress response, which in and of itself may act as a precursor to and/or underlying mechanism of detrimental health outcomes. The purpose of this study was to examine the influence of early childhood and early adolescent low-level lead exposure on early adolescent heart rate variability, a widely-used measure of physiological stress. Participants were 408 children from Jintan, China for whom blood lead levels were measured between 3 and 5 years (early childhood) and again at 12 years (early adolescence). Heart rate variability was assessed at 12 years while participants underwent an induced stress task utilizing the ratio of low to high frequency (LF/HF) ECG measures. Mean blood lead levels in the cohort were 6.63 mcg/dl and 3.10 mcg/dl at 3-5 years and 12 years, respectively. Blood lead levels at 3-5 years of age (β 0.06, p = 0.027), but not at age 12 (β -0.05, p = 0.465), were significantly associated with LF/HF measures while controlling for multiple sociodemographic variables, potentially reflecting a dysregulated stress response with a shift towards sympathetic dominance. These findings suggest that early childhood lead exposure may have a detrimental influence on early adolescent autonomic responses to acute stress, which holds implications for cardiovascular health and overall growth and development.

Key Characteristics of Cardiovascular Toxicants

BACKGROUND

The concept of chemical agents having properties that confer potential hazard called key characteristics (KCs) was first developed to identify carcinogenic hazards. Identification of KCs of cardiovascular (CV) toxicants could facilitate the systematic assessment of CV hazards and understanding of assay and data gaps associated with current approaches.

OBJECTIVES

We sought to develop a consensus-based synthesis of scientific evidence on the KCs of chemical and nonchemical agents known to cause CV toxicity along with methods to measure them.

METHODS

An expert working group was convened to discuss mechanisms associated with CV toxicity.

RESULTS

The group identified 12 KCs of CV toxicants, defined as exogenous agents that adversely interfere with function of the CV system. The KCs were organized into those primarily affecting cardiac tissue (numbers 1-4 below), the vascular system (5-7), or both (8-12), as follows: 1) impairs regulation of cardiac excitability, 2) impairs cardiac contractility and relaxation, 3) induces cardiomyocyte injury and death, 4) induces proliferation of valve stroma, 5) impacts endothelial and vascular function, 6) alters hemostasis, 7) causes dyslipidemia, 8) impairs mitochondrial function, 9) modifies autonomic nervous system activity, 10) induces oxidative stress, 11) causes inflammation, and 12) alters hormone signaling.

DISCUSSION

These 12 KCs can be used to help identify pharmaceuticals and environmental pollutants as CV toxicants, as well as to better understand the mechanistic underpinnings of their toxicity. For example, evidence exists that fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)] air pollution, arsenic, anthracycline drugs, and other exogenous chemicals possess one or more of the described KCs. In conclusion, the KCs could be used to identify potential CV toxicants and to define a set of test methods to evaluate CV toxicity in a more comprehensive and standardized manner than current approaches. https://doi.org/10.1289/EHP9321.

Lead (Pb) exposure and heart failure risk

Lead (Pb) is a heavy metal with widespread industrial use, but it is also a widespread environmental contaminant with serious toxicological consequences to many species. Pb exposure adversely impacts the cardiovascular system in humans, leading to cardiac dysfunction, but its effects on heart failure risk remain poorly elucidated. To better understand the pathophysiological effects of Pb, we review potential mechanisms by which Pb exposure leads to cardiac dysfunction. Adverse effects of Pb exposure on cardiac function include heart failure risk, pressure overload, arrhythmia, myocardial ischemia, and cardiotoxicity. The data reviewed clearly establish that Pb exposure can play an important role in the occurrence and development of heart failure. Future epidemiological and mechanistic studies should be developed to better understand the involvement of Pb exposure in heart failure.

Heart rate variation and human body burdens of environmental mixtures in the Cree First Nation communities of Eeyou Istchee, Canada

INTRODUCTION

Heart rate variability (HRV) is a measure of cardiac autonomic regulation that examines the variation in beat-to-beat fluctuations in heart rate. While many exposure-based studies have examined the effects of single or similar groups of contaminants on HRV parameters, none have examined the association between complex environmental mixtures, including organic and elemental contaminants, and HRV.

METHODS

Using data collected from the Multi-Community Environment-and-Health Study in Eeyou Istchee (Quebec, Canada), we assessed HRV in two time domain measures: root mean square of successive differences (RMSSD) and standard deviation of the N-N (RR) intervals (SDNN); and in three frequency domains: high frequency (HF), low-frequency (LF), and very-low frequency (VLF) in 443 participants. We first examined mixture effects of nineteen organic and metal contaminants in blood using principal component analysis (PCA) and a multivariable general linear regression on HRV responses, adjusting for age, sex, body mass index, smoking status, and kidney disease covariates. We subsequently assessed HRV outcome response variables using Bayesian kernel machine regression (BKMR) to further examine individual contaminant contribution and overall mixture effects.

RESULTS

In the PCA, a significant positive association was observed between RMSSD and principal component (PC) axis 2, which was highly positively-loaded for nickel and moderately negatively-loaded for mercury. A negative association between SDNN and PC-1, which was highly positively-loaded for all PCBs (polychlorinated biphenyls) and organochlorines and moderately positively-loaded for mercury, was observed. Additionally, a significant and positive association was observed between PC-2 and SDNN and a significant and negative association between PC-3 (negatively loaded for cadmium) and LF. Associations with contaminants were not observed for HF or VLF. BKMR results suggest that trans-nonachlor and cis-nonachlor are primarily responsible for reductions in HRV; however, their contributions to HRV deficits was non-significant when examined as a complete mixture.

CONCLUSIONS

While PCA results suggested that organochlorines, mercury, nickel, and cadmium may all play a role in altering various HRV, subsequent BKMR analysis illustrated the individual components driving these effects may be trans- and cis-nonachlor and nickel and likely not mercury or cadmium. However, other contaminants appear to temper this effect when the entire mixture of chemicals is assessed as a whole. This study expands our knowledge of the effects of environmental contaminant mixtures on HRV, which is especially important in exposed populations such as those in the Eeyou Istchee territory, whilst utilizing novel statistical methods such as PCA and BKMR to examine co-exposures concurrently.

Subclinical Neurophysiological Effects of Manganese in Welding Workers

High-level occupational manganese (Mn) exposure has been reported to induce irreversible brain alterations determining a Parkinson-like disease. This study aimed to assess subclinical neurophysiological alterations in welding workers. They were employed in a machine building factory with an average Mn exposure <200 mg/m3. Sixty-eight welding workers (mean age: 34 years; mean Mn exposure duration: 16 years) and 42 flour factory workers (control group) with similar age and smoking habit were recruited. Autonomic nervous function test battery (ANSFT), composed of Valsalva maneuvre-induced heart rate variation (HR-V), heart rate variation following deep breathing (HR-DB) and heart rate variation following immediate standing up (HR-IS) was assessed. Electroencephalogram (EEG), brain electricity activity mapping (BEAM) were also performed. HR-V, HR-DB and HR-IS were significantly lower in Mn- exposed subjects showing altered autonomic nervous system activity, parasympathetic-sympathetic imbalance and, consequently, altered cardiovascular regulation and reactivity. The EEG of the Mn-exposed workers evidenced β-wave rhythms significantly reduced, Θ-waves markedly increased and abnormal wave activities of either localized or diffusive type. In the same workers, BEAM revealed higher Θ, δ and β power values in the F7 area, lower d power values in the FP1, FP2 and C4 areas as well as dissymmetry in the central area, parietal region and occipital region. This study suggests that Mn impairs neuron activity within central nervous system. In this context, brainstem parasympathetic and sympathetic centers, receiving axon projections from cortical and diencephalic areas, may reflect Mn effects on upper pathways. However, direct actions of Mn on these centers cannot be excluded.

Lead toxicity promotes autonomic dysfunction with increased chemoreceptor sensitivity

Mortality and morbidity by toxic metals is an important issue of occupational health. Lead is an ubiquitous heavy metal in our environment despite having no physiological role in biological systems. Being an homeostatic controller is expected that the autonomic nervous system would show a degree of impairment in lead toxicity. In fact, sympathoexcitation associated to high blood pressure and tachypnea has been described together with baroreflex dysfunction. However, the mechanisms underlying the autonomic dysfunction and the interplay between baro- and chemoreflex are not yet fully clarified. The angiotensinogenic PVN-NTS axis (paraventricular nucleus of the hypothalamus - nucleus tractus solitarius axis) is a particularly important neuronal pathway that could be responsible for the autonomic dysfunction and the cardiorespiratory impairment in lead toxicity. Within the current work, we addressed in vivo, baro- and chemoreceptor reflex behaviour, before and after central angiotensin inhibition, in order to better understand the cardiorespiratory autonomic mechanisms underlying the toxic effects of long-term lead exposure. For that, arterial pressure, heart rate, respiratory rate, sympathetic and parasympathetic activity and baro- and chemoreceptor reflex profiles of anaesthetized young adult rats exposed to lead, from foetal period to adulthood, were evaluated. Results showed increased chemosensitivity together with baroreceptor reflex impairment, sympathetic over-excitation, hypertension and tachypnea. Chemosensitivity and sympathetic overexcitation were reversed towards normality values by NTS treatment with A-779, an angiotensin (1-7) antagonist. No parasympathetic changes were observed before and after A-799 treatment. In conclusion, angiotensin (1-7) at NTS level is involved in the autonomic dysfunction observed in lead toxicity. The increased sensitivity of chemoreceptor reflex expresses the clear impairment of autonomic outflow to the cardiovascular and respiratory systems induced by putative persistent, long duration, alert reaction evoked by the long term exposure to lead toxic effects. The present study brings new insights on the central mechanisms implicated in the autonomic dysfunction induced by lead exposure which are relevant for the development of additional therapeutic options to tackle lead toxicity symptoms.

Erectile dysfunction and depression in patients with chronic lead poisoning

In this retrospective study, we aimed to evaluate the relationship between erectile dysfunction (ED) and chronic lead intoxication (CLI) as well as the role of depression in this relationship. We compared the findings of 26 male patients with CLI and 24 male patients as the control group between November 2008 and January 2009. The blood lead levels and smoking index of patients were evaluated for both groups. The International Index of Erectile Dysfunction-erectile function domain (EFD) and Beck Depression Inventory (BDI) were obtained and reviewed in both groups. The mean blood lead levels of patients in the CLI and control groups were 42.1 and 3.2 μg dl(-1) respectively (P < 0.01). The mean interval of lead exposure of patients in CLI group was 71.5 (6-360) months. EFD scores of patients in CLI group were significantly lower, and number of patients with ED in CLI group was statistically higher (P < 0.05). BDI scores of patients in CLI group were significantly higher (P < 0.05). We detected a mildly negative and statistically significant relationship between the EFD scores and blood lead levels (r = -0.453 and P < 0.05). Our results showed that the increased frequency of ED is an independent factor in CLI group.

Early effects of long-term neurotoxic lead exposure in copper works employees

The situation of exposure in a copper works facility in Germany enabled early lead-induced neurotoxic effects to be investigated in the workers. The aim of the investigation was to study the long-term effects of small doses of lead on psychometric/psychophysiological performance of workers. The study involved 70 male lead exposed workers and 27 male controls with no neurotoxic exposure. All test persons were subjected to the method of investigation involving performance data, physiological strain data, and the subjective state. It was found that of the psychometric performance parameters, only the mainly motor performance parameters had a potential for being neurotoxic early indicators. Preferably centrally influenced performance parameters were found to be less suitable early indicators. The lead-exposed subjects exhibited a slowed poststrain resetting behaviour of the vegetative nervous system, which correlated with the individual blood lead level. This was attributed to vagus depression, which had already started in the prevailing situation of exposure and was reflected by diminished cardiac phase duration variability. Our results indicate that it is necessary to more critically choose the lead level standards in the air on the working area. Heart rate variability may be affected even at small lead concentration.

Environmental and occupational exposure to lead as a potential risk factor for cardiovascular disease

We have evaluated current knowledge on relations between environmental and occupational exposure to lead with a strong emphasis on cardiovascular disease risk factors, such as the influence of lead compounds on lipid disturbances and arterial blood pressure. In addition, "novel" biochemical and vascular risk factors for cardiovascular diseases were discussed, as well as the combination of lead exposure and genetic predisposition to cardiovascular diseases. Occupationally and educationally, awareness of the unfavourable effects of lead on cardiovascular diseases risk factors should be emphasised. Indeed, accurate identification of the various mechanisms that might account for the effects of lead on the cardiovascular system should be of the highest priority in this field of research.

Air pollution and heart rate variability: effect modification by chronic lead exposure

BACKGROUND

Outdoor air pollution and lead exposure can disturb cardiac autonomic function, but the effects of both these exposures together have not been studied.

METHODS

We examined whether higher cumulative lead exposures, as measured by bone lead, modified cross-sectional associations between air pollution and heart rate variability among 384 elderly men from the Normative Aging Study. We used linear regression, controlling for clinical, demographic, and environmental covariates.

RESULTS

We found graded, significant reductions in both high-frequency and low-frequency powers of heart rate variability in relation to ozone and sulfate across the quartiles of tibia lead. Interquartile range increases in ozone and sulfate were associated respectively, with 38% decrease (95% confidence interval = -54.6% to -14.9%) and 22% decrease (-40.4% to 1.6%) in high frequency, and 38% decrease (-51.9% to -20.4%) and 12% decrease (-28.6% to 9.3%) in low frequency, in the highest quartile of tibia lead after controlling for potential confounders. We observed similar but weaker effect modification by tibia lead adjusted for education and cumulative traffic (residuals of the regression of tibia lead on education and cumulative traffic). Patella lead modified only the ozone effect on heart rate variability.

CONCLUSIONS

People with long-term exposure to higher levels of lead may be more sensitive to cardiac autonomic dysfunction on high air pollution days. Efforts to understand how environmental exposures affect the health of an aging population should consider both current levels of pollution and history of lead exposure as susceptibility factors.

Lead exposure and cardiovascular disease--a systematic review

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 microg/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.

Autonomic dysfunction due to lead poisoning

We present a case history of a 24 years old male who developed autonomic dysfunction, intestinal pseudo-obstruction and anemia due to lead poisoning. Concomitant recording of blood levels of lead and autonomic function showed a gradual decline in blood lead level (98.8 microg/dL at week 0, 56 microg/dL at week 6, and 40 microg/dL at week 52) and gradual improvement in autonomic functions. Decrease in blood lead levels with DMSA (Meso-2, 3-dimercaptosuccinic acid) therapy showed improvement in autonomic functions. At week 0, the patient had severe loss of autonomic tone and autonomic reactivity which improved at week 6. At the 52nd week, most of the autonomic parameters had normalized except for the persistence of mild loss of parasympathetic reactivity.

Low-level lead exposure, metabolic syndrome, and heart rate variability: the VA Normative Aging Study

BACKGROUND

Altered heart rate variability (HRV), a marker of poor cardiac autonomic function, has been associated with sudden cardiac death and heart failure.

OBJECTIVE

We examined the association of low-level lead exposure measured in bone by K-X-ray fluorescence with alterations in HRV, and whether metabolic syndrome (MetS) or its individual components modify those associations.

METHODS

HRV measures [power in high-frequency (HFnorm) and low-frequency (LFnorm) in normalized units, and LF/HF] were taken among 413 elderly men from the Normative Aging Study. MetS was defined as subjects having three or more of the following criteria: abdominal obesity, hypertriglyceridemia, low high-density lipoprotein, high blood pressure, and high fasting glucose.

RESULTS

Of the subjects, 32% were identified as having MetS. Inverse but nonstatistically significant associations of both tibia and patella lead levels with HFnorm and nonstatistically significant positive relations with LFnorm and LF/HF were found in the entire cohort. There was a graded, statistically significant reduction in HFnorm and increases in LFnorm and LF/HF in association with an increase in patella lead as the number of metabolic abnormalities increased. We also observed that higher patella lead was consistently associated with lower HFnorm and higher LFnorm and LF/HF among subjects with MetS or its individual components. No statistically significant interaction between MetS and tibia lead was observed.

CONCLUSION

The results suggest that elderly men with MetS were more susceptible to autonomic dysfunction in association with chronic lead exposure as measured in patella. The modification by MetS is consistent with a role for oxidative stress in lead toxicity on the cardiovascular system.

Neurobehavioral, autonomic nervous function and lymphocyte subsets among aluminum electrolytic workers

The purpose of our study is to determine the alteration of neurobehavioral parameters, autonomic nervous function and lymphocyte subsets in aluminum electrolytic workers of long-term aluminum exposure. 33 men who were 35.16 +/- 2.95 (mean +/- S.D) years old occupationally exposed to aluminum for 14.91 +/- 6.31 (mean +/- S.D) years. Air Al level and urinary aluminum concentration was measured by means of graphite furnace atomic absorption spectrophotometer. Normal reference group were selected from a flour plant. Neurobehavioral core test battery (NCTB) recommended by WHO was utilized. Autonomic nervous function test battery recommended by Ewing DJ was conducted on subjects. FAC SCAN was used to measure the lymphocyte subsets of peripheral blood. The mean air aluminum level in the workshop was 6.36 mg/m3, ranged from 2.90 to 11.38 mg/m3. Urinary aluminum of the Al electrolytic workers (40.08 +/- 9.36 microgram/mg.cre) was obviously higher than that of control group (26.84 +/- 8.93 m/mg.cre). Neurobehavioral results showed that the scores of DSY, PAC and PA in Al electrolytic workers were significantly lower than those of control group, The score of POMSC, POMSF and SRT among Al exposed workers were significantly augmented in relation to those of control group. Autonomic nervous function test results showed that R-R interval variability of maximum ratio of immediately standing up in Al electrolytic workers were decreased compare with the control group, while the BP-IS, HR-V, HR-DB, R30:15 had no significant change. Peripheral blood lymphocyte subsets test showed that CD4-CD8+ T lymphocyte in Al electrolytic workers increased. This study suggests that Al exposure exerts adverse effects on neurobehavioral performance, especially movement coordination and negative mood, and parasympathetic nervous function; moreover it increase CD4-CD8+ T lymphocyte subsets.

Assessing the suitability of cross-sectional and longitudinal cardiac rhythm tests with regard to identifying effects of occupational chronic lead exposure

The aim of this study was to examine whether signs of neurotoxic influence on the autonomic nervous system, after lengthy occupational lead exposure, could be revealed by appropriate cardiac rhythm analysis. A total of 109 male lead-exposed workers and 27 controls were examined in a cross-sectional study. In addition, 17 lead-exposed participants were investigated a second time in a follow-up study 4 years later. Heart rate variability was assessed in rest, strain, and recovery phases. In the cross-sectional study, lead-exposed persons showed a delayed restoration of cardiac rhythm parameters to the initial vegetative state after the strain phase. This effect significantly increased over a period of 4 more years of exposure in the 17 workers participating in the follow-up study. We found vagal depression caused by long-term lead exposure within the current threshold limit value range, which can be interpreted as an adverse effect.

Subclinical neurophysiological effects of lead: A review on peripheral, central, and autonomic nervous system effects in lead workers

BACKGROUND

The peripheral nerve conduction velocity (NCV), distribution of nerve conduction velocities (DCV), somatosensory, visual, and brainstem auditory evoked potentials (SEP, VEP, and BAEP, respectively), event-related potential (P300), computerized static posturography with spectral analysis (postural balance), and electrocardiographic R-R interval variability (CV(RR)) with spectral analysis appear to be promising techniques for assessing subclinical effects of lead on the peripheral, central and autonomic nervous systems. This article presents an overview of research addressing subclinical neurophysiological effects of lead in workers exposed to lead.

METHODS

We reviewed 102 articles to examine the effects and dose-effects relationships of lead on peripheral, central, and autonomic nervous system function together with reversibility of the effects, interaction between lead and other metals, and relative sensitivity and specificity of each technique. Background and methodology were also reviewed.

RESULTS AND CONCLUSION

Available data suggest that, on a group basis, the reduction in the NCV, together with the effects on the P300 latency, postural balance, and CV(RR), occurs at a mean blood lead concentration (BPb) as low as 30-40 microg/dL; the effects on the latencies of the short-latency SEP, VEP, and BAEP, as well as the DCV, start at a BPb as low as 40-50 microg/dL. Further cross-sectional and preferably prospective studies by using each of those methods are needed to establish more precise dose-effects (and response) relationships of lead.

Assessment of autonomic neurotoxicity in occupational and environmental health as determined by ECG R-R interval variability: a review

Measurement of heart rate variability (coefficient of variation of ECG R-R intervals, CVRR) provides a useful approach for the objective assessment of the autonomic nervous function. It is noninvasive and clinically practical, although it tends to be distorted by confounding factors such as age, alcohol, and tobacco. Specifically, two component coefficients of variation of the respiratory sinus arrhythmia (RSA) and Mayer wave-related sinus arrhythmia (MWSA) in the CVRR (i.e., C-CVRSA and C-CVMWSA), computed from component spectral powers by autoregressive spectral and component analyses, are expected to reflect parasympathetic and sympathetic functions, respectively. This article is intended to present an overview of research, utilizing the CVRR method including the C-CVRSA and C-CVMWSA, in occupational and environmental health. The available literature, addressing the impact of some chemicals and work-related factors on human autonomic nervous system, indicates that parasympathetic activity appears to be more vulnerable to these factors than does sympathetic activity. Since decreased cardiac vagal tone is associated with an increased risk of sudden cardiac death or coronary artery disease, attention should be directed to further discovery of hazardous factors in the environment and work place, which are likely to affect the autonomic nervous system.

Cardiovascular Effects of Environmental Chemicals

This article presents recent data on several environmental toxins: lead, carbon disulfide, asbestos, arsenic, ozone, cadmium, vinyl chloride, fiuorocarbons, freon, and pesticides. These environmental toxins produce both hypertension and cardiac arrhythmias in most studies, and they are not necessarily related to primary lung disease and secondary heart disease. The possible mechanisms that could cause the cardiovascular diseases include (1) damage to the endothelial barrier in the vascular system, (2) activation of leukocytes and platelets, (3) initiation of plaque formation, (4) stimulation of the inflammatory response, (5) kidney-related hypertension, and (6) direct damage to cardiac and blood vessel tissue. Recommendations are that more animal, human cultured cell, and epidemiologic studies should be conducted on the environmental toxins identified in this article.

Vegetative function diagnosis for early detection of lead intoxication

In the search for the early effects of neurotoxic lead poisoning, vegetative function diagnosis is a potential approach, focusing on the behaviour of the cardiac rhythm. Four groups of male subjects (109 copper workers exhibiting mean lead levels in blood of 31.2 micrograms/dl after long-term lead exposure; 27 control subjects having a similar job in the iron and steel industry without neurotoxic exposure; 35 reference subjects from Magdeburg University Hospital without neurotoxic exposure, and 5 subjects to whom benefits have been awarded for disability resulting from lead intoxication) were studied. All subjects underwent the same psychometric test battery. Special attention was paid to the restoration of vegetative tone after exposure. The more extensive the exposure to lead, the longer was the delay in restoration. This effect seems to be reversible, as workers heavily exposed to lead, but otherwise healthy, were more affected than the patients included in this investigation. Simply comparing the cardiac rhythm of exposed and non-exposed subjects at rest is not sufficient for early detection of lead intoxication. The behaviour of cardiac rhythm in humans at rest is the result of long-term influence by a wide range of factors, of which lead exposure is only one.

Autonomic and central nervous system effects of lead in female glass workers in China

To clarify the effects of lead on autonomic and central nervous system functions, electrocardiographic R-R interval variability (CVRR) as well as visual and brainstem auditory evoked potentials (VEP and BAEP) were measured in 36 female workers exposed to lead (exposed group) and in 15 female textile workers (unexposed group). The C-CVLF, C-CVHF (two component CVs of the CVRR reflecting sympathetic and parasympathetic activities, respectively), and LF/HF ratio (indicator of sympatho-vagal balance) were also computed from component spectral powers by means of autoregressive spectral and component analyses. The exposed group had engaged in glass work for 2-17 (mean 7.8) years. Blood lead (BPb) concentrations were 25.8-79.3 (mean 55.6) micrograms/dl in the exposed group and 4.7-8.6 (mean 6.3) micrograms/dl in the unexposed group. The CVRR, C-CVLF, C-CVHF, and LF/HF ratio in the exposed group were significantly lower than those in the unexposed group. Also, the exposed group had more complaints of subjective symptoms and signs than did the unexposed group. On the other hand, no significant differences in either VEP or BAEP latencies were found between the two groups. It is suggested that autonomic nervous function is more susceptible to lead than visual and auditory nervous functions; lead affects sympathetic activity more strongly than parasympathetic activity.

Assessment of thyroid, testes, kidney and autonomic nervous system function in lead-exposed workers

The objective of the study was to assess whether moderate occupational exposure to lead may be associated with early changes in potential target organs (thyroid, testes, kidney, autonomic nervous system). Workers exposed to lead in a lead acid battery factory (n = 98; mean blood lead 51 micrograms/dl, range 40-75 micrograms/dl) and 85 control workers were examined. None of the indicators of kidney function (in urine: retinol-binding protein, beta 2-microglobulin, albumin, N-acetyl-beta-D-glucosaminidase; in serum: creatinine, beta 2-microglobulin), endocrine function (follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, thyroxine, triiodothyronine) and autonomic nervous system (R-R interval variations on the electrocardiogram) were correlated with lead exposure (blood lead or duration of exposure) or showed significantly different mean values between the exposed group and controls. These results and an assessment of the published data suggest that compliance with the Directive of the Council of the European Communities on lead exposure (health surveillance in workers whose lead in blood exceeds 40 micrograms/dl and removal from exposure when blood lead exceeds 70-80 micrograms/dl) would prevent the occurrence of significant biological changes in the majority of lead-exposed workers.