Associations of environmental exposure to metals with the risk of hypertension in China

Particulate matter, polycyclic aromatic hydrocarbons and metals, platelet parameters and blood pressure alteration: Multi-pollutants study among population

Epidemiological findings have determined the linkage of fine particulate matter (PM2.5) and the morbidity of hypertension. However, the mode of action and specific contribution of PM2.5 component in the blood pressure elevation remain unclear. Platelets are critical for vascular homeostasis and thrombosis, which may be involved in the increase of blood pressure. Among 240 high-PM2.5 exposed, 318 low-PM2.5 exposed workers in a coking plant and 210 workers in the oxygen plant and cold-rolling mill enrolled in present study, both internal and external exposure characteristics were obtained, and we performed linear regression, adaptive elastic net regression, quantile g-computation and mediation analyses to analyze the relationship between urine metabolites of polycyclic aromatic hydrocarbons (PAHs) and metals fractions with platelets indices and blood pressure indicators. We found that PM2.5 exposure leads to increased systolic blood pressure (SBP) and pulse pressure (PP). Specifically, for every 10 μg/m3 increase in PM2.5, there was a 0.09 mmHg rise in PP. Additionally, one IQR increase in urinary 1-hydroxypyrene (1.06 μmol/mol creatinine) was associated with a 3.43 % elevation in PP. Similarly, an IQR increment of urine cobalt (2.31 μmol/mol creatinine) was associated with a separate 1.77 % and 4.71 % elevation of SBP and PP. Notably, platelet-to-lymphocyte ratio (PLR) played a mediating role in the elevation of SBP and PP induced by cobalt. Our multi-pollutants results showed that PAHs and cobalt were deleterious contributors to the elevated blood pressure. These findings deepen our understanding of the cardiovascular effects associated with PM2.5 constituents, highlighting the importance of increased vigilance in monitoring and controlling the harmful components in PM2.5.

Reference values for metal(loid)s concentrations in the urine samples of healthy Iranian adults: Results from the first nationally representative human biomonitoring study

BACKGROUND

This study measured the concentrations of arsenic (As), aluminum (Al), cadmium (Cd), chromium (Cr), mercury (Hg), nickel (Ni), and lead (Pb) in the urine samples of the Iranian adult population.

METHODS

This nationally representative study was conducted on 490 participants in six provinces of Iran who were selected based on the clustering method. Participants included healthy Iranian adults aged above 25 years without a history of illness and non-smokers. Fasting urine sampling, body composition, and demographic measurements were performed for each participant. Urine samples were analyzed by acid digesting method using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The analysis included descriptive statistics and multiple linear regression using Python programming language.

RESULTS

The geometrical mean (with corresponding reference values, µg/l) concentrations of metal(loid)s in urine for women, men, and both were 198.2 (625.3), 163.5 (486.1), and 192.5(570.4) for Al, 15.6(51.7), 28.8(71.1), and 21.9 (61.64) for As, 18.5(55.2), 20.7(56.5), and 19.22(55.75) for Pb, 17.9(57.6), 17.9 (53.9), and 17.9(56) for Ni, 13.95(47.5), 20.3(62.2) and 16(51.6) for Cr, 3.5(12.2), 2.9(11.5), and 3.3(12) for Hg, 0.74(2.7), 0.95 (3.6), and 0.81(3.1) for Cd. There was a direct relationship between the concentration of metal(loid)s and demographic indicators and body composition (P<0.05). Moreover, there was a direct relationship between the concentration of As, Cr, Hg, Ni, and Pb with age and wealth index (P<0.05).

CONCLUSIONS

The concentrations found could be used as the reference range for As, Al, Cd, Cr, Hg, Ni, and Pb for human biomonitoring studies on the Iranian adult population.

A Bayesian network for estimating hypertension risk due to occupational aluminum exposure

Background

The correlation between metals and hypertension, such as sodium, zinc, potassium, and magnesium, has been confirmed, while the relationship between aluminum and hypertension is not very clear. This study aimed to evaluate the correlation between plasma aluminum and hypertension in electrolytic aluminum workers by the Bayesian networks (BN).

Methods

In 2019, 476 male workers in an aluminum factory were investigated. The plasma aluminum concentration of workers was measured by inductively coupled plasma mass spectrometry. The influencing factors on the prevalence of hypertension were analyzed by the BN.

Results

The prevalence of hypertension was 23.9% in 476 male workers. The risk of hypertension from plasma aluminum in the Q2, Q3, and Q4 groups was 5.20 (1.90-14.25), 6.92 (2.51-19.08), and 7.33 (2.69-20.01), respectively, compared with that in the Q1 group. The risk of hypertension from the duration of exposure to aluminum of >10 years was 2.23 (1.09-4.57), compared without aluminum exposure. Area under the curve was 0.80 of plasma aluminum and the duration of exposure to aluminum was based on covariates, indicating that aluminum exposure had important predictive value in the prevalence of hypertension in the occupational population. The results of the study using the BN model showed that if the plasma aluminum of all participants was higher than Q4 (≥47.86 µg/L) and the participants were drinking, smoking, diabetes, central obesity, dyslipidemia, and aged >50 years, the proportion of hypertension was 71.2%.

Conclusions

The prevalence of hypertension increased significantly with the increase of plasma aluminum level.

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

A chronic disease, hypertension (HTN) is prevalent among the elderly. Exploring the factors that influence HTN and blood pressure (BP) changes is of great public health significance. However, mixed exposure to multiple serum metals has had less research on the effects on BP and HTN for the elderly. From April to August 2019, 2372 people participated in the community physical examination program for the elderly in Tongling City, Anhui Province. We measured BP and serum levels of 10 metals and collected basic demographic information. We analyzed the relationship between metal levels and changes in BP and HTN by the least absolute shrinkage and selection operator regression, Bayesian kernel machine regression model, and generalized linear model. In multiple models, lead (Pb) and cadmium (Cd) were still significantly associated with HTN occurrence after adjusting for potential confounders (Pb: ORquartile 4 VS quartile 1 = 1.20, 95% CI 1.01-1.43; Cd: ORquartile 4 VS quartile 1 = 1.37, 95% CI 1.16-1.62). In the male subgroup, results were similar to those of the general population. In the female group, Cd was positively correlated with HTN and systolic blood pressure, while Pb was not. According to this study, Pb and Cd were correlated with BP and HTN positively, and there was a certain joint effect. To some extent, our findings provide clues for the prevention of hypertension in the elderly.

Environmental exposure to lead and cadmium are associated with triglyceride glucose index

The triglyceride glucose (TyG) index was suggested as a novel reliable surrogate marker for insulin resistance and related cardiovascular-metabolic diseases. We aimed to evaluate the association between the TyG index and environmental exposure to lead (Pb), mercury (Hg), and cadmium (Cd). A total of 9645 adults who enrolled in the Korea National Health and Nutrition Examination Survey in 2005, 2008-2013, and 2016 were included. Fasting plasma glucose and triglyceride levels were used to calculate the TyG index. Multivariate logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). We noted an increasing trend in the TyG index with increment of blood Pb and Cd concentrations. Participants in the highest quartile of blood Pb and Cd concentrations had higher TyG index values than those in the lowest quartile, with ORs (95% CIs) of 1.32 (1.07-1.63) and 1.29 (1.04-1.59) for Pb and Cd, respectively. Strong associations between blood Pb and Cd concentrations and the TyG index were found in men. Blood Hg concentrations did not show a significant association with the TyG index. Our study suggests that public health strategies for cardiovascular-metabolic disorder prevention should be directed toward individuals exposed to priority heavy metals.

The association between blood heavy metals and gallstones: A cross-sectional study

BACKGROUND AND AIMS

Exposure to heavy metals has been widely recognized as a risk factor for human health. However, there is limited information on the effects of blood heavy metals on gallstones. This study aims to investigate the relationship between blood heavy metals and gallstones using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

7192 participants aged 20 years or older with complete information were included in the study. Serum concentrations of heavy metals were determined by inductively coupled plasma kinetic reaction cell mass spectrometry. Gallstones were presented by standard questionnaires. Logistic regression, nonlinear, subgroup, and sensitivity analyses were used to estimate the association between blood heavy metals and gallstones.

RESULTS

Multivariate logistic regression showed that the highest quintile of blood selenium (Se) was associated with a higher risk of gallstones compared with the lowest quintile (OR = 1.66, 95% CI: 1.16-2.36), particularly in individuals who were under 65 years of age, females, non-Hispanic Whites, non-drinkers, obese, and had a college education or higher. There was no correlation between blood cadmium (Cd), mercury (Hg), lead (Pb), manganese (Mn), and gallstones in the total population. Restricted cubic spline curves showed that a negative correlation was observed between blood Cd (OR = 0.84, 95% CI: 0.710-1.00), Hg (OR = 0.87, 95% CI: 0.78-0.97) and gallstones when Cd < 0.302 μg/L and Hg < 3.160 μg/L.

CONCLUSIONS

Blood Se was an independent risk factor for gallstones, particularly in individuals under 65 years old, females, non-Hispanic Whites, non-drinkers, obese, and had a college education or higher. Furthermore, blood Cd and Hg were associated with a reduced risk of gallstones within a certain range.

Association of urinary thallium with hypertension in children and adolescents aged 8-17 years: NHANES 2005-2018

Hypertension is a key risk factor for cardiovascular disease (CVD). Thallium is a highly toxic metal that exists in all aspects of our lives and can cause damage to human health. The aim of this study was to identify the potential correlation between urinary thallium (U-Tl) and hypertension in American youth aged 8-17 years. The National Health and Nutritional Examination Survey (NHANES) database was mined for cross-sectional information on 2295 American children and adolescents aged 8-17 years. Inductively coupled plasma mass spectrometry (ICP-MS) was utilized to measure U-Tl levels, and the results were categorized into four quartiles (Q1-Q4). Logistic generalized linear models and unweighted restricted cubic spline (RCS) regression were used to investigate the relationship between U-Tl and hypertension. After adjusting for covariates, the odds ratios (ORs) at 95% confidence intervals (CIs) for hypertension prevalence in the 2nd, 3rd, and 4th quartiles were 0.43 (0.22-0.81), 0.54 (0.29-0.99), and 0.43 (0.22-0.81), when compared to the lowest quartile (P for trend = 0.024). RCS plot showed a negative linear correlation between log2-transformed U-Tl levels and hypertension (P for non-linearity = 0.869). Subgroup analysis based on sex indicated a statistically significant link between U-Tl and hypertension in male (P < 0.05). There is a negative linear relationship between U-Tl and hypertension in American children and adolescents aged 8-17 years with low thallium exposure. Due to the nature of cross-sectional studies, further studies are necessary to validate our conclusions and elucidate possible mechanisms.

Associations between multiple urinary metals and the risk of hypertension in community-dwelling older adults

Although metal exposure has been associated with hypertension, the conclusions remain controversial, and studies investigating the predictive effect of multiple metals on hypertension are limited. In this study, we aimed to evaluate the nonlinear dose-response relationship between a single urinary metal and the risk of hypertension, and to assess the predictive effect of multiple urinary metals on hypertension. Of the Yinchuan community-dwelling elderly cohort launched in 2020, 3,733 participants (803 with hypertension and 2,930 without hypertension) were analysed in this study, and the concentrations of 13 metal elements in urine were measured. We found that urinary vanadium (odds ratio (OR): 1.16, 95% confidence interval [CI]: 1.08-1.25), molybdenum (OR: 1.08, 95% CI: 1.01-1.16), and tellurium (OR: 1.14, 95% CI: 1.06-1.22) were associated with higher risk of hypertension, whereas iron (OR: 0.92, 95% CI: 0.85-0.98) and strontium (0.92, 95% CI: 0.85-0.99) were significantly associated with lower risk of hypertension. Restricted cubic splines analysis was conducted in patients with iron concentrations of ≥ 15.48 μg/g and ≤ 399.41 μg/g and a strontium concentration of ≤ 69.41 μg/g, results showed that the risk of hypertension decreased gradually as the urinary concentrations of these metals increased. With an increase in the vanadium concentration in urine, the risk of hypertension gradually increased. In patients with a molybdenum concentration of ≥ 56.82 μg/g and a tellurium concentration of ≥ 21.98 μg/g, the risk of hypertension gradually decreased as the urinary concentrations of these metals increased. Predictive scores based on the 13 metallic elements were significantly associated with a higher risk of hypertension (OR: 1.34 (95% CI: 1.25-1.45). After additionally including urinary metal concentrations as a parameter variable in the traditional hypertension risk assessment model, integrated discrimination and net reclassification increased by 8.00% (P < 0.001) and 2.41% (P < 0.001), respectively. Urinary vanadium, Mo, and Te concentrations were associated with a higher risk of hypertension, while iron and strontium concentrations were associated with a lower risk of hypertension. Multiple urinary metal concentrations can significantly improve the predictive ability of traditional hypertension risk-assessment models.

Increased hypertension risk for the elderly with high blood levels of strontium and lead

Hypertension has long been recognized as the global health burden. Heavy metal pollution may be one of the environmental risk factors of hypertension. However, the association remains unclear. We studied the levels of aluminum (Al), vanadium (V), manganese (Mn), arsenic (As), selenium (Se), strontium (Sr), barium (Ba), titanium (Ti), lead (Pb) and cobalt (Co) in whole blood, and the relationship between trace element exposure and hypertension in the elderly community-based Chinese population. A total of 1013 participants from the west of Anhui Province in China were consecutively enrolled in this study in 2016. The general sociodemographic characteristics, lifestyles, disease history and physical examination information were collected by face-to-face survey and physical examination. The levels of ten trace elements were determined by inductively coupled plasma mass spectrometry (ICP-MS). Multivariable logistic regression model was used to assess the association of trace element exposure with the risk of hypertension. Results showed that the odds ratio of hypertension in the highest quartile was 1.811 (95% CI 1.175-2.790, P trend = 0.005) and 1.772 (95% CI 1.121-2.800, P trend = 0.022), respectively, after adjusting for potential confounders, as compared with the lowest quartile of blood Pb and Sr levels.

Cross-level interaction between individual education and regional chemical fertilizer consumption on the risk of hypertension: evidence from the China hypertension survey

Hypertension is a common and costly public health burden in China, while the interaction effects of individual and contextual level factors on the risk of hypertension remain unclear. This study aimed to investigate whether the interaction effects between individual education and regional chemical fertilizer consumption are associated with the risk of hypertension based on a cross-level interaction perspective. Data was from the China Hypertension Survey (CHS) study, which used a nationally representative sample, and was conducted between 2012 and 2015. A total of 379 467 participants aged over 18 years from 221 counties in 31 provinces were included. A cross-sectional study design and two-level logistic models were conducted to investigate the cross-level interaction between individual education and regional chemical fertilizer consumption on the risk of hypertension after adjusting for potential confounding variables. Compared to individuals with high education (college or more), the adjusted OR (95%CI) for hypertension among those in the high school, middle school, and elementary school or less was 1.16 (1.12-1.21), 1.25 (1.20-1.30), and 1.49 (1.43-1.55), respectively. The association between regional chemical fertilizer consumption and hypertension was not significant. Interaction analysis showed that regional chemical fertilizer consumption was associated with an increased risk of hypertension for individuals with lower education. These patterns were consistent after stratified by sex. This study provided evidence from the Chinese population that interaction between individual education and regional chemical fertilizer was associated with risk of hypertension. Future research and policy aimed to improve population health and reduce hypertension could address the regional context of population as well as individual factors.

Relationship between Occupational Metal Exposure and Hypertension Risk Based on Conditional Logistic Regression Analysis

Occupational exposure is a significant source of metal contact; previous studies have been limited regarding the effect of occupational metal exposure on the development of hypertension. This study was conducted to assess the levels of exposure of certain metals (chromium (Cr), iron (Fe), manganese (Mn), and nickel (Ni)) in hypertensive and non-hypertensive workers and to assess the relationship between the risk of hypertension and metal exposure level. Our study included 138 hypertensive patients as case groups and 138 non-hypertensive participants as controls. The exposure risk level was divided according to the limit value after collecting and testing the metal dust in the workshop. Considering the influence of single- and poly-metal, single factor analysis and conditional logistic regression analysis of poly-metal were carried out. The results of the model indicated that the incidence of hypertension increased with an increase in Cr exposure level, and the risk of hypertension was 1.85 times higher in the highest exposure than in the lowest exposure (95% CI: 1.20−2.86, p < 0.05). Mn has the same effect as Cr. There was no significant correlation between Fe or Ni and hypertension. Our findings suggested that Cr and Mn exposure in the work environment might increase the risk of hypertension, while no effect of Fe and Ni on blood pressure was found. Prospective study designs in larger populations are needed to confirm our findings.

Associations between plasma metal levels and mild renal impairment in the general population of Southern China

BACKGROUND

Metal exposure were assumed to be closely related with declined renal function, but the conclusions were controversial. We employed diverse statistical models and assessed the association between metal mixture exposure and mild renal impairment.

METHODS

A total of 13 plasma metals were measured in 896 general population from Southern China. Subjects with estimated glomerular filtration rate within 60-89 ml/min/1.73 m² and urinary albumin-creatinine ratio <30 mg/g creatinine were defined as mild renal impairment (MRI).

RESULTS

About 31.47 % participants showed MRI. In the multivariate logistic regression models, compared with the first quartile, high levels of arsenic and molybdenum (the fourth quartile) were both associated with MRI, and the ORs (95 % CI) were 1.68 (1.05, 2.68) and 2.21 (1.40, 3.48), respectively. Their predominant roles were identified by the weighted quantile regression (WQS). Besides, restricted cubic spline analysis verified the relationship between molybdenum level and increased MRI risk in a linear and dose-response manner.

CONCLUSION

High levels of arsenic and molybdenum might be independent risk factors of MRI, and they showed combined effect. Our findings might provide vigorous evidence in preventing mild decline in renal function.

Hypertension risk is associated with elevated concentrations of rare earth elements in serum

BACKGROUND

Hypertension is a major contributor to cardiovascular morbidity and mortality, affecting over 17.1 million individuals worldwide. Environmental exposure such as toxic trace elements could be risk factors for hypertension, but the associations of toxic metal exposure with hypertension are not well understood.

METHODS

We recruited 400 volunteers consisting of 200 patients with hypertension (cases) and 200 healthy individuals without hypertension (controls). In the case or control group, half of the subjects came from the rare earth mining (REM) areas and the other half from non-REM areas. Serum levels of 8 rare earth elements (REEs) and 13 non-REEs were determined.

RESULTS

The concentrations of Ce and La were significant higher in the cases than in the controls in all comparisons. Serum concentrations of Mg, Mn, Dy, Ce and La were positively correlated with blood pressure, while those of concentrations K and Se were negatively correlated with blood pressure (p < 0.05). Compared with the lowest quartiles, participants in the highest quartiles of Sm, Gd, Dy, Yb, La and Ce had a 6.01-fold (95 % CI: 2.28, 15.8), 3.29-fold (95 % CI: 1.18, 9.16), 4.07-fold (95 % CI: 1.51,10.9), 7.83-fold (95 % CI: 2.78, 22.4), 20.00-fold (95 % CI: 5.48-72.9) and 6.13-fold (95 % CI: 2.13-17.6) increase in the probability of having hypertension respectively. Among all the detected metals, the univariate odds ratios (UORs) and adjusted odds ratios (AORs) of hypertension for highest vs. lowest quartile serum concentrations of Sm, Gd, Dy, Yb, La and Ce were significantly > 1 (p < 0.05), with the positive dose-response relationships observed between their serum levels and ORs associated with hypertension risk.

CONCLUSIONS

Collectively, there appears to be a positive correlation between hypertension and environmental exposure to REEs, especially La and Ce. Further studies are warranted to investigate the underlying mechanisms responsible for the risk.

The effect of blood cadmium levels on hypertension in male firefighters in a metropolitan city

Background

This study investigated the effect of dispatch frequency on blood cadmium levels and the effect of blood cadmium levels on hypertension in male firefighters in a metropolitan city.

Methods

We conducted a retrospective longitudinal study of male firefighters who completed the regular health checkups, including a health examination survey and blood cadmium measurements. We followed them for 3 years. To investigate the effect of dispatch frequency on blood cadmium levels and the effect of blood cadmium levels on hypertension, we estimated the short-term (model 1) and long-term (model 2) effects of exposure and hypothesized a reversed causal pathway model (model 3) for sensitivity analysis. Sequential conditional mean models were fitted using generalized estimating equations, and the odds ratios (ORs) and the respective 95% confidence intervals (CIs) were calculated for hypertension for log-transformed (base 2) blood cadmium levels and quartiles.

Results

Using the lowest category of dispatch frequency as a reference, we observed that the highest category showed an increase in blood cadmium levels of 1.879 (95% CI: 0.673, 3.086) μg/dL and 0.708 (95% CI: 0.023, 1.394) μg/dL in models 2 and 3, respectively. In addition, we observed that doubling the blood cadmium level significantly increased the odds of hypertension in model 1 (OR: 1.772; 95% CI: 1.046, 3.003) and model 3 (OR: 4.288; 95% CI: 1.110, 16.554). Using the lowest quartile of blood cadmium levels as a reference, the highest quartile showed increased odds of hypertension in model 1 (OR: 2.968; 95% CI: 1.121, 7.861) and model 3 (OR: 33.468; 95% CI: 1.881, 595.500).

Conclusions

We found that dispatch frequency may affect blood cadmium levels in male firefighters, and high blood cadmium levels may influence hypertension in a dose-response manner.

Associations of exposure to multiple metals with blood pressure and hypertension: A cross-sectional study in Chinese preschool children

Exposure to metals might be a risk factor for hypertension, which contributes largely to the global burden of disease and mortality. However, relevant epidemiological studies of associations between metals exposure with hypertension among preschoolers are limited. This study aimed to explore the associations of urine metals with blood pressure and hypertension among Chinese preschoolers. A total of 1220 eligible participants who had urine metals measurement, blood pressure measurements, and relevant covariates were included in this cross-sectional study. Urine concentrations of metals were measured by inductively coupled plasma mass spectrometer. The single and multiple metals regression models were used to investigate the associations of urine metal with blood pressure and the risk of hypertension after adjusting for potential confounders. We observed urine concentrations of chromium, iron, and barium were negatively associated with levels of systolic blood pressure, diastolic blood pressure and the risk of hypertension in the single metal model (all P-FDR adjustment <0.05). Significant associations of urine chromium concentrations with systolic blood pressure, diastolic blood pressure and the risk of hypertension were found in the multi-metal model (β or OR (95% confidence interval) was -3.07 (-5.12, -1.02), -2.25 (-4.29, -0.22), and 0.51 (0.26, 0.97) for 3rd quartile, compared with 1st quartile, respectively). The same association was found for barium concentrations in the multi-metal model, while none of the associations among iron quartiles was significant. In addition, urine chromium, iron and barium may have joint effects on systolic blood pressure, diastolic blood pressure and hypertension. Children's age and body mass index could modify the associations of chromium, iron, and barium concentrations with blood pressure. Our findings suggested that exposure to chromium, iron, and barium was inversely associated with blood pressure and hypertension among preschool children. These findings need further validation in prospective studies.

Co-exposure to priority-controlled metals mixture and blood pressure in Chinese children from two panel studies

Metals may affect adversely cardiovascular system, but epidemiological evidence on the associations of priority-controlled metals including antimony (Sb), arsenic (As), cadmium, lead, and thallium with children's blood pressure (BP) was scarce and inconsistent. We conducted two panel studies with 3 surveys across 3 seasons among 144 and 142 children aged 4-12 years in Guangzhou and Weinan, respectively. During each seasonal survey, urine samples were collected for 4 consecutive days and BP was measured on the 4th day. We obtained 786 BP values and urinary metals measurements at least once within 4 days, while 773, 596, 612, and 754 urinary metals measurements were effective on the health examination day (Lag 0), and the 1^st, 2^nd, and 3^rd day preceding BP measurement (Lag 1, lag 2 and lag 3), respectively. We used linear mixed-effect models, generalized estimating equations and multiple informant models to assess the associations of individual metal at each lag day and accumulated lag day (4 days averaged, lag 0-3) with BP and hypertension, and Bayesian Kernel Machine Regression to evaluate the relations of metals mixture at lag 0-3 and BP outcomes. We found Sb was positively and consistently related to systolic BP (SBP), mean arterial pressure (MAP), and odds of having hypertension within 4 days, which were the strongest at lag 0 and declined over time. And such relationships at lag 0-3 showed in a dose-response manner. Meanwhile, Sb was the only contributor to the relations of mixture with SBP, MAP, and odds of having hypertension. Also, synergistic interaction between Sb and As was significant. In addition, modification effect of passive smoking status on the association of Sb and SBP was more evident in passive smokers. Accordingly, urinary Sb was consistently and dose-responsively associated with increased BP and hypertension, of which Sb was the major contributor among children.

Causal Effect of Genetically Determined Blood Copper Concentrations on Multiple Diseases: A Mendelian Randomization and Phenome-Wide Association Study

Exposures to copper have become a health concern. We aim to explore the broad clinical effects of blood copper concentrations. A total of 376,346 Caucasian subjects were enrolled. We performed a Mendelian randomization and phenome-wide association study (MR-PheWAS) to evaluate the causal association between copper and a wide range of outcomes in UK Biobank, and we constructed a protein-protein interaction network. We found association between blood copper concentrations and five diseases in the overall population and nine diseases in male. MR analysis implicated a causal role of blood copper in five diseases (overall population), including prostate cancer (OR = 0.87, 95% CI 0.77-0.98), malignant and unknown neoplasms of the brain and nervous system (OR = 0.58, 95% CI 0.38-0.89), and hypertension (OR = 0.94, 95% CI 0.90-0.98), essential hypertension (OR = 0.94, 95% CI 0.90-0.98) and cancer of brain and nervous system (OR = 0.63, 95% CI 0.41-0.98). For male, except for dysphagia being newly associated with blood copper (OR = 1.39, 95% CI 1.18-1.63), other MR results were consistent with the overall population. In addition, the PPI network showed possible relationship between blood copper and four outcomes, namely brain cancer, prostate cancer, hypertension, and dysphagia. Blood copper may have causal association with prostate cancer, malignant and unknown neoplasms of the brain and nervous system, hypertension, and dysphagia. Considering that copper is modifiable, exploring whether regulation of copper levels can be used to optimize health outcomes might have public health importance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43657-022-00052-3.

Interaction of biomass fuels use and metals exposure on hypertension: A prospective cohort study in rural areas along the Yangtze River, China

Humans maybe simultaneously exposed to multiple-metals and indoor air pollution in daily life. However, limited prospective studies have assessed the interaction between multiple metals exposure and biomass fuels use on hypertension in China. The prospective cohort study in rural areas along the Yangtze River included 2625 adults in 2014-2015, and they were followed up till 2019. Among 1248 rural residents who were without hypertension at baseline, 377 hypertension events (30.21%) were observed after 4.5 years of average follow-up time. First-morning urine samples of residents were collected at baseline, the association between urinary metals level and hypertension were assessed using quantile g-computation. Additionally, we also examined the effect of biomass fuels use, fuels switching, and cookstove ventilation on the association of metals exposure with hypertension. Quantile g-computation analyses showed a positive joint effect of 17 metals on hypertension, with the odds ratio (OR) of 1.68 (95% CI: 0.89, 3.14) when increasing all seventeen metals by one quartile, and cadmium, lithium, copper contributed the largest positive weights. Biomass fuels use can interact with cadmium exposure on hypertension with OR for interaction of 1.28 (95%CI: 1.00, 1.73), and increase the association between copper, manganese and zinc exposure and systolic blood pressure, lithium exposure and diastolic blood pressure at the follow-up visit. Moreover, switching from biomass fuels to clean fuels during follow up, cookstove ventilation can alleviate the risk of higher blood pressure from metals exposure. In rural areas along the Yangtze River, China, biomass fuels use for cooking can interact with multiple-metals exposure on hypertension. Residents who switched from biomass fuels to clean fuels and who used ventilation had a lower risk of hypertension. Further cohort studies are needed to clarify the mechanism of combined effects of metals exposure and biomass fuels use on the human health.

Novel Strategies for Assessing Associations Between Selenium Biomarkers and Cardiometabolic Risk Factors: Concentration, Visit-to-Visit Variability, or Individual Mean? Evidence From a Repeated-Measures Study of Older Adults With High Selenium

Background and Aims

Previous studies have focused only on the cardiometabolic effects of selenium concentrations. We explored whether selenium levels and their visit-to-visit variability (VVV) and individual mean (IM) are independently associated with cardiometabolic risk factors.

Methods

A three-wave repeated-measures study of older adults with high selenium (n = 201) was conducted in Beijing from 2016 to 2018. Whole blood selenium and urinary selenium concentrations were measured. VVV and IM were used to profile the homeostasis of the selenium biomarkers. Four indicators, namely standard deviation, coefficient of variation, average real variability, and variability independent of the mean, were employed to characterize VVV. We considered 13 cardiometabolic factors: four lipid profile indicators, three blood pressure indices, glucose, uric acid, waistline, hipline, waist-hip ratio, and sex-specific metabolic syndrome score. Linear mixed-effects regression models with random intercepts for the participants were employed to explore the associations of the selenium concentrations, VVV, and IM with the cardiometabolic factors.

Results

The geometric mean whole blood and urinary selenium levels were 134.30 and 18.00 μg/L, respectively. Selenium concentrations were significantly associated with numerous cardiometabolic factors. Specifically, whole blood selenium was positively associated with total cholesterol [0.22, 95% confidence interval (CI): 0.12, 0.33], low-density lipoprotein cholesterol (LDL-C; 0.28, 95% CI: 0.13, 0.42), glucose (0.22, 95% CI: 0.10, 0.34), and uric acid (0.16, 95% CI: 0.04, 0.28). After adjustment for VVV, the IM of whole blood selenium was positively correlated with total cholesterol (0.002, 95% CI: 0.001, 0.004), triglycerides (0.007, 95% CI: 0.004, 0.011), and LDL-C (0.002, 95% CI: 0.000, 0.004). However, we did not observe any robust associations between the VVV of the selenium biomarkers and cardiometabolic risk factors after adjustment for IM.

Conclusion

Our findings suggest that selenium concentrations and their IMs are significantly associated with cardiometabolic risk factors among older adults with high selenium. Longer repeated-measures studies among the general population are required to validate our findings and elucidate the relevant underlying mechanisms.

Blood pressure mediated the effects of cognitive function impairment related to aluminum exposure in Chinese aluminum smelting workers

OBJECTIVES

The aim of this study is to investigate the effects that the Al on blood pressure and the effect of hypertension in aluminum-induced cognitive impairment in electrolytic aluminum worker.

METHODS

The study was conducted 392 male aluminum electrolytic workers in an aluminum plant of China. The concentration of alumina dust in the air of the electrolytic aluminum workshop is 1.07mg/m3-2.13mg/m3. According to the Permissible concentration-Time Weighted Average of alumina dust is 4mg/ m3, which does not exceed the standard. The blood pressure of the workers was measured. The plasma aluminum concentration of workers was determined by ICP-MS (Inductively Coupled Plasma Mass Spectrometry). Cognitive functions were measured using MMSE (Mini-Mental State Examination), VFT (Verbal Fluency Test), ATIME (Average Reaction Time), FOM (Fuld Object Memory Evaluation), DST (Digit Span Test), CDT (Clock Drawing Test) scales. Modified Poisson regression was used to analyze the risk of hypertension and cognitive impairment with different plasma aluminum concentrations. Generalized linear regression model was used to analyze the relationship between aluminum and cognitive function, blood pressure and cognitive function. Causal Mediation Analysis was used to analyze the mediation effect of blood press in aluminum-induced cognitive impairment.

RESULTS

Plasma aluminum appeared to be a risk factor for hypertension (PR (prevalence ratio) = 1.630, 95%-CI (confidence interval): 1.103 to 2.407), systolic blood pressure (PR = 1.578, 95%-CI: 1.038 to 2.399) and diastolic blood pressure (PR = 1.842, 95%-CI: 1.153 to 2.944). And plasma aluminum increased by e-fold, the scores of MMSE and VFT decreased by 0.630 and 2.231 units respectively and the time of ATIME increased by 0.029 units. In addition, generalized linear regression model showed that blood press was negatively correlated with the scores of MMSE and VFT. Finally, causal Mediation Analysis showed that hypertension was a part of the mediating factors of aluminum-induced decline in MMSE score, and the mediating effects was 16.300% (7.100%, 33.200%). In addition, hypertension was a part of the mediating factors of aluminum-induced decline in VFT score, and the mediating effects was 9.400% (2.600%, 29.000%) CONCLUSION: Occupational aluminum exposure increases the risk of hypertension and cognitive impairment. And hypertension may be a mediating factor of cognitive impairment caused by aluminum exposure.

The association between environmental cadmium exposure, blood pressure, and hypertension: a systematic review and meta-analysis

We performed a systematic and meta-analysis study to find the association between cadmium (Cd) exposure and blood pressure (BP)/hypertension (HTN) in exposed general populations. We searched main databases for literature published between year 2000 and April 15, 2021. Quality assessment was performed with the Joanna Briggs Institute (JBI) critical appraisal tools. Heterogeneity between studies was determined by I-squared (I²) statistic. The random effects model was used to determine the association between blood and urine Cd levels with hypertension. The overall standard differences in mean for Cd level in hypertensive and control groups were 3.34, 1.79, and 8.09 based on samples from blood, urine, and hair, respectively. The overall standard differences in mean for Cd level in the low and high exposure groups were - 0.795 and - 1.036 based on blood and urinary samples, respectively. Our findings indicate a positive relationship between blood and hair Cd levels and hypertension. We also found that hair is the optimal biological sample to find the relationship between Cd exposure and hypertension for both genders. However, more studies are needed to confirm these findings.

Sex-specific associations of exposure to metal mixtures with telomere length change: Results from an 8-year longitudinal study

Studies on the relationships between exposure to metal mixtures and telomere length (TL) are limited, particularly longitudinal studies. Few studies are available on the potential sex-specific associations between metal exposures and TL change. We examined blood metal concentrations and TL at baseline (August 2012) and follow-up (June 2020) among 316 participants in a ferro-manganese refinery. The least absolute shrinkage and selection operator (LASSO) followed by the generalized linear model (GLM) was applied to evaluate the associations between multiple-metal exposures and TL change (TL in 2012 minus TL in 2020). Bayesian kernel machine regression (BKMR) was applied to cope with metal mixtures and evaluate their joint effects on TL change. Among men, three statistical methods consistently showed rubidium was negatively associated with TL change (β [95% CI] = -2.755 [-5.119, -0.391] in the GLM) and dominated the negative overall effects of 10 metal mixtures (magnesium, manganese, iron, cobalt, copper, zinc, selenium, rubidium, cadmium, and lead) on TL change (posterior inclusion probabilities = 0.816). Among women, the GLM (β [95% CI] = 4.463 [0.943, 7.983]) and LASSO (β = 4.289) showed rubidium was positively associated with TL change. Interestingly, no significant association was observed between exposure to metal mixtures and TL change in overall participants (P > 0.05). Furthermore, stratified analysis showed significant relationships between rubidium and TL change in men (β = -2.744), women (β = 3.624), and current smokers (β = -3.266) (both P interaction <0.05). In summary, our findings underlined the steady and negative association between rubidium and TL change among men with potential sex-dependent heterogeneities. Further experimental studies are required to expound the underlying mechanisms.

Family History of Hypertension and Cobalt Exposure Synergistically Promote the Prevalence of Hypertension

It has been previously reported that family history of hypertension (FHH) and exposure to metals are each independent risk factor for hypertension, but the interaction between the two in relation to hypertension risk has been poorly studied. The object of this study is Dong ethnic group in Guizhou, China. The impacts of exposure to metals and FHH on hypertension incidence were examined by using the restrictive cubic spline (RCS) model as well as the multivariate logistic regression model. As a result, FHH, together with cobalt and lead exposure, was identified to show independent significant correlation with hypertension incidence (P < 0.05). The risk of hypertension increased with the increase in lead and cobalt exposure quartiles. Typically, the RCS model revealed such dose-response relation. To further confirm the association of cobalt, lead, and FHH with the risk of hypertension, multiplication and addition models were used to analyze the influence of the interactions between these variables on the risk of hypertension. The results showed that there was a multiplying interaction between the influence of the FHH and cobalt on the risk of hypertension. As for the additive interaction between cobalt and FHH, the relative excess risk due to interaction (RERI) was determined to be 0.596 (95% Cl: 0.001-1.191), the attributable proportion due to interaction (AP) was calculated as 0.256 (95% Cl: 0.075-0.437), whereas the synergy index (S) was identified to be 1.814 (95% Cl: 1.080-3.047). Our study provides some limited evidence that a FHH and cobalt exposure synergistically promote the prevalence of hypertension.

Associations of plasma metal concentrations with the risks of all-cause and cardiovascular disease mortality in Chinese adults

BACKGROUND

Exposure to metals/metalloids from both the natural environment and anthropogenic sources have a complex influence on human health. However, relatively few studies have explored the relations of exposure to multiple metals/metalloids with mortality. Therefore, this prospective study aims to examine the relations of multiple metal/metalloids exposures with all-cause and cardiovascular disease (CVD) mortality.

METHODS

A total of 6155 participants within the Dongfeng-Tongji (DF-TJ) cohort were involved in this analysis, which were followed for mortality until December 31, 2018. We applied inductively coupled plasma mass spectrometry (ICP-MS) to measure baseline plasma concentrations of 23 metals. We utilized Cox regression models to calculate the hazard ratios (HRs) for all-cause and CVD mortality associated with metal concentrations. We proposed plasma metal score to assess the simultaneous exposure to multiple metals through summing each metal concentration weighted by the regression coefficients with all-cause mortality.

RESULTS

During the follow-up (mean duration, 9.8 years), we ascertained 876 deaths, including 416 deaths of CVD (157 deaths of coronary heart disease and 259 deaths of stroke). In the multiple-metals model, after adjusting for potential confounders, plasma copper, molybdenum, and vanadium were positively associated with all-cause mortality, whereas manganese, selenium, and thallium were negatively associated with the risk of all-cause mortality, with adjusted HRs (95% Confidence Interval, CI) of the fourth quartiles were 1.73 (1.42-2.11, P-trend < 0.001) for copper, 1.33 (1.09-1.63, P-trend = 0.005) for molybdenum, 1.43 (1.16-1.77, P-trend < 0.001) for vanadium, 0.74 (0.58-0.94, P-trend = 0.005) for manganese, 0.68 (0.56-0.83, P-trend < 0.001) for selenium, and 0.74 (0.59-0.92, P-trend = 0.002) for thallium, respectively. Positive associations were observed between plasma copper, molybdenum, vanadium concentrations and CVD mortality, whereas negative associations were found for plasma selenium and thallium concentrations with CVD mortality in the multiple-metals model. Compared with the first quartiles, the HRs of fourth quartiles were 1.94 (1.45-2.58, P-trend < 0.001) for copper, 1.72 (1.26-2.35, P-trend < 0.001) for molybdenum, 1.81 (1.32-2.47, P-trend < 0.001) for vanadium, 0.67 (0.50-0.89, P-trend = 0.003) for selenium, and 0.58 (0.41-0.81, P-trend < 0.001) for thallium, respectively. The plasma metal score was significantly associated with higher risks of all-cause and CVD death in dose-response fashions. When compared with the first quartiles of plasma metal score, the HRs of fourth quartiles were 2.16 (1.76-2.64; P-trend < 0.001) for all-cause mortality and 3.00 (2.24-4.02; P-trend < 0.001) for CVD mortality.

CONCLUSIONS

The study indicated that several plasma metals/metalloids were key determinants and predictors of all-cause and CVD death in the Chinese population. Our findings highlighted the importance to comprehensively assess and monitor multiple metals/metalloids exposures.

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

BACKGROUND

Exposure to multiple metals is recognized as a common and real scenario in daily life. However, limited prospective studies have assessed associations between multiple metals exposure and hypertension.

METHODS

In total, 2625 adults in a local area on the Yangtze River were investigated at baseline from 2014 to 2015 and followed up in 2019. We measured baseline urine levels of 22 metals and used multivariate logistic analysis and Bayesian kernel machine regression (BKMR) to explore associations between multiple metals exposure and the risk of hypertension.

RESULTS

A total of 385 individuals (29.6%) were diagnosed with hypertension. Five metals (cadmium, copper, magnesium, molybdenum and zinc) were positively associated with hypertension in single-metal models. Cadmium and zinc remained significantly positive associations after adjusting for these five metals, with the odds ratio (OR) in the highest quartiles of 1.49 (95% CI: 1.01, 2.21; p-trend = 0.05) and 1.60 (95% CI: 1.08, 2.38; p-trend = 0.02), respectively. BKMR analysis showed a significant joint effect of multiple metals on hypertension when the concentrations of five metals were at or above their 55th percentile compared with their median values. A potential interaction between cadmium and zinc in increasing the risk of hypertension was observed with the OR_int of 1.41 (95%CI: 1.05, 1.89).

CONCLUSIONS

We identified the joint effect of multiple metals on hypertension and observed a significant interaction between cadmium and zinc. Further cohort studies are needed to clarify the health effects of multiple metals exposure in a larger population.

Heavy metals in soils and edible tissues of Lepidium meyenii (maca) and health risk assessment in areas influenced by mining activity in the Central region of Peru

Heavy metal contamination of soil and agricultural products is an environmental problem, has an adverse effect on the quality of food crops, and is a danger to food security and public health. The concentration of arsenic (As), cadmium (Cd), lead (Pb), iron (Fe) and zinc (Zn) in surface soils and edible hypocotyls tissues of two ecotypes of Lepidium meyenii Walpers (maca) was evaluated in three districts of the Junín province, Peru. In addition, the risk to human health due to exposure to heavy metals from maca consumption was evaluated. Soil samples and maca hypocotyls were collected in areas influenced by mining and metallurgical activity. The mean concentration of Cd (0.32 ± 0.23 mg/kg) and Pb (0.20 ± 0.12 mg/kg) in maca samples exceeded the values established by the Food and Agriculture Organization and the World Health Organization. The bioconcentration factor was less than 1. The estimated daily intake of each metal was below the oral reference dose. The hazard quotient and hazard index were less than 1, it is unlikely to cause non-cancer adverse health outcome. The cancer risk for As and Cd was higher than the tolerable limit (1 × 10-6) in children and adults. In the district of Ondores, the cancer risk for As in children was higher than the acceptable limit (1 × 10-4). Residents of the Ondores district would be more exposed to As and Cd from consumption of maca hypocotyls. It is very important to carry out continuous monitoring of other toxic metals in different ecotypes of maca (red, black, yellow, purple, creamy white, pink) in order to evaluate the variation in the accumulation of heavy metals and the level of toxicity of each metal between ecotypes.

Concentrations of vanadium in urine with hypertension prevalence and blood pressure levels

The associations of vanadium exposure with hypertension risk in animal studies are inconsistent. Furthermore, epidemiologic studies on this topic are scarce. We aimed to assess the associations of vanadium exposure with hypertension prevalence and blood pressure levels in a general Chinese population. We measured urinary vanadium concentrations in 1867 participants to evaluate their internal exposure levels. The associations of urinary vanadium concentrations, categorized into quartiles or treated as continuous variables by logarithm transformation (log2), with hypertension prevalence and blood pressure levels were assessed by the multivariable logistic and linear regression models, respectively. We used the restricted cubic spline model to evaluate the dose-response relationship. Compared with the bottom quartile of vanadium, participants in the third and fourth quartile had an adjusted odds ratio of 2.04 (95% CI:1.40, 2.96) and 2.08 (95% CI:1.42, 3.06) for hypertension, with a linear dose-response relationship. The corresponding number for a doubling of vanadium concentrations was 1.25 (95% CI:1.12, 1.39). Besides, a doubling of vanadium concentrations was associated with a 0.66 (95% CI: 0.01, 1.31) and 0.90 (95% CI: 0.50, 1.31) mm Hg increased systolic and diastolic blood pressure level, respectively. Vanadium exposure was associated with increased hypertension prevalence and blood pressure levels. Prospective studies are needed to confirm our findings in other populations.

Internal metal(loid)s are potentially involved in the association between ambient fine particulate matter and blood pressure: A repeated-measurement study in north China

The effects of ambient fine particulate matter (PM_2.5) exposure on blood pressure have been widely reported. However, there remains uncertainty regarding the underlying roles of particulate matter components. We aimed to investigate the association between ambient PM_2.5 exposure and blood pressure, as well as the potential effects of trace metal(loid)s, in a repeated-measurement study that enrolled women of childbearing age. Our study included 35 participants from Hebei Province, China, each of whom was visited for five times. During each visit, we conducted questionnaire surveys, measured blood pressure, and collected blood. The daily PM_2.5 exposure of participants was estimated according to their residential addresses using a spatiotemporal model that combined monitoring data with satellite measurements and chemical-transport model simulations. This model was used to calculate average PM_2.5 concentrations in 1, 3, 7, 15, 30, and 60 days prior to each visit. Serum concentrations of various trace metal(loid)s were measured. A linear mixed-effects model was used to investigate associations among study variables. Overall, the mean (standard deviation) 60 days PM_2.5 concentration over all five visits was 108.1(43.3) μg/m³. PM_2.5 concentration was positively associated with both systolic and diastolic blood pressures. Likewise, ambient PM_2.5 concentration was positively associated with serum concentrations of manganese and arsenic, and negatively associated with serum concentrations of nickel, tin, and chromium. Only the serum concentration of molybdenum was negatively associated with systolic blood pressure. We concluded that ambient PM_2.5 exposure may contribute to elevated blood pressure, potentially by interfering with internal intake of various metal(loid)s in the human body.

Endothelial Dysfunction Induced by Cadmium and Mercury and its Relationship to Hypertension

Hypertension is an important public health concern that affects millions globally, leading to a large number of morbidities and fatalities. The etiology of hypertension is complex and multifactorial, and it involves environmental factors, including heavy metals. Cadmium and mercury are toxic elements commonly found in the environment, contributing to hypertension. We aimed to assess the role of cadmium and mercury-induced endothelial dysfunction in the development of hypertension. A narrative review was carried out through database searches. In this review, we discussed the critical roles of cadmium and mercury in the etiology of hypertension and provided new insights into potential mechanisms of their effect, focusing primarily on endothelial dysfunction. Although the mechanisms by which cadmium and mercury induce hypertension have yet to be completely elucidated, evidence for both implicates impaired nitric oxide signaling in their hypertensive etiology.

An updated systematic review on the association between Cd exposure, blood pressure and hypertension

BACKGROUND

Since the first report by Perry et al. (1955), most studies affirmed the hypertensive effects of cadmium (Cd) in humans. Nonetheless, conclusions between studies remain inconsistent.

OBJECTIVE

The aim of this study was to reevaluate the evidence for a potential relationship between Cd exposure and altered blood pressure and/or hypertension, focusing on studies published between January 2010 and March 2020.

METHODS

We reviewed all observational studies from database searches (PubMed and SCOPUS) on Cd exposure and blood pressure or hypertension. We extracted information from studies that provided sufficient data on population characteristics, smoking status, exposure, outcomes, and design.

RESULTS

Thirty-eight studies met our inclusion criteria; of those, twenty-nine were cross sectional, three case control, five cohort and one interventional study. Blood or urinary Cd levels were the most commonly used biomarkers.

CONCLUSIONS

A positive association between blood Cd levels and blood pressure and/or hypertension was identified in numerous studies at different settings. Limited number of representative population-based studies of never-smokers was observed, which may have confounded our conclusions. The association between urinary Cd and blood pressure and/or hypertension remains uncertain due to conflicting results, including inverse relationships with lack of strong mechanistic support. We point to the urgent need for additional longitudinal studies to confirm our findings.

Bioaccumulation of Toxic Metals in Children Exposed to Urban Pollution and to Cement Plant Emissions

Cement plants located in urban areas can increase health risk. Although children are particularly vulnerable, biomonitoring studies are lacking. Toenail concentration of 24 metals was measured in 366 children (6-10 years), who live and attend school in a city hosting a cement plant. Living addresses and schools were geocoded and attributed to exposed or control areas, according to modeled ground concentrations of PM₁₀ generated by the cement plant. Air levels of PM₁₀ and NO₂ were monitored. PM₁₀ levels were higher in the exposed, than in the control area. The highest mean PM₁₀ concentration was recorded close to the cement plant. Conversely, the highest NO₂ concentration was in the control area, where vehicular traffic and home heating were the prevalent sources of pollutants. Exposed children had higher concentrations of Nickel (Ni), Cadmium (Cd), Mercury (Hg), and Arsenic (As) than controls. These concentrations correlated each other, indicating a common source. Toenail Barium (Ba) concentration was higher in the control- than in the exposed area. The location of the attended school was a predictor of Cd, Hg, Ni, Ba concentrations, after adjusting for confounders. In conclusion, children living and attending school in an urban area exposed to cement plant emissions show a chronic bioaccumulation of toxic metals, and a significant exposure to PM₁₀ pollution. Cement plants located in populous urban areas seem therefore harmful, and primary prevention policies to protect children health are needed.

The Rise of ST-Elevation Myocardial Infarction in Women of Northeast China

The women of China's Liaoning province display some morbidities in ways that defy medical explanation. Women have higher rates of hypertension, hypercholesterolemia, and metabolic syndrome than men, an anomaly for all three conditions. Most of these patients also suffer from Type 2 Diabetes Mellitus (T2DM) while there was a negative association between being female and T2DM for the rest of China. Each of these conditions can exist independently, but the increase in both their rates and congruence is a recent phenomenon. Stranger still is that Liaoning women are now presenting in hospital emergency departments with ST-Elevation Myocardial Infarction (STEMI), while diabetics predominantly suffer more benign Non-STEMI (NSTEMI) events. Confounding factors in any attempt to study this phenomenon include trace metals like manganese that have been shown to reduce systolic blood pressure in Asian men and raise it in Asian women. Some of the phenomenon may also be associated with the gene for Apolipoprotein 5, but its recent nature suggests other factors besides lipid profiles. Trace metals in the air, water, and diet of Liaoning province, or any urban environment, could play a role.

Airborne metals exposure and risk of hypertension in the Sister Study

BACKGROUND

Hypertension-related disease burden is a major challenge globally, with an estimated 1.56 billion adults expected to be affected by hypertension by 2025. Environmental factors, such as metals, could be risk factors for hypertension, but the relationship between airborne metals and hypertension is rarely studied.

METHODS

Census-tract airborne metal concentrations (arsenic, cadmium, chromium, cobalt, lead, manganese, mercury, nickel, selenium, and antimony) from the U.S. Environmental Protection Agency 2005 National Air Toxics Assessment database were linked to enrollment residential addresses of 47,595 women in the Sister Study cohort. Hypertension was defined as high systolic (≥140 mm Hg) or diastolic (≥90 mm Hg) blood pressure measured by trained examiners at enrollment or taking anti-hypertensive medications. Multivariable log binomial regression was used to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between individual metals and hypertension, with and without co-adjustment for other metals. Quantile-based g-computation was used to estimate the joint effect of the overall metal mixture.

RESULTS

Comparing the highest to lowest quartiles, risk of hypertension was higher among women with higher residential exposure to arsenic (PR = 1.05, 95%CI = 1.02,1.09), lead (PR = 1.04, 95%CI = 1.01,1.08), chromium (PR = 1.03, 95%CI = 1.00,1.06), cobalt (PR = 1.03, 95%CI = 1.00,1.07), and manganese (PR = 1.03, 95%CI = 1.00,1.06). Selenium was associated with lower risk of hypertension (PR = 0.96, 95%CI = 0.93,0.99). Results were similar with mutual adjustment for all other metals. The associations varied by race/ethnicity, with greater PRs in other races/ethnicities (Hispanic, black, and other participants) compared to non-Hispanic white participants. The joint effect of a quartile increase in exposure to all the metals was 1.02 (95%CI = 0.99,1.04).

CONCLUSION

We found that living in areas of higher exposure to arsenic, lead, chromium, cobalt, and manganese was related to higher risk of hypertension, whereas living in areas with higher selenium was inversely related to the risk of hypertension.

Exposure to heavy metals and its association with DNA oxidative damage in municipal waste incinerator workers in Shenzhen, China

Burning municipal waste produces a great deal of harmful heavy metals, which may lead to elevated exposure in incinerator workers and residents living nearby. However, relevant human exposure studies remain scarce, especially in China. This study aimed to determine the concentrations of ten heavy metals in urine of incinerator workers (n = 119, as the exposed group) and residents living nearby (n = 215, as the control group) from Shenzhen (China), and explore the associations between heavy metal exposure and DNA oxidative stress (indicated by 8-hydroxy-2'-deoxyguanosine or 8-OHdG) in humans. The median urinary concentrations of manganese (Mn), iron (Fe), chromium (Cr), arsenic (As), selenium (Se) and 8-OHdG in the exposed group were significantly higher than those in the control group (p < 0.05), suggesting occupational exposure elevated heavy metal intake for the incinerator workers. Nevertheless, there is no correlation statistically significant between the concentrations of any heavy metal and 8-OHdG in urine in the exposed group, indicating heavy metals releasing from waste incineration were not important factors to induce DNA oxidative stress. To our knowledge, this study firstly reported the concentrations of heavy metal in urine and their associations with DNA oxidative damage in waste incinerator workers in Shenzhen, China.

Associations of exposure to metals with the risk of hypertension among an older population aged 40-75 years in rural southwest China

Metal exposure has recently been related to the risk of hypertension. However, the association remains unclear and relevant epidemiologic studies are limited. The present study aimed to assess the associations between exposure to metals and the odds of hypertension, as well as blood pressure (BP) levels. A total of 816 participants were enrolled in southwestern China. Hypertension was defined as a systolic BP (SBP) of ≥140 mmHg or diastolic BP (DBP) of ≥90 mmHg, a self-reported physician diagnosis, or current use of antihypertensive medication. Blood samples were used to detect the levels of exposure to metals, ie, magnesium (Mg), calcium (Ca), iron (Fe), zinc (Zn), arsenic (As), cadmium (Cd), copper (Cu) and lead (Pb). Logistic and linear regression models were used to assess the potential associations. The results show that positive trends for elevated odds of hypertension with increasing quartiles of Fe in a polluted area; and of Mg, Ca and Cu in an unpolluted area. Compared with those in the lowest quartiles, participants in the highest quartiles of Fe, Mg and Ca had 2.7-, 9.0- and 5.1-fold increased odds of hypertension, respectively. High blood Fe and Pb levels in the Cd-polluted area, and Mg and Fe in the unpolluted area were found to be related to increasing SBP and DBP levels. Our findings suggest that exposure to Fe and/or Pb in the polluted area; and Mg, Ca and Fe in the unpolluted area might increase the risk of hypertension or elevate BP levels.

Assessment of residents' total environmental exposure to heavy metals in China

Heavy metal pollution in the air, water, and soil has attracted substantial interest recently; however, assessment of the total human environmental exposure remains limited. Therefore, determining the total human environmental exposure is imperative for the management and control of heavy metal pollution. This study assessed the total environmental exposure levels of heavy metals as well as the exposure contributions of air, water, and soil, focusing on Hg, Cd, As, Pb, and Cr. Data from 3,855 volunteers from the cities of Taiyuan, Dalian, Shanghai, Wuhan, Chengdu, and Lanzhou allowed for comparison of the exposures in urban and rural areas. The levels of total human environmental exposure of Hg, Cd, As, Pb, and Cr were 1.82 × 10⁻⁶ mg/(kg·d), 1.58 × 10⁻⁶ mg/(kg·d), 3.87 × 10⁻⁵ mg/(kg·d), 1.79 × 10⁻⁵ and 7.47 × 10⁻⁵ mg/(kg·d), respectively. There were regional, urban-rural, sex, and age differences in the levels of heavy metal exposure. Water pollution was determined to be the largest contributor to heavy metal exposure, accounting for 97.87%, 92.50%, 80.51%, 76.16% and 79.46% of the Hg, Cd, As, Pb, and Cr, followed by air and soil pollution. These results can provide data to inform environmental protection policies and identify the priority pollutants that can help identify and prevent health risks due to overexposure to these heavy metal pollutants.

Urinary Metal Concentrations and the Incidence of Hypertension Among Adult Residents Along the Yangtze River, China

Metals from the natural environment have potential hypertension effects. However, relevant studies on this topic are few. A total of 1358 adults aged 18-74 years from Chizhou, Maanshan, and Tongling of Anhui Province participated in the baseline study from 2014 to 2015. The follow-up study was performed from 2016 to 2017. Inductively coupled plasma optical emission spectrometry (7000 DV) was used to measure urinary Cr, Mn, Fe, Cu, and Zn of residents. Urinary concentrations of Cd determined via TAS-900 atomic absorption spectrophotometry at 228.8 nm wavelength. A total of 275 hypertension cases were identified. After adjusting for sociodemographic factors and risk factors for hypertension, four metals (Cd, Cr, Cu, and Mn) were significantly associated with hypertension in the single-metal model. Upon including all metals in the same model, the hazard ratios of the highest quartiles Cd and Cu compared with the reference group were 1.42 (95% confidence interval [CI] 1.09-2.02) and 1.56 (95% CI 1.16-2.09) for cases of hypertension. Our findings suggested that high levels of Cd and Cu might increase the incidence of hypertension. Further studies involving larger population should be conducted to confirm these findings.

Association of exposure to multiple metals with papillary thyroid cancer risk in China

Papillary thyroid cancer (PTC) has inflicted huge threats to the health of mankind. Metal pollution could be a potential risk factor of PTC occurrence, but existing relevant epidemiological researches are limited. The current case-control study was designed to evaluate the relationships between exposure to multiple metals and the risk of PTC. A total of 262 histologically confirmed PTC cases were recruited. Age- and gender-matched controls were enrolled at the same time. Urine samples were used as biomarkers to reflect the levels of environmental exposure to 13 metals. Conditional logistic regression models were adopted to assess the potential association. Single-metal and multi-metal models were separately conducted to evaluate the impacts of single and co-exposure to 13 metals. The increased concentration of urinary Cd, Cu, Fe, and Pb quartiles was found significant correlated with PTC risk. We also found the decreased trends of urinary Se, Zn, and Mn quartiles with the ORs for PTC. These dose-response associations between Pb and PTC were observed in the single-metal model and remained significant in the multi-metal model (OR_25-50th=1.39, OR_50-75th=3.32, OR_>75th=7.62, p for trend <0.001). Our study suggested that PTC was positively associated with urinary levels of Cd, Cu, Fe, Pb, and inversely associated with Se, Zn, and Mn. Targeted public health policies should be made to improve the environment and the recognition of potential risk factors. These findings need additional studies to confirm in other population.