Lead-Attributable Cardiovascular Disease Burden: Global Burden of Disease Study 2023
Abstract
IMPORTANCE: Despite declines, lead exposure remains a major risk factor for cardiovascular disease (CVD) mortality. Quantifying the direct effects of cumulative bone lead exposure on CVD is essential to guide prevention and policy.
OBJECTIVES: To estimate the association between bone lead levels and CVD, derive an exposure-response curve, and estimate global, regional, and national lead-attributable disease burden for 1990 to 2023.
DESIGN, SETTING, AND PARTICIPANTS: Analysis of 42 028 adults from 9 cycles of the US National Health and Nutrition Examination Survey (NHANES) spanning 1988 through 2013, with follow-up through December 2015 capturing 1748 CVD deaths, was combined with a systematic review and meta-regression. Bone lead was estimated from blood lead, age, and cohort-specific exposure histories. Cox proportional hazards models adjusted for blood pressure and confounders estimated hazard ratios for CVD mortality. A bayesian meta-regression using the Burden of Proof framework pooled NHANES results with published data to estimate the risk curve, which was then applied to lead exposure and CVD estimates to estimate population-attributable fractions and lead-attributable CVD burden.
EXPOSURE: Estimated bone lead levels.
MAIN OUTCOMES AND MEASURES: Lead-attributable CVD mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) by age, sex, year, and location.
RESULTS: NHANES participants were aged 18 to 90 years (median, 46…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 42 participants or records.
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