Association of Multi-metals with the Risk of Hypertension and the Interaction with Obesity: A Cross-sectional Study in China

Overview

Journal Front Public Health

Specialty Public Health

Date 2023 Apr 3

PMID 37006554

Authors

Shan Wu

Lvrong Li

Guiyuan Ji

Xiaohui Xing

Jiajie Li

Anping Ma

Yuan Wei

Dongwei Zhao

Huimin Huang

Wenjun Ma

Banghua Wu

Ming Dong

Tao Liu

Qingsong Chen

Affiliations

Soon will be listed here.

Abstract

Background: Environmental exposure to multiple metals have been inconsistently associated with hypertension. Obesity is an important independent risk factor for hypertension, and few studies have assessed the interaction between obesity and metals in this context. We aimed to clarify their association and interaction.

Methods: This cross-sectional study included 3,063 adults from 11 districts or counties, Guangdong. We measured the whole blood levels of 13 metals and used multipollutant-based statistical methods to analyze the association of metals with hypertension. The interaction between metals and obesity on hypertension was assessed on additive and multiplicative scales.

Results: Four metals (manganese, arsenic, cadmium, and lead) were significantly associated with hypertension risk, five metals (manganese, zinc, arsenic, cadmium, and lead) were related to elevated SBP levels, five metals (manganese, zinc, selenium, cadmium, and lead) were associated with elevated DBP levels in single-metal model. Manganese remained significantly related to hypertension risk [odds ratio, 1.35 (1.02-1.78)] after adjusting for these four metals. Significant positive dose-response relationships between manganese, arsenic, cadmium, lead and hypertension risk were observed ( for overall < 0.001, for non-linearity > 0.05). Compared with those in the lowest quartile, participants in the highest manganese quartile had a 2.83 mmHg (95% Cl: 0.71-4.96) ( = 0.040) higher level of SBP. Individuals in the highest quartiles of zinc and lead had a 1.45 mmHg (0.10-2.81) ( = 0.033) and 2.06 mmHg (0.59-3.53) ( = 0.020) higher level of DBP, respectively. The negative interactions between cadmium, lead and obesity influences hypertension risk. BKMR analysis showed a significant joint effect of manganese, arsenic, cadmium and lead on hypertension when the concentrations of four metals were at or above their 55th percentile compared to their median values.

Conclusions: The combined effect of four metals (manganese, arsenic, cadmium and lead) were associated with the prevalence of hypertension. Potential interaction effects of cadmium, lead and obesity on hypertension risk may exist. Further cohort studies in larger population are needed to clarify these findings.

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References

Steenland K, Barry V, Anttila A, Sallmen M, McElvenny D, Todd A . A cohort mortality study of lead-exposed workers in the USA, Finland and the UK. Occup Environ Med. 2017; 74(11):785-791. DOI: 10.1136/oemed-2017-104311. View

Kim J . Dietary zinc intake is inversely associated with systolic blood pressure in young obese women. Nutr Res Pract. 2013; 7(5):380-4. PMC: 3796663. DOI: 10.4162/nrp.2013.7.5.380. View

Lee Y, Lyu E, Oh S, Park H, Ro H, Heo Y . Daily Copper and Manganese Intakes and Their Relation to Blood Pressure in Normotensive Adults. Clin Nutr Res. 2015; 4(4):259-66. PMC: 4641988. DOI: 10.7762/cnr.2015.4.4.259. View

Flora G, Gupta D, Tiwari A . Toxicity of lead: A review with recent updates. Interdiscip Toxicol. 2012; 5(2):47-58. PMC: 3485653. DOI: 10.2478/v10102-012-0009-2. View

Antonowicz J, Andrzejak R, Lepetow T, Skoczynska A, SMOLIK R . [Blood lipid parameters in smelters chronically exposed to heavy metals]. Med Pr. 1996; 47(3):207-15. View

Yuan Y, Xiao Y, Feng W, Liu Y, Yu Y, Zhou L . Plasma Metal Concentrations and Incident Coronary Heart Disease in Chinese Adults: The Dongfeng-Tongji Cohort. Environ Health Perspect. 2017; 125(10):107007. PMC: 5933370. DOI: 10.1289/EHP1521. View

Wu W, Jiang S, Zhao Q, Zhang K, Wei X, Zhou T . Environmental exposure to metals and the risk of hypertension: A cross-sectional study in China. Environ Pollut. 2017; 233:670-678. DOI: 10.1016/j.envpol.2017.10.111. View

ONeal S, Zheng W . Manganese Toxicity Upon Overexposure: a Decade in Review. Curr Environ Health Rep. 2015; 2(3):315-28. PMC: 4545267. DOI: 10.1007/s40572-015-0056-x. View

Yu Y, Jiang C, Jin Y, Xu L, Liu B, Zhang W . [Association between serum uric acid and fasting plasma glucose in middle and elderly Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi. 2015; 35(10):1155-9. View

10.

Vaziri N, Gonick H . Cardiovascular effects of lead exposure. Indian J Med Res. 2008; 128(4):426-35. View

11.

Garner R, Levallois P . Cadmium levels and sources of exposure among Canadian adults. Health Rep. 2016; 27(2):10-8. View

12.

Zhong Q, Wu H, Niu Q, Jia P, Qin Q, Wang X . Exposure to multiple metals and the risk of hypertension in adults: A prospective cohort study in a local area on the Yangtze River, China. Environ Int. 2021; 153:106538. DOI: 10.1016/j.envint.2021.106538. View

13.

Martins A, Almeida Lopes A, Urbano M, Carvalho M, Silva A, Tinkov A . An updated systematic review on the association between Cd exposure, blood pressure and hypertension. Ecotoxicol Environ Saf. 2021; 208:111636. PMC: 7785863. DOI: 10.1016/j.ecoenv.2020.111636. View

14.

Vallee A, Gabet A, Grave C, Blacher J, Olie V . Associations between urinary cadmium levels, blood pressure, and hypertension: the ESTEBAN survey. Environ Sci Pollut Res Int. 2020; 27(10):10748-10756. DOI: 10.1007/s11356-019-07249-6. View

15.

Aoki Y, Brody D, Flegal K, Fakhouri T, Axelrad D, Parker J . Blood Lead and Other Metal Biomarkers as Risk Factors for Cardiovascular Disease Mortality. Medicine (Baltimore). 2016; 95(1):e2223. PMC: 4706249. DOI: 10.1097/MD.0000000000002223. View

16.

Kristal-Boneh E, Coller D, Froom P, Harari G, Ribak J . The association between occupational lead exposure and serum cholesterol and lipoprotein levels. Am J Public Health. 1999; 89(7):1083-7. PMC: 1508848. DOI: 10.2105/ajph.89.7.1083. View

17.

Zhou M, Wang H, Zeng X, Yin P, Zhu J, Chen W . Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019; 394(10204):1145-1158. PMC: 6891889. DOI: 10.1016/S0140-6736(19)30427-1. View

18.

Wang L, Wang H, Hu M, Cao J, Chen D, Liu Z . Oxidative stress and apoptotic changes in primary cultures of rat proximal tubular cells exposed to lead. Arch Toxicol. 2009; 83(5):417-27. DOI: 10.1007/s00204-009-0425-z. View

19.

Xu J, White A, Niehoff N, OBrien K, Sandler D . Airborne metals exposure and risk of hypertension in the Sister Study. Environ Res. 2020; 191:110144. PMC: 7658027. DOI: 10.1016/j.envres.2020.110144. View

20.

Angeli J, Almenara Cruz Pereira C, de Oliveira Faria T, Stefanon I, Padilha A, Vassallo D . Cadmium exposure induces vascular injury due to endothelial oxidative stress: the role of local angiotensin II and COX-2. Free Radic Biol Med. 2013; 65:838-848. DOI: 10.1016/j.freeradbiomed.2013.08.167. View