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Prospective cohort study of lead exposure and electrocardiographic conduction disturbances in the Department of Veterans Affairs Normative Aging Study.

Abstract

BACKGROUND

No studies have examined the association between cumulative low-level lead exposure and the prospective development of electrocardiographic conduction abnormalities, which may mediate the association between lead and several cardiovascular end points.

OBJECTIVE

We prospectively examined the association between lead exposure and the development of electrocardiographic conduction abnormalities.

METHODS

We assessed blood lead, bone lead--a biomarker of cumulative lead exposure--measured with K-shell X-ray fluorescence, and electrocardiographic end points among 600 men in the Normative Aging Study who were free of electrocardiographic abnormalities at the time of the baseline ECG. Of these men, we had follow-up data from a second electrocardiogram for 496 men 8.1 (SD = 3.1) years later, on average. We used repeated measures linear regression to analyze change in electrocardiographic conduction timing and logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for developing specific conduction disturbances and adjusted for potential confounders.

RESULTS

Mean (± SD) blood (5.8 ± 3.6), patella bone (30.3 ± 17.7), and tibia bone (21.6 ± 12.0) lead concentrations were similar to those found in samples from the general U.S. population and much lower than those reported in occupationally exposed groups. Compared with those in the lowest tertile of tibia lead, those in the highest had a 7.94-ms (95% CI, 1.42-14.45) increase in heart rate-corrected QT (QTc) interval and a 5.94-ms increase in heart rate-corrected QRS (95% CI, 1.66-10.22) duration > 8 years. Those in the highest tertile of tibia lead also had increased odds of QT prolongation (QTc ≥ 440 msec; OR = 2.53; 95% CI, 1.22-5.25) and JT prolongation (heart rate-corrected JT > 360 msec; OR = 2.53; 95% CI, 0.93-6.91). Results were weaker for patella lead. No associations were identified with blood lead.

CONCLUSIONS

This study suggests that low-level cumulative exposure to lead is associated with worse future cardiac conductivity in the ventricular myocardium, as reflected in QT interval characteristics.

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  • Authors+Show Affiliations

    ,

    Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA.

    , , , , ,

    Source

    Environmental health perspectives 119:7 2011 Jul pg 940-4

    MeSH

    Adult
    Aged
    Arrhythmias, Cardiac
    Boston
    Cohort Studies
    Electrocardiography
    Heart Block
    Heart Conduction System
    Humans
    Lead
    Lead Poisoning
    Linear Models
    Logistic Models
    Long QT Syndrome
    Male
    Middle Aged
    Odds Ratio
    Patella
    Prospective Studies
    Tibia
    Veterans

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

    Language

    eng

    PubMed ID

    21414889

    Citation

    Eum, Ki-Do, et al. "Prospective Cohort Study of Lead Exposure and Electrocardiographic Conduction Disturbances in the Department of Veterans Affairs Normative Aging Study." Environmental Health Perspectives, vol. 119, no. 7, 2011, pp. 940-4.
    Eum KD, Nie LH, Schwartz J, et al. Prospective cohort study of lead exposure and electrocardiographic conduction disturbances in the Department of Veterans Affairs Normative Aging Study. Environ Health Perspect. 2011;119(7):940-4.
    Eum, K. D., Nie, L. H., Schwartz, J., Vokonas, P. S., Sparrow, D., Hu, H., & Weisskopf, M. G. (2011). Prospective cohort study of lead exposure and electrocardiographic conduction disturbances in the Department of Veterans Affairs Normative Aging Study. Environmental Health Perspectives, 119(7), pp. 940-4. doi:10.1289/ehp.1003279.
    Eum KD, et al. Prospective Cohort Study of Lead Exposure and Electrocardiographic Conduction Disturbances in the Department of Veterans Affairs Normative Aging Study. Environ Health Perspect. 2011;119(7):940-4. PubMed PMID: 21414889.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prospective cohort study of lead exposure and electrocardiographic conduction disturbances in the Department of Veterans Affairs Normative Aging Study. AU - Eum,Ki-Do, AU - Nie,Linda H, AU - Schwartz,Joel, AU - Vokonas,Pantel S, AU - Sparrow,David, AU - Hu,Howard, AU - Weisskopf,Marc G, Y1 - 2011/03/17/ PY - 2010/12/01/received PY - 2011/03/16/accepted PY - 2011/3/19/entrez PY - 2011/3/19/pubmed PY - 2011/10/25/medline SP - 940 EP - 4 JF - Environmental health perspectives JO - Environ. Health Perspect. VL - 119 IS - 7 N2 - BACKGROUND: No studies have examined the association between cumulative low-level lead exposure and the prospective development of electrocardiographic conduction abnormalities, which may mediate the association between lead and several cardiovascular end points. OBJECTIVE: We prospectively examined the association between lead exposure and the development of electrocardiographic conduction abnormalities. METHODS: We assessed blood lead, bone lead--a biomarker of cumulative lead exposure--measured with K-shell X-ray fluorescence, and electrocardiographic end points among 600 men in the Normative Aging Study who were free of electrocardiographic abnormalities at the time of the baseline ECG. Of these men, we had follow-up data from a second electrocardiogram for 496 men 8.1 (SD = 3.1) years later, on average. We used repeated measures linear regression to analyze change in electrocardiographic conduction timing and logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for developing specific conduction disturbances and adjusted for potential confounders. RESULTS: Mean (± SD) blood (5.8 ± 3.6), patella bone (30.3 ± 17.7), and tibia bone (21.6 ± 12.0) lead concentrations were similar to those found in samples from the general U.S. population and much lower than those reported in occupationally exposed groups. Compared with those in the lowest tertile of tibia lead, those in the highest had a 7.94-ms (95% CI, 1.42-14.45) increase in heart rate-corrected QT (QTc) interval and a 5.94-ms increase in heart rate-corrected QRS (95% CI, 1.66-10.22) duration > 8 years. Those in the highest tertile of tibia lead also had increased odds of QT prolongation (QTc ≥ 440 msec; OR = 2.53; 95% CI, 1.22-5.25) and JT prolongation (heart rate-corrected JT > 360 msec; OR = 2.53; 95% CI, 0.93-6.91). Results were weaker for patella lead. No associations were identified with blood lead. CONCLUSIONS: This study suggests that low-level cumulative exposure to lead is associated with worse future cardiac conductivity in the ventricular myocardium, as reflected in QT interval characteristics. SN - 1552-9924 UR - https://www.unboundmedicine.com/medline/citation/21414889/Prospective_cohort_study_of_lead_exposure_and_electrocardiographic_conduction_disturbances_in_the_Department_of_Veterans_Affairs_Normative_Aging_Study_ L2 - https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.1003279?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -