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Low-level lead exposure and the prevalence of gout: an observational study.

Abstract

BACKGROUND

Blood lead levels (BLLs) less than 1.21 µmol/L (<25 µg/dL) among adults are considered acceptable by current national standards. Lead toxicity can lead to gouty arthritis (gout), but whether the low lead exposure in the contemporary general population confers risk for gout is not known.

OBJECTIVE

To determine whether BLLs within the range currently considered acceptable are associated with gout.

DESIGN

Population-based cross-sectional study.

SETTING

The National Health and Nutrition Examination Survey for 2005 through 2008.

PATIENTS

6153 civilians aged 40 years or older with an estimated glomerular filtration rate greater than 10 mL/min per 1.73 m2.

MEASUREMENTS

Outcome variables were self-reported physician diagnosis of gout and serum urate level. Blood lead level was the principal exposure variable. Additional data collected were anthropometric measures, blood pressure, dietary purine intake, medication use, medical history, and serum creatinine concentration.

RESULTS

The prevalence of gout was 6.05% (95% CI, 4.49% to 7.62%) among patients in the highest BLL quartile (mean, 0.19 µmol/L [3.95 µg/dL]) compared with 1.76% (CI, 1.10% to 2.42%) among those in the lowest quartile (mean, 0.04 µmol/L [0.89 µg/dL]). Each doubling of BLL was associated with an unadjusted odds ratio of 1.74 (CI, 1.47 to 2.05) for gout and 1.25 (CI, 1.12 to 1.40) for hyperuricemia. After adjustment for renal function, diabetes, diuretic use, hypertension, race, body mass index, income, and education level, the highest BLL quartile was associated with a 3.6-fold higher risk for gout and a 1.9-fold higher risk for hyperuricemia compared with the lowest quartile.

LIMITATION

Blood lead level does not necessarily reflect the total body lead burden.

CONCLUSION

Blood lead levels in the range currently considered acceptable are associated with increased prevalence of gout and hyperuricemia.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Stanford University School of Medicine, 1000 Welch Road, Suite 203, Palo Alto, CA 94304, USA.

    ,

    Source

    Annals of internal medicine 157:4 2012 Aug 21 pg 233-41

    MeSH

    Adult
    Age Factors
    Aged
    Cadmium
    Creatinine
    Cross-Sectional Studies
    Diet
    Environmental Exposure
    Female
    Gout
    Humans
    Lead
    Logistic Models
    Male
    Mercury
    Metabolic Clearance Rate
    Middle Aged
    Nutrition Surveys
    Prevalence
    Risk Factors
    Sensitivity and Specificity
    Uric Acid

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22910934

    Citation

    Krishnan, Eswar, et al. "Low-level Lead Exposure and the Prevalence of Gout: an Observational Study." Annals of Internal Medicine, vol. 157, no. 4, 2012, pp. 233-41.
    Krishnan E, Lingala B, Bhalla V. Low-level lead exposure and the prevalence of gout: an observational study. Ann Intern Med. 2012;157(4):233-41.
    Krishnan, E., Lingala, B., & Bhalla, V. (2012). Low-level lead exposure and the prevalence of gout: an observational study. Annals of Internal Medicine, 157(4), pp. 233-41. doi:10.7326/0003-4819-157-4-201208210-00003.
    Krishnan E, Lingala B, Bhalla V. Low-level Lead Exposure and the Prevalence of Gout: an Observational Study. Ann Intern Med. 2012 Aug 21;157(4):233-41. PubMed PMID: 22910934.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Low-level lead exposure and the prevalence of gout: an observational study. AU - Krishnan,Eswar, AU - Lingala,Bharathi, AU - Bhalla,Vivek, PY - 2012/8/23/entrez PY - 2012/8/23/pubmed PY - 2012/10/20/medline SP - 233 EP - 41 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 157 IS - 4 N2 - BACKGROUND: Blood lead levels (BLLs) less than 1.21 µmol/L (<25 µg/dL) among adults are considered acceptable by current national standards. Lead toxicity can lead to gouty arthritis (gout), but whether the low lead exposure in the contemporary general population confers risk for gout is not known. OBJECTIVE: To determine whether BLLs within the range currently considered acceptable are associated with gout. DESIGN: Population-based cross-sectional study. SETTING: The National Health and Nutrition Examination Survey for 2005 through 2008. PATIENTS: 6153 civilians aged 40 years or older with an estimated glomerular filtration rate greater than 10 mL/min per 1.73 m2. MEASUREMENTS: Outcome variables were self-reported physician diagnosis of gout and serum urate level. Blood lead level was the principal exposure variable. Additional data collected were anthropometric measures, blood pressure, dietary purine intake, medication use, medical history, and serum creatinine concentration. RESULTS: The prevalence of gout was 6.05% (95% CI, 4.49% to 7.62%) among patients in the highest BLL quartile (mean, 0.19 µmol/L [3.95 µg/dL]) compared with 1.76% (CI, 1.10% to 2.42%) among those in the lowest quartile (mean, 0.04 µmol/L [0.89 µg/dL]). Each doubling of BLL was associated with an unadjusted odds ratio of 1.74 (CI, 1.47 to 2.05) for gout and 1.25 (CI, 1.12 to 1.40) for hyperuricemia. After adjustment for renal function, diabetes, diuretic use, hypertension, race, body mass index, income, and education level, the highest BLL quartile was associated with a 3.6-fold higher risk for gout and a 1.9-fold higher risk for hyperuricemia compared with the lowest quartile. LIMITATION: Blood lead level does not necessarily reflect the total body lead burden. CONCLUSION: Blood lead levels in the range currently considered acceptable are associated with increased prevalence of gout and hyperuricemia. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/22910934/full_citation L2 - https://www.annals.org/article.aspx?doi=10.7326/0003-4819-157-4-201208210-00003 DB - PRIME DP - Unbound Medicine ER -