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Associations between Blood Lead Levels and Coronary Artery Stenosis Measured Using Coronary Computed Tomography Angiography

  • Kim, Suwhan1
  • Kang, Wonyang1, 2
  • Cho, Seunghyeon1
  • Lim, Dae-Young1
  • Yoo, Yeongjae1
  • Park, Ryoung Jin3
  • Lee, Byung Chan4
  • Moon, Jai-Dong1
  • Park, Won-Ju1
  • 1 Chonnam National University (CNU) Medical School and CNU Hwasun Hospital, Republic of Korea
  • 2 Korea Workers’ Compensation & Welfare Service, Republic of Korea
  • 3 Gwangyang Sarang General Hospital, Republic of Korea
  • 4 CNU Medical School and CNU Hwasun Hospital, Republic of Korea
Published Article
Environmental Health Perspectives
Environmental Health Perspectives
Publication Date
Feb 23, 2021
DOI: 10.1289/EHP7351
PMID: 33621129
PMCID: PMC7901725
PubMed Central


Background: Lead exposure is a risk factor for increased blood pressure and cardiovascular disease, even when blood lead levels (BLLs) are within the normal range. Objective: This study aimed to investigate the association between BLL and coronary artery stenosis (CAS) in asymptomatic adults using 128-slice dual-source coronary computed tomography (CT) angiography. Methods: We analyzed medical records data from 2,193 adults (1,461 men and 732 women) who elected to complete a screening health examination, coronary CT angiography, and BLL measurement during 2011–2018 and had no history of CAS symptoms, cardiovascular disease, or occupational exposure to lead. Logistic regression models were used to estimate associations between moderate-to-severe CAS ( ≥ 25 % stenosis) and a 1 - μ g / dL increase in blood lead, with and without adjustment for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, regular exercise, smoking status, and alcohol drinking. Results: BLLs ranged from 0.12 to 10.14 μ g / dL , with an arithmetic mean of 2.71 ± 1.26 μ g / dL . The arithmetic mean was higher for men than for women ( 2.98 ± 1.26 μ g / dL vs. 2.18 ± 1.08 μ g / dL , p < 0.001 ) and higher in the moderate-to-severe CAS group than in the no-CAS or < 25 % stenosis group ( 3.02 ± 1.44 μ g / dL vs. 2.67 ± 1.23 μ g / dL , p < 0.001 ). Moderate-to-severe CAS was significantly associated with BLL before and after adjustment, with an adjusted odds ratio for a 1 - μ g / dL increase in BLL of 1.14 (95% CI: 1.02, 1.26), p = 0.017 . Conclusions: BLL was positively associated with the prevalence of moderate-to-severe CAS in Korean adults who completed an elective screening examination for early cardiovascular disease, 94% of whom had a BLL of < 5 μ g / dL . More efforts and a strict health policy are needed to further reduce BLLs in the general population.

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