Metal biomarker mixtures and blood pressure in the United States: cross-sectional findings from the 1999-2006 National Health and Nutrition Examination Survey (NHANES)

• Type of Material: Article
• Authors: Todd Everson, Emory University; Megan M. Niedzwiecki, Icahn School of Medicine at Mount Sinai; Daniell Toth, U.S. Bureau of Labor Statistics; Maria Tellez-Plaza, Biomedical Research Institute INCLIVA; Haoran Liu, Emory University; Dana Barr, Emory University; Matthew Gribble, Emory University
• Language: English
• Date: 2021-02-14
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12940-021-00695-1
• Title of Journal or Parent Work: ENVIRONMENTAL HEALTH
• Volume: 20
• Issue: 1
• Start Page: 15
• End Page: 15
• Grant/Funding Information: This work was supported in part by the HERCULES Exposome Research Center funded by the National Institute of Environmental Health Sciences (P30 ES019776).
• Keywords: Life Sciences & Biomedicine; Environmental epidemiology; Synergy; Environmental Sciences; Mixtures; Risk assessment; Survey statistics; Public, Environmental & Occupational Health; Environmental Sciences & Ecology; cardiovascular epidemiology; Science & Technology; Antagonism
• Research Categories: Biology, Ecology; Health Sciences, Epidemiology; Environmental Sciences

Abstract

Background: The objective of this study was to identify conditional relationships between multiple metal biomarkers that predict systolic and diastolic blood pressure in the non-institutionalized United States adult population below the age of 60. Methods: We used inorganic exposure biomarker data and blood pressure data from three cycles (1999–2004) of the National Health and Nutrition Examination Survey (NHANES) to construct regression trees for blood pressure among adults ages 20–60 (adjusted for age, sex, body mass index, race, and smoking status) to identify predictors of systolic (SBP) and diastolic blood pressure (DBP). We also considered relationships among non-Hispanic black, Mexican-American, and white adults separately. Results: The following metal exposure biomarkers were conditionally predictive of SBP and/or DBP in the full sample: antimony (Sb), barium (Ba), cadmium (Cd), cesium (Cs), lead (Pb), tungsten (W) and molybdenum (Mo). The highest average SBP (> 120 mmHg) was observed among those with low Sb (≤ 0.21 μg/dL) high Cd (> 0.22 μg/g creatinine) and high Pb (> 2.55 μg/dL) biomarkers. Those with the highest average DBP had high urinary W levels (> 0.10 μg/g creatinine) in combination with either urinary Sb > 0.17 μg/g creatinine or those with urinary Sb ≤ 0.17 μg/g creatinine, but with high blood Pb levels (> 1.35 μg/dL). Predictors differed by ethnicity, with Cd as the main predictor of SBP among non-Hispanic black adults, and Pb not selected by the algorithm as a predictor of SBP among non-Hispanic white adults. Conclusions: Combinations of metal biomarkers have different apparent relationships with blood pressure. Additional research in toxicological experimental models and in epidemiological studies is warranted to evaluate the suggested possible toxicological interactions between Sb, Cd, and Pb; and between W, Sb, and Pb; for cardiovascular (e.g., blood pressure) health. We also think future epidemiological research on inorganic exposure sets in relation to health outcomes like blood pressure might benefit from stratification by race and ethnicity.