Sex-Specific Effects of Combined Heavy Metal Exposure on Blood Pressure: A Bayesian Kernel Machine Regression Analysis

Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. Previous studies have indicated that the presence of heavy metals in the air may be a risk factor for hypertension. This study examined the combined effects of heavy metals on blood pressure considering, sex differences. A health impact survey was conducted with 561 residents near waste incineration facilities in Buki-myeon, Cheongju, Korea. Blood samples were analyzed for heavy metal concentrations, and the blood pressure was measured. Multiple linear and Bayesian kernel machine regressions (BKMR) were used to assess the association between heavy metal exposure and blood pressure. Men had higher blood mercury and lead concentrations, while women had higher cadmium levels. The multiple linear regression analysis revealed no significant associations between heavy metals and systolic blood pressure. However, cadmium was significantly associated with increased diastolic blood pressure in the total group and women, whereas lead was associated with the same in men. In the BKMR analysis, the joint effect of the three metals was significantly associated with diastolic blood pressure below the 45th percentile and above the 55th percentile only in men. These findings underscore the importance of considering sex differences in environmental health studies and public health strategies.