Environmental Lead Exposure is Associated with Higher Predicted 10-year Atherosclerotic Cardiovascular Disease Risk in Chinese Middle-aged and Older Adults

Background: Environmental lead exposure has been connected with an increased risk of cardiovascular disease (CVD). Nonetheless, little is known about its impact on atherosclerotic cardiovascular disease (ASCVD). Methods To investigate the relationship between environmental lead exposure and the 10-year ASCVD risk in Chinese middle-aged and older adults, we conducted a cross-sectional study in rural areas of southern China in 2019–2020. We used the face-to-face questionnaire survey and physical examination to collect data and measured blood lead by ICP-MS. The 10-year ASCVD risk score was calculated through the Prediction for ASCVD Risk in China (China-PAR) equation model, and classified into low-risk (< 5.0%), intermediate-risk (5.0-9.9%), and high-risk (≥ 10%) categories. Generalized linear model (GLM) and logistic regression model were applied to estimate associations between quartiles (Q) of blood lead and the 10-year ASCVD risk categories in overall and subgroup populations. Results We found that the blood lead of all subjects was 1.79 µg/L with an interquartile range (IQR) of 1.14–44.91 µg/L, and the predicted 10-year ASCVD risk score was 3.20% (IQR: 1.70–5.90%). The predicted 10-year ASCVD risk score increased with the quartiles of blood lead ( P  < 0.001). The higher lead exposure levels, the more subjects in the intermediate- and high-risk of ASCVD. After full adjustment for potential confounders, subjects in Q3 of blood lead had an odds ratio (OR) of 2.64 with a 95% confidence interval (CI) of 1.05–6.61 ( P  = 0.038) for the grade of 10-year ASCVD risk, compared with subjects in Q1. Subgroup analyses showed that the OR was higher in subjects those were males, below 60 years old, current smokers, and with hypertension. Conclusions Our study pointed out a nonlinear relationship between environmental lead exposure and 10-year ASCVD risk categories, highlighting the importance of controlling environmental lead exposure to prevent ASCVD, especially in susceptible populations.