title: Lead levels and ischemic heart disease in a prospective study of middle-aged and elderly men: the VA Normative Aging Study.
abstract: BACKGROUND
  Lead exposure has been associated with higher blood pressure, hypertension, electrocardiogram abnormalities, and increased mortality from circulatory causes.
  
  
  OBJECTIVE
  We assessed the association between bone lead-a more accurate biomarker of chronic lead exposure than blood lead-and risk for future ischemic heart disease (IHD).
  
  
  METHODS
  In a prospective cohort study (VA Normative Aging Study), 837 men who underwent blood or bone lead measurements at baseline were followed-up for an ischemic heart disease event between 1 September 1991 and 31 December 2001. IHD was defined as either a diagnosis of myocardial infarction or angina pectoris that was confirmed by a cardiologist. Events of fatal myocardial infarction were assessed from death certificates.
  
  
  RESULTS
  An IHD event occurred in 83 cases (70 nonfatal and 13 fatal). The mean blood, tibia, and patella lead levels were higher in IHD cases than in noncases. In multivariate Cox-proportional hazards models, one standard deviation increase in blood lead level was associated with a 1.27 (95% confidence interval, 1.01-1.59) fold greater risk for ischemic heart disease. Similarly, a one standard deviation increase in patella and tibia lead levels was associated with greater risk for IHD (hazard ratio for patella lead = 1.29; 95% confidence interval, 1.02-1.62).
  
  
  CONCLUSIONS
  Men with increased blood and bone lead levels were at increased risk for future IHD. Although the pathogenesis of IHD is multifactorial, lead exposure may be one of the risk factors.
authors.affiliation: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. njain1@partners.org
authors.forename: Nitin B
authors.initials: NB
authors.lastname: Jain
authors.forename: Vijayalakshmi
authors.initials: V
authors.lastname: Potula
authors.forename: Joel
authors.initials: J
authors.lastname: Schwartz
authors.forename: Pantel S
authors.initials: PS
authors.lastname: Vokonas
authors.forename: David
authors.initials: D
authors.lastname: Sparrow
authors.forename: Robert O
authors.initials: RO
authors.lastname: Wright
authors.forename: Huiling
authors.initials: H
authors.lastname: Nie
authors.forename: Howard
authors.initials: H
authors.lastname: Hu
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D007854:Lead / Q000032:analysis* / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology*; D010329:Patella / Q000737:chemistry*; D011446:Prospective Studies; D012307:Risk Factors; D013977:Tibia / Q000737:chemistry*; D014481:United States / Q000453:epidemiology; D014728:Veterans
chemical_list: D007854:Lead