title: Associations of toenail arsenic, cadmium, mercury, manganese, and lead with blood pressure in the normative aging study.
abstract: BACKGROUND
  Arsenic, cadmium, mercury, and lead are associated with cardiovascular disease in epidemiologic research. These associations may be mediated by direct effects of the metals on blood pressure (BP) elevation. Manganese is associated with cardiovascular dysfunction and hypotension in occupational cohorts.
  
  
  OBJECTIVE
  We hypothesized that chronic arsenic, cadmium, mercury, and lead exposures elevate BP and that manganese lowers BP.
  
  
  METHODS
  We conducted a cross-sectional analysis of associations between toenail metals and BP among older men from the Normative Aging Study (n = 639), using linear regression and adjusting for potential confounders.
  
  
  RESULTS
  An interquartile range increase in toenail arsenic was associated with higher systolic BP [0.93 mmHg; 95% confidence interval (CI): 0.25, 1.62] and pulse pressure (0.76 mmHg; 95% CI: 0.22, 1.30). Positive associations between arsenic and BP and negative associations between manganese and BP were strengthened in models adjusted for other toenail metals.
  
  
  CONCLUSIONS
  Our findings suggest associations between BP and arsenic and manganese. This may be of public health importance because of prevalence of both metal exposure and cardiovascular disease. Results should be interpreted cautiously given potential limitations of toenails as biomarkers of metal exposure.
authors: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA. irinam@email.unc.edu
authors: Irina
authors: I
authors: Mordukhovich
authors: Robert O
authors: RO
authors: Wright
authors: Howard
authors: H
authors: Hu
authors: Chitra
authors: C
authors: Amarasiriwardena
authors: Andrea
authors: A
authors: Baccarelli
authors: Augusto
authors: A
authors: Litonjua
authors: David
authors: D
authors: Sparrow
authors: Pantel
authors: P
authors: Vokonas
authors: Joel
authors: J
authors: Schwartz
mesh_terms: D000368:Aged; D000375:Aging; D001151:Arsenic / Q000378:metabolism*; D001794:Blood Pressure; D001900:Boston; D002104:Cadmium / Q000378:metabolism; D015331:Cohort Studies; D004781:Environmental Exposure / Q000032:analysis; D004782:Environmental Health; D004785:Environmental Pollutants / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007854:Lead / Q000378:metabolism; D008297:Male; D008345:Manganese / Q000378:metabolism; D008628:Mercury / Q000378:metabolism; D019216:Metals, Heavy / Q000378:metabolism*; D009262:Nails / Q000378:metabolism*
chemical_list: D004785:Environmental Pollutants; D019216:Metals, Heavy; D002104:Cadmium; D007854:Lead; D008345:Manganese; D008628:Mercury; D001151:Arsenic