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The Association of Blood Lead with Cardiovascular Disease Incidence and Mortality: Findings from the Strong Heart Study Cohort.

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Title: The Association of Blood Lead with Cardiovascular Disease Incidence and Mortality: Findings from the Strong Heart Study Cohort.
Authors: Lieberman-Cribbin, Wil1,2,3 wliebermancrib@northwell.edu, Nigra, Anne E.1, Kupsco, Allison1, Domingo-Relloso, Arce1,4, Schilling, Kathrin1, Ying Zhang5, Fretts, Amanda M.6, Cole, Shelley7, Umans, Jason G.8,9, Jarrett, Jeffery M.10, Lewin, Michael11, Ruiz, Patricia12, Zheng Li13, Navas-Acien, Ana1
Source: Environmental Health Perspectives. Jun2026, Vol. 134 Issue 2, p160-169. 10p.
Subject Terms: *Mass spectrometry, *Lead, *Biomarkers, Cardiovascular disease related mortality, Risk assessment, Public health surveillance, Physical diagnosis, Cardiovascular diseases, Research funding, Questionnaires, Cardiovascular diseases risk factors, Descriptive statistics, Surveys, Longitudinal method, Factor analysis, Data analysis software, Psychology of Native Americans, Proportional hazards models
Abstract: BACKGROUND: Evidence on lead and the burden of cardiovascular disease (CVD) derived from National Health and Nutrition Examination Survey (NHANES) data, a general sample of the U.S. population, lacks sufficient representation of American Indians. Moreover, there is limited prospective evidence of lead and incident CVD outcomes. OBJECTIVES: We evaluated whether blood lead levels were associated with CVD mortality and incidence in American Indian adults from the Strong Heart Study (SHS). METHODS: Whole blood samples collected in 1998-1999 among 1,818 participants were analyzed for lead using inductively coupled plasma mass spectrometry. CVD incidence and mortality data were available through 2019. We used progressively adjusted multivariable Cox proportional hazards models to estimate the risk of composite CVD and coronary heart disease (CHD) mortality and incidence by baseline blood lead levels. RESULTS: The median (p20, p80) blood lead was 22.5 (14.2, 37.3) μg/L, similar to that of a representative sample of U.S. adults in NHANES 1999-2000. During follow-up, 578 (31.8%) participants had a composite CVD event, and 454 (25.0%) participants had a CHD event. After adjustment for demographics, lifestyle, and cardiovascular risk factors, the hazard ratio (95% CI) per change across the 80th to 20th quantiles in blood lead was 1.15 (1.02-1.30) and 1.22 (1.08-1.37) for CVD and CHD mortality, respectively, and 1.13 (1.02-1.24) and 1.12 (0.99-1.25) for CVD and CHD incidence, respectively. In flexible dose-response models, the associations appeared to be nonlinear, with a clear increased risk of CVD and CHD mortality at blood lead concentrations above 35 μg/L. DISCUSSION: Blood lead levels in American Indian adults, which are comparable to populations in the U.S. and globally, were associated with an increased risk of CVD and CHD incidence and mortality. These findings highlight the importance of further reducing lead exposure, including American Indian communities. [ABSTRACT FROM AUTHOR]
Copyright of Environmental Health Perspectives is the property of National Institute of Environmental Health Sciences and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: The Association of Blood Lead with Cardiovascular Disease Incidence and Mortality: Findings from the Strong Heart Study Cohort.
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  Data: <searchLink fieldCode="AR" term="%22Lieberman-Cribbin%2C+Wil%22">Lieberman-Cribbin, Wil</searchLink><relatesTo>1,2,3</relatesTo><i> wliebermancrib@northwell.edu</i><br /><searchLink fieldCode="AR" term="%22Nigra%2C+Anne+E%2E%22">Nigra, Anne E.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Kupsco%2C+Allison%22">Kupsco, Allison</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Domingo-Relloso%2C+Arce%22">Domingo-Relloso, Arce</searchLink><relatesTo>1,4</relatesTo><br /><searchLink fieldCode="AR" term="%22Schilling%2C+Kathrin%22">Schilling, Kathrin</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Ying+Zhang%22">Ying Zhang</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Fretts%2C+Amanda+M%2E%22">Fretts, Amanda M.</searchLink><relatesTo>6</relatesTo><br /><searchLink fieldCode="AR" term="%22Cole%2C+Shelley%22">Cole, Shelley</searchLink><relatesTo>7</relatesTo><br /><searchLink fieldCode="AR" term="%22Umans%2C+Jason+G%2E%22">Umans, Jason G.</searchLink><relatesTo>8,9</relatesTo><br /><searchLink fieldCode="AR" term="%22Jarrett%2C+Jeffery+M%2E%22">Jarrett, Jeffery M.</searchLink><relatesTo>10</relatesTo><br /><searchLink fieldCode="AR" term="%22Lewin%2C+Michael%22">Lewin, Michael</searchLink><relatesTo>11</relatesTo><br /><searchLink fieldCode="AR" term="%22Ruiz%2C+Patricia%22">Ruiz, Patricia</searchLink><relatesTo>12</relatesTo><br /><searchLink fieldCode="AR" term="%22Zheng+Li%22">Zheng Li</searchLink><relatesTo>13</relatesTo><br /><searchLink fieldCode="AR" term="%22Navas-Acien%2C+Ana%22">Navas-Acien, Ana</searchLink><relatesTo>1</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22Environmental+Health+Perspectives%22">Environmental Health Perspectives</searchLink>. Jun2026, Vol. 134 Issue 2, p160-169. 10p.
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  Data: *<searchLink fieldCode="DE" term="%22Mass+spectrometry%22">Mass spectrometry</searchLink><br />*<searchLink fieldCode="DE" term="%22Lead%22">Lead</searchLink><br />*<searchLink fieldCode="DE" term="%22Biomarkers%22">Biomarkers</searchLink><br /><searchLink fieldCode="DE" term="%22Cardiovascular+disease+related+mortality%22">Cardiovascular disease related mortality</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+assessment%22">Risk assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Public+health+surveillance%22">Public health surveillance</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+diagnosis%22">Physical diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Cardiovascular+diseases%22">Cardiovascular diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Cardiovascular+diseases+risk+factors%22">Cardiovascular diseases risk factors</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Surveys%22">Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Factor+analysis%22">Factor analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Psychology+of+Native+Americans%22">Psychology of Native Americans</searchLink><br /><searchLink fieldCode="DE" term="%22Proportional+hazards+models%22">Proportional hazards models</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: BACKGROUND: Evidence on lead and the burden of cardiovascular disease (CVD) derived from National Health and Nutrition Examination Survey (NHANES) data, a general sample of the U.S. population, lacks sufficient representation of American Indians. Moreover, there is limited prospective evidence of lead and incident CVD outcomes. OBJECTIVES: We evaluated whether blood lead levels were associated with CVD mortality and incidence in American Indian adults from the Strong Heart Study (SHS). METHODS: Whole blood samples collected in 1998-1999 among 1,818 participants were analyzed for lead using inductively coupled plasma mass spectrometry. CVD incidence and mortality data were available through 2019. We used progressively adjusted multivariable Cox proportional hazards models to estimate the risk of composite CVD and coronary heart disease (CHD) mortality and incidence by baseline blood lead levels. RESULTS: The median (p20, p80) blood lead was 22.5 (14.2, 37.3) μg/L, similar to that of a representative sample of U.S. adults in NHANES 1999-2000. During follow-up, 578 (31.8%) participants had a composite CVD event, and 454 (25.0%) participants had a CHD event. After adjustment for demographics, lifestyle, and cardiovascular risk factors, the hazard ratio (95% CI) per change across the 80th to 20th quantiles in blood lead was 1.15 (1.02-1.30) and 1.22 (1.08-1.37) for CVD and CHD mortality, respectively, and 1.13 (1.02-1.24) and 1.12 (0.99-1.25) for CVD and CHD incidence, respectively. In flexible dose-response models, the associations appeared to be nonlinear, with a clear increased risk of CVD and CHD mortality at blood lead concentrations above 35 μg/L. DISCUSSION: Blood lead levels in American Indian adults, which are comparable to populations in the U.S. and globally, were associated with an increased risk of CVD and CHD incidence and mortality. These findings highlight the importance of further reducing lead exposure, including American Indian communities. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Environmental Health Perspectives is the property of National Institute of Environmental Health Sciences and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1021/EHP.6c00057
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        Text: English
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      – SubjectFull: Mass spectrometry
        Type: general
      – SubjectFull: Lead
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      – SubjectFull: Biomarkers
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      – SubjectFull: Cardiovascular disease related mortality
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      – SubjectFull: Physical diagnosis
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      – SubjectFull: Cardiovascular diseases
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      – SubjectFull: Psychology of Native Americans
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      – SubjectFull: Proportional hazards models
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