Authors: Ana Navas-Acien,1 Eliseo Guallar,2,3 Ellen K. Silbergeld,1 and Stephen J. Rothenberg4,5

Source: Environ Health Perspect. 2007 March; 115(3): 472–482.

Objective This systematic review evaluates the evidence on the association between lead exposure and cardiovascular end points in human populations.

Methods We reviewed all observational studies from database searches and citations regarding lead and cardiovascular end points.

Results A positive association of lead exposure with blood pressure has been identified in numerous studies in different settings, including prospective studies and in relatively homogeneous socioeconomic status groups. Several studies have identified a dose–response relationship. Although the magnitude of this association is modest, it may be underestimated by measurement error. The hypertensive effects of lead have been confirmed in experimental models. Beyond hypertension, studies in general populations have identified a positive association of lead exposure with clinical cardiovascular outcomes (cardiovascular, coronary heart disease, and stroke mortality; and peripheral arterial disease), but the number of studies is small. In some studies these associations were observed at blood lead levels < 5 μg/dL.

Conclusions We conclude that the evidence is sufficient to infer a causal relationship of lead exposure with hypertension. We conclude that the evidence is suggestive but not sufficient to infer a causal relationship of lead exposure with clinical cardiovascular outcomes. There is also suggestive but insufficient evidence to infer a causal relationship of lead exposure with heart rate variability.