Lead Exposure and Cardiovascular Disease—A Systematic Review

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.