Combined effect of lead exposure and allostatic load on cardiovascular disease mortality—A preliminary study

Emmanuel Obeng-Gyasi, Alesia C. Ferguson, Katherine A. Stamatakis, Michael A. Province

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20 Scopus citations


This study explores the combined effect of lead (Pb) exposure and an index of chronic physiological stress on cardiovascular disease mortality using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2008 linked to 1999–2014 National Death Index data. Chronic physiological stress was measured using the allostatic load (AL) index, which was formed by analyzing markers from the cardiovascular, inflammatory, and metabolic systems, with Pb levels, assessed using blood lead levels (BLL). The dataset was analyzed with statistical techniques to explore (a) the relationship between Pb exposure and AL, and (b) the combined role of Pb and AL on cardiovascular disease mortality. Results indicated that AL was more elevated in those with BLLs above the 50th percentile in the US population and that those with elevated AL were more likely to have high BLL. Finally, the interaction of AL and BLL significantly increased the likelihood of cardiovascular disease mortality. These findings highlight the need for considering the totality of exposures experienced by populations to build holistic programs to prevent Pb exposure and reduce stressors to promote optimal health outcomes and reduce cardiovascular mortality risk.

Original languageEnglish
Article number6879
JournalInternational journal of environmental research and public health
Issue number13
StatePublished - Jul 1 2021


  • Allostatic load
  • Cardiovascular disease mortality
  • Lead exposure
  • Mixed exposures
  • Stress


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