Environmental heavy metals and risk of ischemic heart disease and stroke in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

巴西成人健康纵向研究 (ELSA-Brasil) 中的环境重金属与缺血性心脏病和中风的风险

• 批准号: 9890186
• 负责人: PAULO ANDRADE LOTUFO
• 金额: $ 17.37万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-21 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9890186
• 关键词: Adult; Affect; Arsenic; Biological Process; Biology; Biomedical Research; Blood; Blood Preservation; Brazil; Cadmium; Cardiovascular Diseases; Cardiovascular system; Case-Control Studies; Cessation of life; China; Chromium; Clinical; Cobalt; Collection; Consensus; Copper; Cross-Sectional Studies; Data; Developing Countries; Development; Diabetes Mellitus; Diet; Dietary Intervention; Disease; Disease Outcome; Environmental Exposure; Epidemic; Etiology; Europe; Event; Exposure to; Funding Opportunities; Health; Heavy Metals; Hypertension; Individual; International; Interview; Investments; Joints; Laboratories; Lead; Link; Longitudinal Studies; Magnesium; Manganese; Mediating; Mercury; Metabolism; Metal exposure; Metals; Molybdenum; Myocardial Ischemia; National Toxicology Program; Nested Case-Control Study; Nickel; Obesity; Outcome; Participant; Persons; Physical Examination; Play; Population; Portuguese; Positioning Attribute; Prospective Studies; Prospective cohort; Prospective cohort study; Public Health; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Sampling; Selenium; Serum; Site; Smoking; South America; Stroke; Supplementation; Testing; Time; Toxic effect; Trace Elements; Trace metal; Tungsten; United States; Urine; Vanadium; Vascular Diseases; Vascular System; Woman; Work; Zinc; adjudicate; cardiometabolism; cardiovascular disorder prevention; cardiovascular disorder risk; case control; cohort; coronary artery calcium; coronary calcium scoring; cost efficient; data resource; design; diabetes risk; dietary trace element; disability; experience; follow-up; global health; interest; men; nervous system disorder; physical inactivity; population based; population health; programs; toxic metal

PROJECT SUMMARY Environmental degradation and exposure to heavy metals (over which individuals often have little control) may have a direct impact on cardiovascular diseases (CVD) development, which have become one of the most pressing nemesis for individual- and population-health globally. Recent studies have provided provocative evidence linking environmental exposure to heavy metals to increased risk of diabetes and hypertension, which are strong CVD risk factors. In contrast, prospective cohort studies have shown that higher levels of dietary and serum essential trace metals are directly associated with lower CVD risk and that supplementation of which may have potential benefits by mitigating the effects of toxic metals on the cardiovascular system. However, very few studies have directly and comprehensively investigated exposure to multiple metals particularly their joint effects on affecting CVD risk (including stroke). The ongoing Brazilian Longitudinal Study of Adult Health (in Portuguese, ‘Estudo Longitudinal de Sau´ de do Adulto’, ELSA-Brasil), the only large prospective study established in South America to specifically investigate risk factors for cardiometabolic health, represents a unique resource to study the roles of multiple metal exposures and their interactions with dietary trace elements in affecting CVD risk. At baseline, 4,428 CVD-free participants at the ELSA-Brasil site in Sao Paulo completed 1) physical examinations; 2) clinical laboratory tests; 3) in-person interviews; 4) collections of blood and urine samples; and 5) a CT examination to quantify coronary artery calcium (CAC) score. To date, a total of 466 incident CVD (~150 stroke) cases have been adjudicated in the ELSA-Brasil cohort in the 10-year follow up. ln the current application aims to investigate, we will leverage these exceptional resources and the substantial investment of time and effort by ELSA-Brasil study investigators over the past ten years to investigate, in a most cost-efficient and timely manner, the roles of metals playing in CVD development. Specifically, the current application aims to utilize this ongoing prospective cohort study to not only determine whether heavy metal exposures increase CAC score and CVD risk, but also identify the optimal body levels of essential metals that could mitigate CVD risk from toxic metals. If antagonistic effects exist and optimal body levels of essential metals that could reduce toxic metal impacts are confirmed, this work would lead to simple, safe, readily-available, acceptable and highly-affordable nutritional intervention for CVD prevention that will have both clinical and public health significance worldwide.

项目概要 环境退化和重金属暴露（个人通常无法控制）可能会 直接影响心血管疾病（CVD）的发展，心血管疾病已成为最严重的疾病之一 最近的研究提供了挑衅性的全球个人和人口健康的克星。 有证据表明环境中重金属暴露与糖尿病和高血压风险增加有关， 相比之下，前瞻性队列研究表明，较高水平的饮食和 血清必需微量金属与较低的 CVD 风险直接相关，补充其可能 通过减轻有毒金属对心血管系统的影响而具有潜在的好处，但是很少。 研究直接、全面地调查了多种金属的暴露，特别是它们的联合影响 正在进行的巴西成人健康纵向研究（葡萄牙语， ‘Estudo Longitudinal de Sau´ de do Adulto’，ELSA-Brasil），是在南方建立的唯一大型前瞻性研究 美国专门调查心脏代谢健康的危险因素，代表了独特的研究资源 多种金属暴露的作用及其与膳食微量元素的相互作用对心血管疾病风险的影响。 基线时，圣保罗 ELSA-Brasil 中心的 4,428 名无 CVD 参与者完成了 1) 体检； 2) 临床实验室测试； 3) 现场访谈； 4) 采集血液和尿液样本； 迄今为止，共有 466 例 CVD（约 150 例中风）。 ELSA-巴西队列中的病例已在当前申请目标的 10 年随访中得到裁决。 为了进行调查，我们将利用这些特殊的资源以及大量的时间和精力投入 ELSA-巴西研究人员在过去十年中以最具成本效益和及时的方式进行调查， 具体来说，当前的应用旨在利用这一正在进行的过程。 前瞻性队列研究不仅确定重金属暴露是否会增加 CAC 评分和 CVD 风险，同时还确定了体内必需金属的最佳水平，可以减轻有毒金属引起的 CVD 风险。 如果存在拮抗作用，并且可以减少有毒金属影响的必需金属的最佳体内水平是 经证实，这项工作将带来简单、安全、易于获得、可接受和高度负担得起的营养 CVD 预防干预措施将在全球范围内具有临床和公共卫生意义。