ORIGINAL PAPER
Effect of combined exposure to lead, mercury, and cadmium on hypertension: the 2008–2013 Korean National Health and Nutrition Examination Surveys
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1
Seoul Medical Center, Seoul, Republic of Korea
(Department of Research Institute)
2
Seoul Medical Center, Seoul, Republic of Korea
(Department of Occupational Environmental Medicine)
Online publication date: 2025-06-13
Corresponding author
KyooSang Kim
Seoul Medical Center, Department of Research Institute, Sinnae-ro156, 02053 Seoul, South Korea
HIGHLIGHTS
- A novel national-scale analysis of heavy metals and hypertension risk were used.
- Lead (Pb) and cadmium (Cd) showed the strongest association with hypertension.
- Mercury had a weaker link to hypertension compared to Pb and Cd.
- Combined exposure to heavy metals revealed significant hypertension risk.
- Findings emphasize the need for monitoring heavy metal exposure for cardiovascular disease prevention.
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ABSTRACT
Objectives: Many studies have demonstrated the effects of heavy metals on hypertension. However, to date, no study has used the Korean National
Health and Nutrition Examination Survey (KNHANES) to analyze the effects of combined exposure to heavy metals on hypertension. Therefore,
this study inferred the study population using weights based on a rolling sample and used standardized scores to estimate the effects of combined
exposure to heavy metals on hypertension. Material and Methods: The authors used raw participant data from KNHANES (2008–2013), when
heavy metal levels in the blood were measured. The authors analyzed the effects of lead, mercury, and cadmium on hypertension. The authors calculated
standardized scores based on a regression analysis to analyze the effects of combined exposure. The odds ratios (ORs) of hypertension due
to heavy metals were calculated using multivariate logistic regression, with the lowest quartile as the reference category. Results: In the crude regression
analysis, lead, mercury, and cadmium exposure were associated with significant differences in the rate of hypertension (p < 0.05). However,
when other heavy metals were included as covariates, only lead (OR = 1.29, 95% confidence interval [CI]: 1.08–1.55) and cadmium (OR = 1.47,
95% CI: 1.24–1.74) showed significant effects (p < 0.01). When the authors analyzed the effects of combined exposure to heavy metals, the OR of
hypertension for the highest quartile, relative to the lowest quartile, was 1.78 (95% CI: 1.50–2.11, p < 0.001). Linear regression analysis revealed that
heavy metal exposure was significantly associated with hypertension prevalence (p < 0.001). Conclusions: This study verified that heavy metal exposure
affects the prevalence of hypertension and that combined exposure to multiple heavy metals is associated with a higher risk of hypertension
than exposure to a single heavy metal. Further research is necessary to screen for heavy metal-related risk factors and evaluate whether the interactions
between heavy metals are positive or negative. Int J Occup Med Environ Health. 2025;38(3)