近日，全球疾病负担2023首席协作组报道了心血管疾病负担的主要危险因素。相关论文于2026年3月30日发表在《美国医学会志》上。

尽管铅暴露水平有所下降，但其仍是心血管疾病死亡的主要危险因素。量化累积骨铅暴露对心血管疾病的直接影响，对于指导预防策略和公共卫生政策至关重要。

为了评估骨铅水平与心血管疾病之间的关联，推导暴露-反应曲线，并估算1990年至2023年全球、区域和国家层面可归因于铅暴露的疾病负担，研究组整合了两部分数据：一是对1988年至2013年间美国国家健康与营养调查（NHANES）9个周期的42028名成年人进行分析，随访至2015年12月，共记录1748例心血管死亡；二是系统综述与Meta回归。骨铅水平根据血铅水平、年龄以及特定队列的暴露史进行估算。采用Cox比例风险模型（校正血压及其他混杂因素）估算心血管死亡的风险比。基于“举证责任”框架的贝叶斯Meta回归将NHANES结果与已发表数据合并，以估算风险曲线，然后将该曲线应用于铅暴露与心血管疾病的估算值，计算人群归因分数及可归因于铅暴露的心血管疾病负担。暴露因素为估算的骨铅水平。按年龄、性别、年份和地点划分的可归因于铅暴露的心血管疾病死亡率、伤残损失寿命年、寿命损失年及伤残调整寿命年。

NHANES参与者年龄为18至90岁（中位年龄46岁[四分位距32-63岁]），51.5%为女性，估算的骨铅水平范围为0.17 μg/g至301 μg/g（中位数为13.3 μg/g）。较高的骨铅水平与较高的心血管疾病风险相关：与估算的工业化前水平（0.027 μg/g）相比，骨铅水平为5 μg/g、10 μg/g、25 μg/g、50 μg/g和100 μg/g时，心血管疾病死亡风险分别增加7.5%（95%不确定区间[UI] 1.7%~14.1%）、15.8%（95% UI 12.7%~19.1%）、41.3%（95% UI 34.2%~49.2%）、71.3%（95% UI 55.4%~90.0%）和87.9%（95% UI 61.0%~121.2%）。2023年全球范围内，可归因于铅暴露的死亡人数为350万（95% UI 260万~440万），伤残调整寿命年为7160万（95% UI 5240万~9030万），分别占全球全部死亡人数的5.8%（95% UI 4.3%~7.2%）和全部伤残调整寿命年的2.6%（95% UI 1.8%~3.2%）。铅暴露是全球第八大死亡危险因素，也是第二大环境危险因素。

研究结果表明，累积铅暴露仍然是全球心血管疾病死亡的一个主要且可预防的促成因素。迫切需要加强监测、监管和治理，以减轻可归因于铅的疾病负担。

附：英文原文

Title: Lead-Attributable Cardiovascular Disease Burden: Global Burden of Disease Study 2023

Author: GBD Lead Collaborators, Jeffrey D. Stanaway, Sandra Spearman, Nicole K. DeCleene, Vanessa Garcia, Laura Lara-Castor, Stephen S. Lim, Christopher J. L. Murray, Gregory A. Roth, Matthew A. Seymour, Benjamin Stark, Michael Brauer

Issue&Volume: 2026-03-30

Abstract:

Importance  Despite declines, lead exposure remains a major risk factor for cardiovascular disease (CVD) mortality. Quantifying the direct effects of cumulative bone lead exposure on CVD is essential to guide prevention and policy.

Objectives  To estimate the association between bone lead levels and CVD, derive an exposure-response curve, and estimate global, regional, and national lead-attributable disease burden for 1990 to 2023.

Design, Setting, and Participants  Analysis of 42028 adults from 9 cycles of the US National Health and Nutrition Examination Survey (NHANES) spanning 1988 through 2013, with follow-up through December 2015 capturing 1748 CVD deaths, was combined with a systematic review and meta-regression. Bone lead was estimated from blood lead, age, and cohort-specific exposure histories. Cox proportional hazards models adjusted for blood pressure and confounders estimated hazard ratios for CVD mortality. A bayesian meta-regression using the Burden of Proof framework pooled NHANES results with published data to estimate the risk curve, which was then applied to lead exposure and CVD estimates to estimate population-attributable fractions and lead-attributable CVD burden.

Exposure  Estimated bone lead levels.

Main Outcomes and Measures  Lead-attributable CVD mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) by age, sex, year, and location.

Results  NHANES participants were aged 18 to 90 years (median, 46 [IQR, 32-63] years) and 51.5% of participants were female, with estimated bone lead levels ranging from 0.17 μg/g to 301 μg/g (median, 13.3 μg/g). Higher bone lead levels were associated with higher CVD risk: relative to estimated preindustrial levels of 0.027 μg/g, bone lead levels of 5 μg/g, 10 μg/g, 25 μg/g, 50 μg/g, and 100 μg/g corresponded to 7.5% (95% uncertainty interval [UI], 1.7%-14.1%), 15.8% (95% UI, 12.7%-19.1%), 41.3% (95% UI, 34.2%-49.2%), 71.3% (95% UI, 55.4%-90.0%), and 87.9% (95% UI, 61.0%-121.2%) greater CVD mortality risk, respectively. Globally in 2023, 3.5 million (95% UI, 2.6 million to 4.4 million) deaths and 71.6 million (95% UI, 52.4 million to 90.3 million) DALYs were attributable to lead exposure, accounting for 5.8% (95% UI, 4.3%-7.2%) of all deaths and 2.6% (95% UI, 1.8%-3.2%) of all DALYs. Lead was the eighth leading risk for global mortality and second leading environmental risk.

Conclusions and Relevance  Cumulative lead exposure remains a major, preventable contributor to global CVD mortality. Strengthened surveillance, regulation, and remediation are urgently required to reduce the lead-attributable burden.

DOI: 10.1001/jama.2026.2197

Source: https://jamanetwork.com/journals/jama/fullarticle/2846862