Arsenic, Lead, Cadmium, Mercury and Hypertension among Asian Populations in the United States: NHANES 2011-2016

Abstract Background:Asian Americans have been reported having higher arsenic (As), lead (Pb), cadmium (Cd) and mercury (Hg) levels, comparing with non-Asian Americans. Exposure to these metals/metalloids have been associated with risk of hypertension, however, limited studies have explored the associations of As, Pb, Cd and Hg levels with hypertension among general Asian Americans. This study aimed to investigate the associations of As, Pb, Cd and Hg levels with blood pressure and prevalence of hypertension among Asian Americans who participated in the 2011-2016 National Health and Nutrition and Examination Survey (NHANES).Methods:The study included participants aged 20 years and older with determinations of As, Pb, Cd and Hg in blood (n=7913) and urine (n=3954). These metals levels were measured by inductively coupled plasma mass spectrometry. Systolic (SBP) and diastolic blood pressure (DBP) levels were examined through a standardized protocol. Censored normal regression model and logistic regression model were employed to explore the associations of As, Pb, Cd and Hg levels with blood pressure levels and hypertension respectively, and potential confounders were also adjusted in these regression models.Results:In multivariable-adjusted models, blood Hg levels were associated with increased SBP (tertile 2 vs. tertile 1: β=-0.9 mmHg, 95%CI:-6.1, 4.4; tertile 3 vs. tertile 1: β=5.6, 95%CI: 0.0, 11.2; P trend=0.003), DBP level (tertile 2 vs. tertile 1: β=4.1 mmHg, 95% CI: 0.1, 8.1; tertile 3 vs. tertile 1: β=5.8 mmHg, 95% CI: 1.9, 9.7; P trend=0.003) and prevalence of hypertension (tertile 2 vs. tertile 1: OR=1.2, 95% CI: 0.4, 3.4; tertile 3 vs. tertile 1: OR=2.8, 95% CI: 1.1, 7.3; P trend=0.001) among Asian Americans. The positive associations were also found between blood methyl-Hg level and blood pressure levels and prevalence of hypertension, whereas we did not identify significant associations of As, Pb and Cd levels in blood and urine with blood pressure levels and hypertension among Asian Americans. Conclusions:Highly exposed to Hg level among Asian Americans might associated with increased blood pressure levels and prevalence of hypertension. Further prospective studies with larger sample size should be performed to warrant the results.