Journal of Preventive Medicine and Public Health

Original Articles

A Meta-analysis of the Association between Blood Lead and Blood Pressure.: Sang Baek Koh, Chun Bae Kim, Chung Mo Nam, Hong Ryul Choi, Bong Suk Cha, Jong Ku Park, Ho Sung Jee; Korean J Prev Med. 2001;34(3):262-268.

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Abstract PDF: OBJECTIVES
To integrate the results of studies which assess an association between blood lead and blood pressure. METHODS: We surveyed the existing literature using a MEDLINE search with blood lead and blood pressure as key words, including reports published from January 1980 to December 2000. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers exposed to lead, and 2) both blood pressure and blood lead must have been measured and presented with sufficient details so as to estimate or calculate the size of the association as a continuous variable. Among the 129 articles retrieved, 13 studies were selected for quantitative meta-analysis. Before the integration of each regression coefficient for the association between blood pressure and blood lead, a homogeneity test was conducted. RESULTS: As the homogeneity of studies was rejected in a fixed effect model, we used the results in a random effect model. Our quantitative meta-analysis yielded weighted regression coefficients of blood lead associated with systolic blood pressure and diastolic blood pressure results of 0.0047 (95% confidence interval [CI]: -0.0061, 0.0155) and 0.0004 (95% CI: -0.0031, 0.0039), respectively. CONCLUSIONS: The published evidence suggested that there may be a weak positive association between blood lead and blood pressure, but the association is not significant.; Summary

Trend of the Changes in the Level of Blood Lead, Urinary Arsenic and Urinary Cadmium of Children in Ulsan: 3-year Follow-up Study.: Choong Ryeol Lee, Cheol In Yoo, Ji Ho Lee, Hun Lee, Yangho Kim; Korean J Prev Med. 2001;34(2):166-174.

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Abstract PDF: OBJECTIVES
To obtain basic data on blood lead level and urinary level of arsenic and cadmium of children living near a petrochemical estate and a suburban area in Ulsan, Korea and to observe the trend of the changes in the level of these metals in these children. METHODS: The study subjects comprised 626 children living near a petrochemical estate and 299 children living in a suburban area of Ulsan. We analyzed the level of lead, arsenic and cadmium using atomic absorption spectrometer. RESULTS: The mean levels of blood lead in children living near the petrochemical estate were 5.25 microgram/dl, 5.24 microgram/dl, and 7.24 microgram/dl in the years 1997, 1999, and 2000, respectively, whereas those of children living in the suburban area were 3.81 microgram/dl, 4.75 microgram/dl, and 7.19 microgram/dl respectively. The mean levels of urinary arsenic in children living near the petrochemical estate were 4.57 microgram/g creatinine, 4.78 microgram/g creatinine, and 6.02 microgram /g creatinine in the year 1997, 1999, and 2000 respectively, whereas those of children living in suburban area were 2.35 microgram/g creatinine, 4.75 microgram/g creatinine, and 7.07 microgram/g creatinine, respectively. The mean levels of urinary cadmium in children living near the petrochemical estate were 1.15 microgram/g creatinine, 1.05 microgram/g creatinine, and 1.71 microgram/g creatinine in the year 1997, 1999, and 2000, respectively, whereas those of the children living in the suburban area were 0.74 microgram/g creatinine, 1.29 microgram/g creatinine, and 1.48 microgram/g creatinine, respectively. There were increasing trends in the level of blood lead, urinary arsenic and cadmium of children in Ulsan, and the differences in the level of these metals were disappearing between the children living in other areas year by year. CONCLUSIONS: These results suggest that the amount of exposure to lead, arsenic, and cadmium is increasing from year to year, and there is a need for periodic biological and atmospheric monitoring of these metals in Ulsan.; Summary

Different Effect of Blood Lead on Zinc Protoporphyrin by Gender in Korean Lead Workers.: Hyun Cheol Ahn, Yong Bae Kim, Gap Soo Lee, Kyu Yoon Hwang, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee; Korean J Prev Med. 1999;32(4):499-504.

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Abstract PDF: OBJECTIVES
To evaluate whether a relation between blood lead and zinc proto porphyrin(ZPP) was modified by gender in Korean lead workers. METHODS: A cross-sectional study was conducted with 1,304 male and 101 female subjects in 1997. The relation between blood lead and ZPP were evaluated with linear, exponential, and quadratic models. Then, the different effect of gender on the relation was examined by adding the interaction terms in the each model. RESULTS: Mean+/-SD of blood lead and ZPP level was different between male(27.7+/-10 microgram /dl and 51.3+/-23.4 microgram/dl) and female subjects(22.5+/-9.2 microgram/dl and 78.7+/-38.6 microgram/dl). After adjusting for possible confounders, the effect modification by gender was significant in linear(beta=1.119, p<0.001), exponential(beta=Exp(0.008), p<0.05), and quadratic model(beta= 1.388, p<0.001). In separate analysis, a quadratic relation between blood lead and ZPP was shown in male lead workers(beta=0.036, p<0.001), but an exponential relation in female lead workers(n=Exp(0.029), p<0.001). CONCLUSION: Our data showed that the increasing rate of ZPP in female were always higher than in male lead workers, suggesting that females were more susceptible to occupational lead exposure than males.; Summary

Lipid Peroxidation and Antioxidants in Workers Exposed to Lead.: Won Jin Lee, Cheon Hyun Hwang, Cheong Sik Kim, Soung Hoon Chang, Yang Ho Kim, Hae Joon Kim; Korean J Prev Med. 1998;31(3):449-459.

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Abstract PDF: This study was started to find out if plasma malondialdehyde(MDA), alpha-tocopherol and erythrocyte superoxide dismutase(SOD) activity could be markers of biological activity resulting from exposed to lead in workers. Blood samples were randomly obtained from lead -exposed workers(n=29), CO2 welders(n=60) and office workers(n=60). We used whole blood to analyse blood lead with atomic absorption spectrophotometer. Superoxide dismutase activity in erythrocyte was measured with spetrophotometer. MDA and alpha-tocopherol in plasma were measured with high performance liquid chromatography. Lead-exposed workers was significantly high in blood lead concentration(29.37 ng/dl) compared with welders(6.42 ng/dl) and office workers(5.01 ng/dl). The level of plasma MDA was significantly higher in the lead-exposed workers(1.87 nmol/g cholesterol) than the welders(1.41 nmol/g cholesterol) and office workers(1.41 nmol/g cholesterol). Erythrocyte SOD activity in lead-exposed workers(56.80 U/g Hb) was significantly increased than those of welders(37.63 U/g Hb) and office workers(20.47 U/g Hb). The plasma alpha-tocopherol level of lead-exposed workers(4.93 ng/g cholesterol) was statistically different from welders(4.25 ng/g cholesterol) and office workers(4.28 ng/g cholesterol). Neither age nor smoking was related to SOD or MDA level. Blood lead was significantly correlated with erythrocyte SOD activity(r=0.405), plasma MDA(r=0.296) and alpha-tocopherol(r=0.207). Plasma MDA was also significantly correlated with SOD (r=0.217). In multiple regression analysis, the change of MDA and SOD activity level related to the blood lead concentration. These results suggested that the increase of plasma MDA and erythrocyte SOD activity in lead-exposed workers had a close relationship with the oxidative stress induced by lead.; Summary

Blood Lead Levels of Children in Ulsan Industrial Area.: Cheol In Yoo, Ji Ho Lee, Choong Ryeol Lee, Sung Ryul Kim, Seon Ho Lee; Korean J Prev Med. 1998;31(2):240-248.

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Abstract PDF: We conducted this study, to obtain basic data of lead concentrations in children of Ulsan industrial area and to evaluate the difference in blood lead levels between industrial area and suburban area. The study subjects were composed of 348 school children residing in industrial area and 100 school children of suburban area. There is no difference in age and sex distribution of study participants between industrial and suburban area. The obtained results were as follows: l. The geometric means of blood lead levels of study participants were 4.90 ng/dl, which is lower than current acceptable value 10 ng/dl. 2. The children residing in industrial area had the higher blood lead levels(5.26 ng/dl) than suburban children(3.81 ng/dl) with statistical significance(P<0.001).; Summary

The change of validity of blood zinc protoporphyrin test by different cut-off level in level workers.: Yong Bae Kim, Hyun Cheol Ahn, Young Hwangbo, Gap Soo Lee, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee; Korean J Prev Med. 1997;30(4):741-751.

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Abstract PDF: Measurement of blood lead (PbB) and blood zinc protoporphyrin (ZPP) are most common biological indices to identify the individual at risk for excess or the health sequences by lead exposure. Because PbB is known most important and reliable index of lead exposure, PbB is often regarded as a gold standard to detect lead exposure. But in Korea PbB is a secondary test item of detailed health check-up with positive finding of screening test in most occasion. Our lead standard requires all lead workers to take annual heath-check twice a year for investigation of their health effect due to lead exposure. Blood ZPP is one of most important index to detect high lead absorption in lead workers as a screening test. Measurement of blood ZPP is known well to correlate with PbB in steady state of exposure in most lead workers and is often used as a primary screening test to detect high lead absorption of lead workers with the advantage of simplicity, easiness, portability and low cost. The current cut-off criteria of blood ZPP for further detailed health check-up is 100 ng/dl which is supposed to match the level of 40 ng/dl of PbB according to our standard. Authors tried to investigate the validity of current criteria of cut-off level(100 ng/dl) of blood ZPP and possible another better cut-off level of it to detect the lead workers whose PbB level over 40 ng/dl. The subjects in our study were 212 male workers in three small scale storage battery industries. Blood ZPP, PbB and hemoglobin(Hb) were selected as the indices of lead exposure. The results were as follows. 1. The mean of blood ZPP, PbB and Hb in lead workers were 79.5+/-46.7 ng/dl, 38.7+/-15.1 ng/dl, and 14.8+/-1.2 g/dl, respectively. There were significant differences in blood ZPP, PbB and Hb by industry(P<0.01). 2. The percents of lead workers whose blood ZPP were above 100 ng/dl in the group of work duration below 1, 1-4, 5-9 and above 10 years were 8.6%, 17.2%, 47.6%, and 50.0%, respectively. The percents of lead workers whose PbB were above 40 ng/dl in those were 31.4%, 40.4%, 71.4%, and 86.4%, respectively. 3. The percents of lead workers whose PbB were below 40 ng/dl, 40-59 ng/dl and above 60 ng/dl were 54.7%, 34.9% and 10.4%, respectively. Those of lead workers whose blood ZPP were below 100 ng/dl, 100-149 ng/dl and above 150 ng/dl were 79.2%, 13.7% and 7.1%, respectively. 4. Simple linear regression of PbB on blood ZPP was statistically significant(P<0.05) and as PbB was 40 ng/dl, blood ZPP was 82.1 ng/dl. 5. While the highest sensitivity and specificity of blood ZPP test to detect lead workers with PbB over 40 ng/dl were observed in the cut-off level of 50 ng/dl and 100 ng/dl of blood ZPP, respectively, the highest validity(sensitivity+specificity) of blood ZPP to detect lead workers with PbB over 40 ng/dl was observed in the cut-off level of around 70 ng/dl of blood ZPP. But even with optimal cut-off level of around 70 ng/dl of blood ZPP, still 25.0% of false negative and 20.7% false positive lead workers were found. As the result of this study, it was suggested that reconsideration of current blood ZPP cut-off of our lead standard from 100 ng/dl to somewhat lower level such as around 70 ng/dl and the inclusion of PbB measurement as a primary screening test for lead workers was highly recommended for the effective prevention of lead workers.; Summary

Exposed level of workers in the factory next to a led recycling factory.: Jin Ha Kim, Duk Hee Lee, Yong Hwan Lee; Korean J Prev Med. 1996;29(3):693-700.

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Abstract PDF: The purpose of this study was to determine whether workers at a factory next to a lead recycling factory in Pusan, were affected by lead contamination. The mean air lead concentration of lead recycling factory was 0.21mg/m3(TWA=0.05mg/m3). Thirty-nine male workers of Factory A, Cr. plating factory next to the lead recycling factory were exposed group and a comparison group, 62 male workers of Factory B were selected from another Cr. plating factory about 8.5km away from lead recycling factory. Air lead concentration of each workplace was checked for 4 times from August 5 to August 20 in 1995 by low volume air sampler. Each subject was interviewed about age, life-style, smoking, work history, and residence etc, and venous blood was drawn for lead measurement by graphite furnace atomic absorption spectrometry. We have observed that air lead concentration and blood lead concentration of Factory A was higher than Factory B(2.6 +/- 1.6 Vs. 1.2 +/- 0.2 microgram/m3, 14.9 +/- 1.6 Vs. 12.2 +/- 1.6 microgram/dl). We believe that other environmental lead sources such as transportation and residence did not affect air lead and blood lead concentration differences of both factory. We concluded that high air lead and blood lead concentration of Factory A were caused by lead contamination generated by the neighboring lead recycling factory.; Summary

Blood Lead Level and Intelligence among Children.: Duk Hee Lee, Yong Hwan Lee, Jin Ha Kim, In Geun Park, Tae Young Han, She Han Jang; Korean J Prev Med. 1995;28(2):373-385.

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Abstract PDF: The association between blood lead children and Intelligent Quotient(IQ) was investigated in a sample of l00 boys and girls aged 6-8 years from one primary school within an industrial area of Pusan. The trained undergraduates in school of public health administered an I.Q. test one by one. Parents answered a questionnaire on demographic, perinatal and socioeconomic variables. Atomic Absorbtion spectrophotometer was used to determine blood lead levels. The geometric mean of blood lead value was 7.99 microgram/dl. In total children, there was no significant relationship between blood lead level and I.Q. But in the children who were born of gestational age of less than 38 weeks, children with higher levels of blood lead performed more poorly on I.Q. test with correlation coefficient from -0.68 to -0.71. But, the children who were born of gestational age of 38 weeks and more were same as total children. These results suggest that exposure to low levels of lead in the children who were born premature probably may result in impaired intelligent development. But, we think that more profound study should be performed with sufficient numbers of subjects.; Summary

The levels of blood lead and zinc protoporphyrin for healthy urban population in Korea.: Dong Il Kim, Yong Kyu Kim, Jung Man Kim, Kap Yull Jung, Joon Youn Kim; Korean J Prev Med. 1992;25(3):287-302.

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Abstract PDF: Hemoglobin(Hb), zinc protoporphyrin(ZPP) and blood lead(PbB) levels were determined for 1,851 blood samples collected from healthy urban population to establish reliable baselines for Hb, ZPP and PbB levels by age and sex. ZPP values were analyzed with a Hmatofluorometer and PbB determinations were concurrently carried out using flameless atomic absorption spectrophotometry. The blood sampling period was about 6 months from May, 1991 and the summarized results were as follows; 1. The mean value of Hb in male female were 14.55+/-1.81 g/dl and 12.61+/-1.81 g/dl respectively and there was statistically significant difference(p<0.05). 2. The mean value of ZPP in pre-schoolchildren was 37.49+/-13.31 microgram/dl for male, 35.77+/-11.85 microgram/dl for female and that of ZPP in after 7 years groups was 31.91+/-8.23 microgram/dl for male, 30.11+/-9.11 microgram/dl for female and there was statistically significant difference(p<0.05). 3. The mean value of PbB in pre-schoolchildren was 25.10+/-5.21 microgram/dl for male, 24.45+/-4.18 microgram/dl for female and that of PbB in after 7 years groups was 24.28+/-3.00 microgram/dl for male, 21.99+/-5.05 microgram/dl for female and there was statistically significant difference(p<0.05).; Summary

Relationship of between blood lead level and lead related symptoms in low level lead exposure.: Kyu Yoon Hwang, Jae Eog Ahn, Kyu Dong Ahn, Byung Kook Lee, Joung Soon Kim; Korean J Prev Med. 1991;24(2):181-194.

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Abstract PDF: This study intended to obtain an useful information on the prevalence of subjective symptoms, and to clarify the interrelationships between blood lead and lead related symptoms in low level lead exposure. The 93 male workers exposed to lead and 56 male nonexposed workers were examined for their blood lead (PBB), Zinc-protoporphy (ZPP), hemoglobin (HB) and personal history, and completed 15 questionnaires related to symptoms of lead absorption; also measured lead concentration in air (PBA) in the workplace. The results obtained were as follow; 1. The means of blood lead (PBB), blood ZPP and hemoglobin (HB) among workers exposed to lead were 26.1+/-8.8 microgram/dl, 28.3+/-26.0 microgram/dl and 16.2+/-1.2g/dl; whereas those of nonexposed workers were 18.7+/-5.1 microgram/dl, 20.6+/-8.7 microgram/dl and 17.3+/-1.1g/dl. The means of above three indicies between two groups showed significant difference statistically (p<0.05). 2. The means of blood lead (PBB), blood ZPP and hemoglobin of workers exposed to different lead concentration in air were as follows; When it was below 25 microgram/m3 , the indices were 24.7+/-79, 26.1+/-26.8 microgram/dl and 16.4+/-1.1 g/dl respectively; These indices were 27.1+/-8.5, 23.9+/-10.92 /dl and 16.2+/-1.3 g/dl when the lead concentration in air was 25~50 microgram/m3; and they were 3.4+/-9.3, 42.3+/-31.3 microgram/dl and 15.5+/-1.2 g/dl when the concentration of lead was above 50 microgram/m3. Although there were statistical difference in blood lead and hemoglobin among three different lead concentration in air, there was no statistical difference of blood ZPP among the three groups with different exposure levels (p>0.05). 3. The most frequently by complained symptom was "Generalized weakness and fatigue", and fewest symptom was "Intermittent pains in abdomen". 4. Only two symptoms out of fifteen symptoms checked by themselves revealed significant difference between exposed and nonexposed groups. These were "Intermittent pains of abdomen" and "Joint pain or arthralgia" (p<0.05). No positive correlation was found between the levels of blood lead and symptom groups categorized as gastrointestinal, neuromuscular and constitutional symptoms. 5. Blood lead (r=0.3995) and ZPP (r=0.2837) showed statistically significant correlation with mean lead concentration in air, whereas correlations were not demonstrated between blood lead and lead related symptoms or blood ZPP and lead related symptoms. 6. Blood lead (PBB) and ZPP showed association (r=0.2466) and the equation PBB=23.75+0.0842 ZPP was derived. 7. On stepwise multiple regression, using blood lead level as a dependent variable and ZPP, hemoglobin (HB), age, work duration (WD) and symptom prevalence as a independent variables, only ZPP significantly contributed a lot to blood lead level. 8. While the ZPP measurement was found to be a good indicator in evaluating health effect of lead absorption in low level lead exposure, lead related symptoms were not sensitive enough to evaluate of lead absorption in low level exposure.; Summary

Cohort Observafion of Blood Lead Concentration of Storage Battery Workers.: Chang Yoon Kim, Jung Man Kim, Gu Wung Han, Jung Han Park; Korean J Prev Med. 1990;23(3):324-337.

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Abstract PDF: To assess the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, 156 workers (116 exposed subjects and 40 controls) of a newly established battery factory were examined for their blood lead concentration (Pb-B) in every 3 months up to 18 months. Air lean concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean Pb-B of the controls was 21.97 +/- 33.6 microgram/dl at the preemployment examination and slightly increased to 22.75 +/- 3.38 microgram/dl after 6 months. Mean Pb-B of the workers who were employed before the factory was in operation (Group A) was 20.49 +/- 3.84 microgram/dl on employment and it was increased to 23.90 +/- 5.30 microgram/dl after 3 months <(P<0.01). Pb-B was increased to 28.84 +/- 5.76 microgram/dl 6 months after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 26.83 microgram/dl and 28.28 microgram/dl in the subsequent 4 tests. Mean Pb-B of the workers who were employed after the factory had been operation but before the intervention program was initiated (Group B) was 16.58 +/- 4.53 microgram/dl before the exposure and it was increased to 28.82 +/- 5.66 microgram/dl (P<0.01) in 3 months later (1 month after the intervention). The values of subsequent 4 tests remained between 26.46 and 28.54 microgram/dl. Mean Pb-B of the workers who were employed after intervention program had been started (Group C) was 19.45 +/- 3.44 microgram/dl at the preemployment examination and gradually increased to 22.70 +/- 4.55 microgram/dl after 3 months (P<0.01), 23.68 +/- 4.18 microgram/dl after 6 months, and 24.42 +/- 3.60 microgram/dl after 9 months. Work stations were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 mg/m3, and after intervention the levels were decreased to 0.216 mg/m3 and 0.208 mg/m3 in follow-up tests. The Pb-A of part II was decreased from 0.232 mg/m3 to 0.148 mg/m3, and 0.120 mg/m3 after the invention. Pb-A of part III and IV was tested only after intervention and the Pb-A of part III were 0.124 mg/m3 in January 1988 and 0.081 mg/m3 in August 1988. The Pb-A of part IV, not stationed at one place but moving around, was 0.110 mg/m3 in August 1988. There was no consistent relationship between Pb-B and Pb-A. Pb-B of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. Pb-B of the workers in the part of the lowest Pb-A increased more rapidly. Pb-B of group C workers was the highest in part I and the lowest in part IV. These findings suggest that Pb-B is more valid method than Pb-A for monitoring the health of lead workers and intervention in personal hygiene is more effective than environmental intervention.; Summary

Blood Lead Concentration of Taxi Drivers in Taegu, Korea.: Kun Sakong, Pock Soo Kang, Jong Hak Chung; Korean J Prev Med. 1990;23(3):255-261.

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Abstract PDF: Taxi drivers are exposed to vehicular exhaust aerosols which are a major source of atmospheric lead pollution in Korea where lead additives are incorporated in petrol. To investigate the blood lead concentration, their correlation factors and influences on taxi drivers, samples were collected from 90 taxi drivers who were living in the Taegu City, during August, 1989. Blood lead concentration was estimated by the atomic absoption spectrophotometer (IL.551) equipped with flameless furnace atomizer (IL.665). The results were analyzed statistically and compared with control group were 26.34 +/- 6.53 microgram/dl and 20.77 +/- 4.80 microgram/dl respectively (p<0.01). No significant correlation was observed between the blood lead concentration of taxi drivers and driver career (r=0.093). There were no difference of statistical significance in the blood lead concentration of smokers and nonsmokers.; Summary

English Abstract

Heavy Metal as Risk Factor of Cardiovascular Disease : An Analysis of Blood Lead and Urinary Mercury.: Dae Seon Kim, Eun Hee Lee, Seung Do Yu, Jung Hoon Cha, Seung Chul Ahn; J Prev Med Public Health. 2005;38(4):401-407.

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Abstract PDF: OBJECTIVES
We wanted to investigate the relationship between heavy metal, especially lead and mercury, to the blood pressure and cholesterol level in children. METHODS: This study was undertaken in three primary schools and the study subjects were a total of 274 children. The lead in the blood and the urine mercury were analyzed by performing atomic absorption spectroscopy. RESULTS: All of participants' blood lead levels and urine mercury concentrations were below the suggested level of concern according to the criteria of the CDC and ATSDR. We found no significant correlation between lead, mercury and the blood pressure. The blood lead level did not show any relationship with the blood pressure and cholesterol. However, the urine mercury levels were associated with the serum cholesterol. CONCLUSION: Our study suggests that mercury can induce an increase of cholesterol as a risk factor of myocardial infraction and coronary/cardiovascular disease.; Summary

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