Associations of toenail arsenic, cadmium, mercury, manganese, and lead with blood pressure in the Normative aging study

Irina Mordukhovich, Robert O. Wright, Howard Hu, Chitra Amarasiriwardena, Andrea Baccarelli, Augusto Litonjua, David Sparrow, Pantel Vokonas, Joel Schwartz

Research output: Contribution to journalArticlepeer-review

109 Scopus citations


Background: Arsenic, cadmium, mercury, and lead are associated with cardiovascular disease in epidemiologic research. These associations may be mediated by direct effects of the metals on blood pressure (BP) elevation. Manganese is associated with cardiovascular dysfunction and hypotension in occupational cohorts. Objectives: We hypothesized that chronic arsenic, cadmium, mercury, and lead exposures elevate BP and that manganese lowers BP. Methods: We conducted a cross-sectional analysis of associations between toenail metals and BP among older men from the Normative Aging Study (n = 639), using linear regression and adjusting for potential confounders. Results: An interquartile range increase in toenail arsenic was associated with higher systolic BP [0.93 mmHg; 95% confidence interval (CI): 0.25, 1.62] and pulse pressure (0.76 mmHg; 95% CI: 0.22, 1.30). Positive associations between arsenic and BP and negative associations between manganese and BP were strengthened in models adjusted for other toenail metals. Conclusions: Our findings suggest associations between BP and arsenic and manganese. This may be of public health importance because of prevalence of both metal exposure and cardiovascular disease. Results should be interpreted cautiously given potential limitations of toenails as biomarkers of metal exposure.

Original languageEnglish
Pages (from-to)98-104
Number of pages7
JournalEnvironmental Health Perspectives
Issue number1
StatePublished - Jan 2012
Externally publishedYes


  • Arsenic
  • Blood pressure
  • Cadmium
  • Epidemiology
  • Lead
  • Manganese
  • Mercury
  • Metals


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