Study for Promotion of Health in Recycling Lead (SPHERL) is a prospective 2-year follow-up study of lead workers with exposure levels varying between and within individuals. SPHERL addresses to what extent between-subject differences or within-subject changes in lead exposure may have a measurable impact on blood pressure, the cardiovascular system, renal function, the autonomic nervous system, peripheral nervous conduction velocity, and neurocognitive function. At the beginning of December 2015, 70 participants were included in the study.
Background * Whether low-level lead exposure impacts on blood pressure, regulation of the cardiovascular system, glomerular or tubular renal function, sympathetic nervous modulation, peripheral nervous conduction velocity, and neurocognitive function remains uncertain. Study Population * SPHERL will enroll 500 lead recycling workers with changing lead exposure, who will be examined at baseline (2014-2015) and followed up at annual intervals for 2 years (2016-2017). Methods * Volunteers eligible for the study are (i) new and existing hires without previous occupational lead exposure who will be performing tasks with or without occupational lead exposure and (ii) existing hires with occupational lead exposure who will be transitioning to job tasks without occupational lead exposure within the next 2 years. * Blood lead concentration will be the main biomarker of exposure. * The main outcome variables are (i) blood pressure measured conventionally and by ambulatory monitoring, and analyzed as continuous or categorical variable, both cross-sectionally and longitudinally; (ii) indexes of glomerular and tubular renal function, (iii) heart rate variability analyzed in the frequency domain as measure of autonomous sympathetic modulation, (iv) peripheral nerve conductivity, (v) neurocognitive performance, (vi) and quality of life \[the EuroQOL five dimensions (EQ-5D) questionnaire\]. Expected Outcomes * Assuming a 4-fold or higher surge in the blood lead concentration, the study is powered to demonstrate over 2 years an acceleration in the age-related rise of systolic blood pressure by 1 to 4 mm Hg or an increase of the coefficient of multiple determination (R2) from 0.22 to 0.24 by adding the change in the blood lead concentration to models relating changes in blood pressure to three other covariables. The longitudinal design of our study complies with the temporality principle of the Bradford-Hill criteria for assessing possible causality between outcomes and exposure.
Study Type
OBSERVATIONAL
Enrollment
270
University of Leuven
Leuven, Belgium
Annual change in systolic blood pressure as measured by 24-h ambulatory monitoring
Time frame: Baseline, 1 year and 2 years
Annual change in central hemodynamics
Annual changes in the central hemodynamics, including aortic blood pressure, the central systolic augmentation index, and aortic pulse wave velocity
Time frame: Baseline, 1 year and 2 years
Annual change in heart function
Annual changes in ECG-derived indexes
Time frame: Baseline, 1 year and 2 years
Annual change in renal function
Annual changes in glomerular and tubular renal function measured on a continuous scale and the incidence of renal dysfunction
Time frame: Baseline, 1 year and 2 years
Annual change in autonomic nervous function
Annual changes in alterations in the autonomic nervous cardiovascular modulation, as assessed by heart rate variability
Time frame: Baseline, 1 year and 2 years
Annual change in peripheral nervous conduction velocity
Annual changes in nerve conduction velocity
Time frame: Baseline, 1 year and 2 years
Annual change in neurocognitive performance
Annual changes in neurocognitive testing
Time frame: Baseline, 1 year and 2 years
Annual change in quality of life
Annual changes in self-assessed quality of life
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Time frame: Baseline, 1 year and 2 years