# Environmental heavy metals and risk of ischemic heart disease and stroke in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

> **NIH NIH R01** · BROWN UNIVERSITY · 2021 · $173,773

## Abstract

PROJECT SUMMARY
Environmental degradation and exposure to heavy metals (over which individuals often have little control) may
have a direct impact on cardiovascular diseases (CVD) development, which have become one of the most
pressing nemesis for individual- and population-health globally. Recent studies have provided provocative
evidence linking environmental exposure to heavy metals to increased risk of diabetes and hypertension, which
are strong CVD risk factors. In contrast, prospective cohort studies have shown that higher levels of dietary and
serum essential trace metals are directly associated with lower CVD risk and that supplementation of which may
have potential benefits by mitigating the effects of toxic metals on the cardiovascular system. However, very few
studies have directly and comprehensively investigated exposure to multiple metals particularly their joint effects
on affecting CVD risk (including stroke). The ongoing Brazilian Longitudinal Study of Adult Health (in Portuguese,
‘Estudo Longitudinal de Sau´ de do Adulto’, ELSA-Brasil), the only large prospective study established in South
America to specifically investigate risk factors for cardiometabolic health, represents a unique resource to study
the roles of multiple metal exposures and their interactions with dietary trace elements in affecting CVD risk. At
baseline, 4,428 CVD-free participants at the ELSA-Brasil site in Sao Paulo completed 1) physical examinations;
2) clinical laboratory tests; 3) in-person interviews; 4) collections of blood and urine samples; and 5) a CT
examination to quantify coronary artery calcium (CAC) score. To date, a total of 466 incident CVD (~150 stroke)
cases have been adjudicated in the ELSA-Brasil cohort in the 10-year follow up. ln the current application aims
to investigate, we will leverage these exceptional resources and the substantial investment of time and effort by
ELSA-Brasil study investigators over the past ten years to investigate, in a most cost-efficient and timely manner,
the roles of metals playing in CVD development. Specifically, the current application aims to utilize this ongoing
prospective cohort study to not only determine whether heavy metal exposures increase CAC score and CVD
risk, but also identify the optimal body levels of essential metals that could mitigate CVD risk from toxic metals.
If antagonistic effects exist and optimal body levels of essential metals that could reduce toxic metal impacts are
confirmed, this work would lead to simple, safe, readily-available, acceptable and highly-affordable nutritional
intervention for CVD prevention that will have both clinical and public health significance worldwide.

## Key facts

- **NIH application ID:** 10169446
- **Project number:** 5R01ES031391-02
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** PAULO ANDRADE LOTUFO
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $173,773
- **Award type:** 5
- **Project period:** 2020-05-21 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10169446

## Citation

> US National Institutes of Health, RePORTER application 10169446, Environmental heavy metals and risk of ischemic heart disease and stroke in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (5R01ES031391-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10169446. Licensed CC0.

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