Associations of heavy metal mixtures with blood pressure among U.S.adults in NHANES 2017-2018 by four statistical modelsOACSTPCDMEDLINE

To the Editor:Hypertension is one of the leading risk factors for cardiovascular disease and affects approximately 30%of the adult population.^([1,2])Environmental heavy metal pollution is an important public health concern.Toxic metals may increase the risk of hypertension or other cardiovascular diseases,even beyond the influence of conventional behavioral risk factors.^([3])Meanwhile certain essential trace elements,such as selenium,zinc,and iron,are involved in various enzyme reactions directly related to blood pressure regulation and are beneficial to the human body within a specific range.^([4])The analysis of health outcomes specific to metal mixtures is challenging by nonlinear relationships and interactions between toxic metals and essential trace elements.^([5])The development of innovative statistical methods for analyzing mixtures has greatly facilitated the exploration of the health effects of multiple pollutant exposures,such as Bayesian kernel machine regression(BKMR)and quantile g-computation(QG-C).