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ʻO ka lāʻau ʻawaʻawa maʻamau he kumu pilikia nui ia no ka maʻi maʻi cardiovascular i nā pākeke a me ka hōʻino ʻana o ka naʻau i nā keiki, a hiki ke hōʻeha i nā pae kepau i manaʻo ʻia he palekana. I ka makahiki 2019, ʻo ke alakaʻi alakaʻi ke kuleana no 5.5 miliona mau make mai ka maʻi cardiovascular ma ka honua holoʻokoʻa a me ka nalowale o 765 miliona mau helu IQ i nā keiki i kēlā me kēia makahiki.
Kokoke ka hoʻolaha ʻana i ke kepau ma nā wahi a pau, e like me ka pena alakaʻi, ka ʻaila hinu, kekahi mau paipu wai, nā seramika, nā mea hoʻonaninani, nā mea ʻala, a me ka hoʻoheheʻe ʻana, ka hana pākaukau a me nā ʻoihana ʻē aʻe.

He ma'i kahiko ka make kepau. Ua kākau ʻo Dioscorides, he kauka Helene a me ka lāʻau lapaʻau ma Roma kahiko, iā De
ʻO Materia Medica, ka hana koʻikoʻi ma ka lāʻau lapaʻau no nā makahiki he mau makahiki, i wehewehe i nā hōʻailona o ka make ʻana o ke kēpau ma kahi o 2,000 mau makahiki i hala. ʻO ka poʻe i loaʻa i ka lāʻau make kepau ke loaʻa i ka luhi, ke poʻo, ka huhū, ka ʻōpū o ka ʻōpū, a me ka constipation. Ke ʻoi aku ka nui o ke alakaʻi koko ma mua o 800 μg/L, hiki i ka ʻawaʻawa kepau koʻikoʻi ke hoʻoulu i ka convulsions, encephalopathy, a me ka make.
Ua ʻike ʻia ka lāʻau ʻawaʻawa maʻamau ma mua o hoʻokahi haneli i hala ma ke ʻano he kumu o ka atherosclerosis a me ka gout "lead toxic". Ma ka autopsy, 69 o 107 mau maʻi me ka gout i hoʻokomo ʻia i ke kēpau i "paʻakikī o ka pā aʻa me nā loli atheromatous." I ka makahiki 1912, William Osler (William Osler)
"ʻO ka waiʻona, ke alakaʻi, a me ka gout ke kuleana nui i ka pathogenesis o arteriosclerosis, ʻoiai ʻaʻole i hoʻomaopopo maikaʻi ʻia ke ʻano o ka hana," i kākau ai ʻo Osler. ʻO ka laina alakaʻi (kahi waiho polū maikaʻi o ke kēpau sulfide ma ka ʻaoʻao o nā ʻāʻī) he ʻano ia o ka make ʻana o ke kēpau mau i nā pākeke.
I ka makahiki 1924, ua pāpā ʻo New Jersey, Philadelphia a me New York City i ke kūʻai ʻana i ka ʻaila poʻi ma hope o ka 80 pakeneka o nā limahana e hana ana i ke kēpau tetraethyl ma Standard Oil ma New Jersey i ʻike ʻia ua loaʻa i ka make kepau, a ua make kekahi o lākou. Ma ka lā 20 o Mei, 1925, ua hōʻuluʻulu ʻo Hugh Cumming, ke kauka lapaʻau nui o ʻAmelika Hui Pū ʻIa, i nā ʻepekema a me nā ʻelele ʻoihana e hoʻoholo inā he palekana ke hoʻohui i ka tetraethyl lead i ka ʻaila. Ua ʻōlelo ʻo Yandell Henderson, he physiologist a loea i ke kaua kemika, "ʻo ka hoʻohui ʻana o ke kēpau tetraethyl e hōʻike mālie i kahi heluna nui e alakaʻi i ka ʻona a me ka paʻakikī o nā aʻa". Manaʻo ʻo Robert Kehoe, ka luna lapaʻau nui o Ethyl Corporation, ʻaʻole pono nā keʻena aupuni e pāpā i ke alakaʻi tetraethyl mai nā kaʻa a hiki i ka wā i hōʻike ʻia ai ka ʻona. "ʻAʻole ʻo ka nīnau inā he pōʻino ke kēpau, akā inā he pōʻino ke kumu o ke kēpau," wahi a Kehoe.
ʻOiai ke hoʻomau nei ka ʻeli ʻana i ke kēpau no 6,000 mau makahiki, ua hoʻonui nui ʻia ka hana alakaʻi i ke kenekulia 20. ʻO ke kēpau he metala malleable a lōʻihi hoʻi i hoʻohana ʻia no ka pale ʻana i ka wahie mai ke ahi wikiwiki loa, e hoʻemi i ka "engine knock" i loko o nā kaʻa, ka lawe ʻana i ka wai inu, hoʻopaʻa i nā kini meaʻai, e hoʻolohilohi lōʻihi ka pena a pepehi i nā inike. ʻO ka mea pōʻino, ʻo ka hapa nui o ke kēpau i hoʻohana ʻia no kēia mau hana e pau i loko o ke kino o nā kānaka. Ma ka piko o ka ma'i make make kepau ma United States, ua ho'opa'a 'ia he mau haneli keiki i ka halema'i i kēlā me kēia kauwela no ke alaka'i encephalopathy, a he hapahā o lākou i make.
ʻIke ʻia nā kānaka i kēia manawa i ke alakaʻi ma nā pae ma mua o nā pae kūlohelohe. I ka makahiki 1960, ka mea geochemist ʻo Clair Patterson, nāna i hoʻohana i nā isotopes alakaʻi e koho i ka makahiki o ka Honua ma 4.5 biliona makahiki.
Ua ʻike ʻo Patterson i ka ʻeli ʻana, ka hoʻoheheʻe ʻana a me ka hoʻokuʻu ʻana o ke kaʻa i hopena i ka waiho ʻana o ke alakaʻi i ka lewa he 1,000 mau manawa ʻoi aku ka kiʻekiʻe ma mua o nā pae kūlohelohe maoli i nā laʻana kumu glacier. Ua ʻike pū ʻo Patterson he 1,000 mau manawa kiʻekiʻe ke kiʻekiʻe o ke kēpau i loko o nā iwi o nā kānaka ma nā ʻāina ʻoihana.
Ua hōʻemi ʻia ka hōʻike alakaʻi ma mua o 95% mai ka makahiki 1970, akā ke lawe mau nei ka hanauna i kēia manawa he 10-100 mau manawa ʻoi aku ka nui o ke alakaʻi ma mua o ka poʻe e noho ana i ka wā ma mua o ka ʻoihana.
Me nā ʻokoʻa liʻiliʻi, e like me ke alakaʻi i ka wahie mokulele a me nā pahu a me nā pākiʻi lead-acid no nā kaʻa kaʻa, ʻaʻole hoʻohana hou ʻia ke kēpau ma ʻAmelika Hui Pū ʻIa a me ʻEulopa. Manaʻo nā kauka he nui ka pilikia o ka lāʻau make kepau. Eia nō naʻe, ʻo ka pena kēpau ma nā hale kahiko, ka ʻaila kepau i waiho ʻia i loko o ka lepo, ke kēpau i hoʻoheheʻe ʻia mai nā paipu wai, a me nā hoʻokuʻu ʻana mai nā mea kanu ʻoihana a me nā mea puhi ahi ke kōkua pū i ka ʻike alakaʻi. I nā ʻāina he nui, hoʻokuʻu ʻia ke kēpau mai ka hoʻoheheʻe ʻana, ka hana pākaukau a me ka e-waste, a loaʻa pinepine ʻia i loko o nā pena, nā seramika, nā mea hoʻonaninani a me nā mea ʻala. Ua hōʻoia ʻia ka noiʻi ʻana ʻo ka ʻawaʻawa haʻahaʻa haʻahaʻa haʻahaʻa he kumu pilikia ia no ka maʻi cardiovascular ma nā pākeke a me ka hōʻino ʻana o ka naʻau i nā keiki, ʻoiai ma nā pae i manaʻo ʻia he palekana a ʻaʻole pōʻino paha. E hōʻuluʻulu kēia ʻatikala i nā hopena o ka lāʻau ʻawaʻawa haʻahaʻa haʻahaʻa

Hōʻike, absorption a me ka ukana i loko
ʻO ka ʻai ʻana a me ka inhalation ke ala nui o ka hoʻolaha ʻana i ke kēpau. Hiki i nā kamaliʻi me ka ulu wikiwiki a me ka ulu ʻana ke komo maʻalahi i ke kēpau, a ʻo ka nele o ka hao a i ʻole ka calcium hiki ke hoʻoikaika i ka absorption kepau. Komo ke alakaʻi i ka calcium, hao, a me ka zinc i loko o ke keena ma o nā kahawai calcium a me nā mea lawe metala e like me ka mea lawe metala divalent 1[DMT1]. ʻO ka poʻe me nā polymorphism genetic e hāpai ana i ka hao a i ʻole ka calcium absorption, e like me nā mea e hoʻoulu ai i ka hemochromatosis, ua hoʻonui i ka absorption lead.
I ka wā e komo ai, mālama ʻia ka 95% o ke koena kepau i loko o ke kino o ke kanaka makua i loko o nā iwi; 70% o ke koena kepau i loko o ke kino o ke keiki aia i loko o ka iwi. Ma kahi o 1% o ka nui o ka ukana kepau i loko o ke kino o ke kanaka e holo i loko o ke koko. ʻO 99% o ke alakaʻi i loko o ke koko aia i loko o ke koko ʻulaʻula. ʻO ka hoʻopaʻa ʻana o ke alakaʻi koko holoʻokoʻa (ke kēpau hou a me ke alakaʻi hou ʻia mai ka iwi) ʻo ia ka biomarker i hoʻohana nui ʻia o ka pae ʻike. ʻO nā mea e hoʻololi ai i ka metabolism o ka iwi, e like me ka menopause a me ka hyperthyroidism, hiki ke hoʻokuʻu i ke kēpau i hoʻopaʻa ʻia i loko o nā iwi, e hoʻonui ai i ke kiʻekiʻe o ke koko.
I ka makahiki 1975, i ka wā i hoʻohui ʻia ai ke kēpau i ka ʻaila, ua alakaʻi ʻo Pat Barry i kahi noiʻi autopsy o 129 poʻe Pelekania a hoʻohālikelike i kā lākou ukana a pau. ʻO ka awelika o ka ukana ma ke kino o ke kanaka he 165 mg, e like me ke kaumaha o kahi pahu pepa. ʻO 566 mg ka ukana kino o nā kāne me ka lāʻau make kepau, ʻekolu wale nō manawa o ka haʻawe awelika o ka hāpana kāne holoʻokoʻa. I ka hoʻohālikelike ʻana, ʻo ka nui o ka ukana ma ke kino o ka wahine he 104 mg. I nā kāne a me nā wahine, ʻoi aku ka kiʻekiʻe o ke alakaʻi i loko o ka ʻiʻo palupalu i loko o ka aorta, aʻo nā kāne ke kiʻekiʻe aʻe i nā pā atherosclerotic.
Ke piʻi aʻe nei kekahi mau heluna kanaka i ka make kepau ke hoʻohālikelike ʻia me ka heluna kanaka. ʻOi aku ka pilikia o nā pēpē a me nā keiki liʻiliʻi i ka ʻai ʻana i ke kēpau ma muli o kā lākou ʻai ʻole ʻana i ka waha, a ʻoi aku ka nui o lākou e komo i ke kēpau ma mua o nā keiki nui a me nā pākeke. ʻO nā keiki liʻiliʻi e noho ana i nā hale mālama maikaʻi ʻole ʻia i kūkulu ʻia ma mua o ka makahiki 1960, ua pilikia lākou i ka make kepau mai ka ʻai ʻana i nā ʻāpana pena a me ka lepo o ka hale i hoʻopaʻa ʻia. ʻO ka poʻe e inu ana i ka wai paipu mai nā paipu i hoʻopaʻa ʻia i ke kēpau a i ʻole e noho kokoke ana i nā mokulele a i ʻole nā ​​wahi ʻē aʻe i hoʻopaʻa ʻia i ke kēpau, ʻoi aku ka nui o ka pilikia o ka hoʻomohala ʻana i ka lāʻau ʻawaʻawa haʻahaʻa. Ma ʻAmelika Hui Pū ʻIa, ʻoi aku ka kiʻekiʻe o ke alakaʻi i ka lewa ma nā kaiāulu kaʻawale ma mua o nā kaiāulu i hoʻohui ʻia. ʻO ka poʻe hana i ka hoʻoheheʻe ʻana, ka hana ʻana i ka pākaukau a me nā ʻoihana kūkulu, a me ka poʻe e hoʻohana ana i nā pū ahi a i ʻole nā ​​ʻāpana pōkā i loko o ko lākou kino, ke piʻi nui nei ka pilikia o ka make kepau.
ʻO ke alakaʻi ke kemika mua loa i ana ʻia ma ka National Health and Nutrition Examination Survey (NHANES). I ka hoʻomaka ʻana o ka haʻalele ʻana o ka ʻaila alakaʻi, ua hāʻule ka pae koko kepau mai 150 μg/L i ka makahiki 1976 a i ka 90 i ka makahiki 1980.
μg/L, he helu hōʻailona. Ua hoʻohaʻahaʻa pinepine ʻia nā pae kepau koko i manaʻo ʻia he pōʻino. I ka makahiki 2012, ua hoʻolaha nā Centers for Disease Control and Prevention (CDC) ʻaʻole i hoʻoholo ʻia kahi pae palekana o ke alakaʻi i loko o ke koko o nā keiki. Ua hoʻohaʻahaʻa ka CDC i ka maʻamau no ke kiʻekiʻe o ke kēpau koko i nā keiki - hoʻohana pinepine ʻia e hōʻike i nā hana e hōʻemi ai i ka hoʻolaha ʻana o ke kepau - mai 100 μg/L a i 50 μg/L i ka makahiki 2012, a i 35 μg/L i ka makahiki 2021. μg/dL, e hōʻike ana i ka hōʻike nui o ka ʻawaʻawa alakaʻi ma nā pae haʻahaʻa.

ʻO ka make, ka maʻi a me ke kīnā
"He mea make ke alakaʻi ma nā wahi a pau, a aia ke alakaʻi ma nā wahi a pau," i kākau ai ʻo Paul Mushak lāua ʻo Annemarie F. Crocetti, nā lālā ʻelua o ka National Board of Air Quality i koho ʻia e Pelekikena Jimmy Carter, i loko o kahi hōʻike i ka ʻaha kūkā ma 1988. ʻO ka hiki ke ana i ke kiʻekiʻe o ke kēpau i loko o ke koko, nā niho a me nā iwi e hōʻike ana i nā pilikia olakino e pili ana i ka maʻi poʻo haʻahaʻa haʻahaʻa i ke kino kanaka. ʻO nā haʻahaʻa haʻahaʻa o ka lāʻau ʻawaʻawa he kumu pilikia no ka hānau mua ʻana, a me ka hōʻino o ka naʻau a me ka nānā ʻana i ka hyperactivity disorder (ADHD), ka hoʻonui ʻana i ke koko a me ka emi ʻana o ka loli o ka puʻuwai i nā keiki. I ka poʻe mākua, ʻo nā haʻahaʻa haʻahaʻa o ka lāʻau ʻawaʻawa he kumu pilikia ia no ka hōʻino ʻole ʻana o ka maʻi maʻi, hypertension a me ka maʻi cardiovascular

Ka ulu a me ka neurodevelopment
I ka nui o ke kēpau i loa'a ma'amau i nā wāhine hāpai, he mea pilikia ka ho'olaha kepau no ka hānau mua. I loko o kahi hui hānau hānau Kanada, ua hoʻonui ʻia ka piʻi ʻana o 10 μg/L i nā pae alakaʻi koko makuahine me ka 70% piʻi nui o ka hānau mua ʻana. No nā wāhine hāpai me nā kiʻekiʻe o ka vitamina D ma lalo o 50 mmol/L a ua hoʻonui ʻia ke kiʻekiʻe o ke alakaʻi koko e 10 μg/L, ua piʻi ka pilikia o ka hānau mua ʻana i ʻekolu manawa.
Ma kahi noiʻi ʻāina mua o nā keiki me nā hōʻailona lapaʻau o ka lāʻau make, ʻo Needleman et al. Ua ʻike ʻia ʻo nā keiki me nā pae kiʻekiʻe o ke alakaʻi e ulu aʻe i nā hemahema neuropsychological ma mua o nā keiki me nā pae haʻahaʻa o ke alakaʻi, A ua helu ʻia lākou he ʻilihune e nā kumu ma nā wahi e like me ka distraction, nā mākau hoʻonohonoho, impulsivity a me nā ʻano ʻano ʻē aʻe. He ʻumi mau makahiki ma hope mai, ʻo nā keiki i loko o ka hui me nā pae kiʻekiʻe o ke poʻo dentin he 5.8 mau manawa i loaʻa i ka dyslexia a me 7.4 mau manawa e haʻalele i ke kula ma mua o nā keiki o ka hui me nā pae alakaʻi haʻahaʻa.
ʻOi aku ka nui o ka ratio o ka emi ʻana o ka naʻau i ka piʻi ʻana o nā pae alakaʻi i nā keiki me nā pae alakaʻi haʻahaʻa. I loko o kahi hōʻuluʻulu hōʻuluʻulu ʻana o ʻehiku cohorts prospective, ua pili ka piʻi ʻana o nā pae kepau koko mai 10 μg/L a i 300 μg/L me ka emi ʻana o 9-point i ka IQ o nā keiki, akā ʻo ka emi nui loa (he emi ʻana he 6-point) i ka wā i hoʻonui mua ʻia ke kiʻekiʻe o ke alakaʻi koko e 100 μg/L. Ua like nā ʻōkuhi pane no ka emi ʻana o ka cognitive e pili ana i ke ana ʻana i nā pae kepau i ka iwi a me ka plasma.

ʻO ka hōʻike alakaʻi he kumu pilikia ia no nā maʻi kūlohelohe e like me ADHD. Ma ka noiʻi ʻana o nā keiki mai ka makahiki 8 a hiki i ka 15, ʻoi aku ka nui o ka ADHD ma mua o ka 13 μg/L, ʻoi aku ka nui o ka loaʻa ʻana o ka ADHD ma mua o ka poʻe me nā pae kepau koko i ka quintile haʻahaʻa. I kēia mau keiki, ma kahi o 1 i loko o 5 mau hihia o ADHD hiki ke hoʻopili ʻia i ka ʻike alakaʻi.

ʻO ka hoʻolaha ʻana i ke alakaʻi kamaliʻi he kumu pilikia ia no ka ʻano antisocial, me ka ʻano e pili ana i ka maʻi ʻino, delinquency, a me ka hana hewa. I loko o ka meta-analysis o 16 mau haʻawina, ua pili mau ke kiʻekiʻe o ke alakaʻi koko me ka maʻi ʻino i nā keiki. I loko o ʻelua mau noiʻi cohort, ʻoi aku ka nui o ke alakaʻi koko a i ʻole nā ​​pae dentin lead i ka wā kamaliʻi i pili me ka piʻi ʻana o ka delinquency a me ka hopu ʻana i ka wā ʻōpio.
ʻO ka hoʻonui ʻia ʻana o ke alakaʻi i ka wā kamaliʻi ua pili pū me ka emi ʻana o ka nui o ka lolo (ma muli paha o ka emi ʻana o ka nui o nā neurons a me nā lālā dendrite), a ua hoʻomau ʻia ka nui o ka lolo i ka wā makua. I loko o kahi noiʻi i hoʻokomo ʻia i ka poʻe ʻelemakule, ʻoi aku ka nui o ke koko kiʻekiʻe a i ʻole ka iwi kepau i pili i ka emi ʻana o ka naʻau, ʻoi aku ka poʻe i lawe i ka APOE4 allele. He kumu pilikia paha ka hoʻomaka ʻana o ke alakaʻi ʻana i ka wā kamaliʻi no ka hoʻomohala ʻana i ka maʻi o Alzheimer, akā ʻaʻole maopopo ka hōʻike.

Nephropathy
ʻO ka hoʻolaha ʻana i ke alakaʻi he kumu pilikia ia no ka hoʻomohala ʻana i ka maʻi maʻi maʻi maʻi. Hōʻike ʻia nā hopena nephrotoxic o ke kēpau i loko o nā kino hoʻokomo intranuclear o nā tubules renal proximal, tubule interstitial fibrosis a me ka hana ʻole o ka renal mau loa. Ma waena o ka poʻe i komo i ka noiʻi NHANES ma waena o 1999 a me 2006, ʻo ka poʻe mākua me ke kiʻekiʻe o ke alakaʻi koko ma luna o 24 μg/L he 56% ka nui o ka hoʻemi ʻana o ka glomerular filtration rate (<60 mL/[min · 1.73 m2]) ma mua o ka poʻe me nā pae koko alakaʻi ma lalo o 11 μg/L. I loko o kahi noiʻi cohort, ʻoi aku ka nui o ka poʻe me ke kiʻekiʻe o ke alakaʻi koko ma luna o 33 μg/L he 49 ka nui o ka pilikia o ka hoʻomohala ʻana i ka maʻi maʻi maʻi maʻi ma mua o ka poʻe me nā pae alakaʻi koko haʻahaʻa.

ʻO ka maʻi cardiovascular
ʻO nā hoʻololi kelepona i hoʻokomo ʻia i ke alakaʻi he ʻano o ke koko kiʻekiʻe a me ke atherosclerosis. I loko o nā noiʻi hoʻokolohua, hoʻonui nā pae haʻahaʻa haʻahaʻa o ke alakaʻi i ke koʻikoʻi oxidative, hoʻemi i nā pae o ka bioactive nitric oxide, a hoʻoulu i ka vasoconstriction ma ka hoʻoulu ʻana i ka protein kinase C, e alakaʻi ana i ka hypertension mau. Hoʻopau ke alakaʻi i ka nitric oxide, hoʻonui i ka hoʻokumu ʻana o ka hydrogen peroxide, keʻakeʻa i ka hoʻoponopono endothelial, hoʻopilikia i ka angiogenesis, hoʻoikaika i ka thrombosis, a alakaʻi i ke atherosclerosis (Figure 2).
Ua hōʻike ʻia kahi haʻawina in vitro i ka moʻomeheu endothelial i loko o kahi kaiapuni me ka nui o ke alakaʻi o 0.14 a i ka 8.2 μg/L no 72 mau hola i hōʻino ʻia ka membrane cell (nā waimaka liʻiliʻi a i ʻole nā ​​perforations i ʻike ʻia e ka scanning electron microscopy). Hāʻawi kēia haʻawina i nā hōʻike ultrastructural ʻo ke alakaʻi hou a i ʻole ke alakaʻi i ke komo hou ʻana i ke koko mai ka iwi mai ke kumu o ka endothelial dysfunction, ʻo ia ka loli mua loa i ʻike ʻia i ka mōʻaukala kūlohelohe o nā maʻi atherosclerotic. I loko o kahi hōʻuluʻulu cross-sectional o kahi hōʻailona hōʻailona o nā pākeke me ka pae koko awelika o 27 μg/L a ʻaʻohe mōʻaukala o ka maʻi cardiovascular, piʻi ke kiʻekiʻe o ke alakaʻi koko e 10%
Ma μg, ʻo ka lakiō o ke ʻano no ka hoʻokaʻawale ʻana i ke aʻa coronary koʻikoʻi (ʻo ia hoʻi, ka helu Agatston> 400 me ka helu helu o 0 [0 e hōʻike ana ʻaʻole calcification] a me nā helu kiʻekiʻe e hōʻike ana i ka nui o ka calcification range) ʻo 1.24 (95% ka manawa hilinaʻi 1.01 a 1.53).
ʻO ka hoʻolaha ʻana i ke alakaʻi he kumu pilikia nui ia no ka make mai ka maʻi cardiovascular. Ma waena o 1988 a me 1994, 14,000 ʻAmelika kanaka makua i komo i ka NHANES survey a hahai ʻia no 19 mau makahiki, a he 4,422 o lākou i make. Hoʻokahi o ʻelima mau kānaka make i ka maʻi naʻau. Ma hope o ka hoʻoponopono ʻana i nā mea pilikia ʻē aʻe, ʻo ka hoʻonui ʻana i ke kiʻekiʻe o ke koko mai ka 10th percentile a hiki i ka 90th percentile ua pili pū me ka pālua o ka make ʻana mai ka maʻi naʻau coronary. Piʻi nui ka pilikia o ka maʻi maʻi maʻi puʻuwai a me ka maʻi puʻuwai coronary i ka wā i emi ai ke kiʻekiʻe o ke kēpau ma lalo o 50 μg/L, me ka ʻole o ka paepae maopopo (Nā Kiʻi 3B a me 3C). Manaʻo nā kānaka noiʻi he hapaha miliona o ka make ʻana o ka maʻi cardiovascular i kēlā me kēia makahiki ma muli o ka maʻi ʻawaʻawa haʻahaʻa haʻahaʻa. ʻO kēia mau mea, he 185,000 i make i ka maʻi puʻuwai coronary.
ʻO ka hoʻolaha ʻana i ke alakaʻi kekahi o nā kumu i piʻi mua ai ka make ʻana o ka maʻi naʻau coronary a hāʻule i ke kenekulia i hala. Ma ʻAmelika Hui Pū ʻIa, ua piʻi nui ka make ʻana o ka maʻi naʻau coronary i ka hapa mua o ke kenekulia 20, a piʻi nui i ka makahiki 1968, a laila e emi mau ana. Aia i kēia manawa he 70 pākēneka ma lalo o kona piko 1968. Hoʻopili ʻia ka hoʻolaha ʻana i ke alakaʻi i ka ʻaila i alakaʻi ʻia me ka emi ʻana o ka make mai ka maʻi naʻau coronary (Figure 4). Ma waena o ka poʻe i komo i ka noiʻi NHANES, i ukali ʻia a hiki i ʻewalu mau makahiki ma waena o 1988-1994 a me 1999-2004, 25% o ka hōʻemi ʻana i ka maʻi maʻi coronary ma muli o ka emi ʻana o ke kiʻekiʻe o ke alakaʻi koko.

I nā makahiki mua o ka hoʻopau ʻana i ka ʻaila hoʻokele, ua hāʻule nui ka nui o ke koko kiʻekiʻe ma ʻAmelika Hui Pū ʻIa. Ma waena o 1976 a me 1980, 32 pakeneka o ka poʻe mākua ʻAmelika i loaʻa i ke koko kiʻekiʻe. I ka makahiki 1988-1992, he 20% wale nō. ʻO nā kumu maʻamau (ka paka, nā lāʻau no ke koko, ka momona, a me ka nui nui o ka cuff i hoʻohana ʻia no ke ana ʻana i ke koko i loko o ka poʻe momona) ʻaʻole wehewehe i ka hāʻule o ke koko. Eia naʻe, ua hāʻule ka pae koko median ma ʻAmelika Hui Pū ʻIa mai 130 μg/L i ka makahiki 1976 a i 30 μg/L i ka makahiki 1994, e hōʻike ana ʻo ka emi ʻana o ka hoʻolaha ʻana i ke alakaʻi kekahi kumu o ka hāʻule ʻana o ke koko. Ma ka Strong Heart Family Study, i komo pū me kahi hui ʻAmelika ʻAmelika, ua hoʻemi ʻia ke kiʻekiʻe o ke alakaʻi koko e ≥9 μg/L a ua hoʻemi ʻia ke koko systolic e ka awelika o 7.1 mm Hg (waiwai hoʻololi).
Nui nā nīnau i pane ʻole ʻia e pili ana i ka hopena o ka hoʻolaha ʻana i ke alakaʻi i ka maʻi cardiovascular. ʻAʻole maopopo ka lōʻihi o ka hoʻolaha ʻana i mea e hoʻoulu ai i ka hypertension a i ʻole ka maʻi cardiovascular, akā ʻike ʻia ka loaʻa ʻana o ke alakaʻi kumulative lōʻihi i ana ʻia i loko o ka iwi e ʻoi aku ka ikaika o ka mana wānana ma mua o ka wā pōkole i ana ʻia i ke koko. Eia naʻe, ʻo ka hōʻemi ʻana i ka hoʻolaha ʻana i ke kepau e hōʻemi ana i ke koko a me ka pilikia o ka make mai ka maʻi cardiovascular i loko o 1 a 2 mau makahiki. Hoʻokahi makahiki ma hope o ka pāpā ʻana i ka wahie alakaʻi mai ka heihei NASCAR, ʻoi aku ka haʻahaʻa o nā kaiāulu kokoke i ke alahele i ka make ʻana o ka maʻi maʻi coronary i hoʻohālikelike ʻia me nā kaiāulu peripheral. ʻO ka mea hope loa, pono e aʻo i nā hopena cardiovascular lōʻihi i ka poʻe i ʻike ʻia i nā pae alakaʻi ma lalo o 10 μg/L.
ʻO ka emi ʻana o ka ʻike ʻana i nā kemika ʻona ʻē aʻe i kōkua pū i ka emi ʻana o ka maʻi naʻau coronary. ʻO ka hoʻopau ʻana i ka ʻaila ʻaila alakaʻi mai ka makahiki 1980 a hiki i ka makahiki 2000, ua hoʻemi ʻia nā mea ʻala ma 51 mau wahi metropolitan, e hopena i ka piʻi ʻana o 15 pakeneka o ka manaʻolana o ke ola. Kakaikahi ka poe puhi paka. I ka makahiki 1970, ma kahi o 37 ka nui o nā poʻe mākua ʻAmelika i puhi i ka uahi; I ka makahiki 1990, he 25 pakeneka wale nō o nā ʻAmelika i puhi. ʻOi aku ka kiʻekiʻe o ke kēpau koko ma mua o ka poʻe puhi paka. He mea paʻakikī ke hoʻohenehene i nā hopena o ka mōʻaukala a me nā hopena o kēia manawa o ka haumia ea, ka uahi paka a me ke alakaʻi i ka maʻi naʻau coronary.
ʻO ka maʻi naʻau coronary ke kumu nui o ka make ma ka honua holoʻokoʻa. Ua hōʻike ʻia ma mua o ʻumikūmālua mau haʻawina ʻo ka hoʻolaha ʻana i ke alakaʻi he mea koʻikoʻi a nānā ʻole ʻia no ka make mai ka maʻi naʻau coronary. I loko o ka meta-analysis, ua ʻike ʻo Chowdhury et al ʻo ke kiʻekiʻe o ke alakaʻi koko he mea koʻikoʻi koʻikoʻi no ka maʻi naʻau coronary. I loko o ʻewalu mau noiʻi (me ka huina o 91,779 i komo), ʻo ka poʻe me ke koko alakaʻi i loko o ka quintile kiʻekiʻe loa he 85% kiʻekiʻe o ka make ʻole o ka myocardial infarction, bypass surgery, a i ʻole ka make mai ka maʻi naʻau coronary ma mua o ka poʻe i ka quintile haʻahaʻa. I ka makahiki 2013, ka Environment Protection Agency (EPA)
Ua hoʻoholo ka 'Oihana Hoʻomalu i ka hoʻolaha ʻana i ke alakaʻi i mea pilikia no ka maʻi naʻau coronary; He ʻumi makahiki ma hope mai, ua ʻae ka American Heart Association i kēlā hopena.