This systematic review evaluates the association between lead exposure and cardiovascular endpoints in human populations. The review includes observational studies from various databases, focusing on blood pressure and clinical cardiovascular outcomes. Key findings include: 1. **Blood Pressure**: A positive association between lead exposure and blood pressure has been consistently identified in numerous studies across different settings, including prospective studies and homogeneous socioeconomic groups. The dose-response relationship is also observed, suggesting a causal link. However, the magnitude of this association may be underestimated due to measurement errors. 2. **Clinical Cardiovascular Outcomes**: Studies in general populations have found a positive association between lead exposure and clinical cardiovascular outcomes such as coronary heart disease, stroke, and peripheral arterial disease. These associations are observed at blood lead levels below 5 μg/dL, indicating that even low levels of lead exposure can have significant health impacts. 3. **Heart Rate Variability**: Some studies have reported a negative association between lead exposure and heart rate variability, suggesting potential cardiac autonomic dysfunction. However, the evidence is not sufficient to infer a causal relationship due to methodological limitations. 4. **Public Health Implications**: The review concludes that there is sufficient evidence to infer a causal relationship between lead exposure and hypertension. However, there is suggestive but insufficient evidence to infer a causal relationship with clinical cardiovascular outcomes and heart rate variability. The findings have immediate public health implications, including the need to lower occupational safety standards for blood lead and establish criteria for screening elevated lead exposure in adults. Regulatory and public health interventions are also necessary to prevent and reduce lead exposure. Overall, the review emphasizes the importance of addressing lead exposure to mitigate its adverse effects on cardiovascular health.This systematic review evaluates the association between lead exposure and cardiovascular endpoints in human populations. The review includes observational studies from various databases, focusing on blood pressure and clinical cardiovascular outcomes. Key findings include: 1. **Blood Pressure**: A positive association between lead exposure and blood pressure has been consistently identified in numerous studies across different settings, including prospective studies and homogeneous socioeconomic groups. The dose-response relationship is also observed, suggesting a causal link. However, the magnitude of this association may be underestimated due to measurement errors. 2. **Clinical Cardiovascular Outcomes**: Studies in general populations have found a positive association between lead exposure and clinical cardiovascular outcomes such as coronary heart disease, stroke, and peripheral arterial disease. These associations are observed at blood lead levels below 5 μg/dL, indicating that even low levels of lead exposure can have significant health impacts. 3. **Heart Rate Variability**: Some studies have reported a negative association between lead exposure and heart rate variability, suggesting potential cardiac autonomic dysfunction. However, the evidence is not sufficient to infer a causal relationship due to methodological limitations. 4. **Public Health Implications**: The review concludes that there is sufficient evidence to infer a causal relationship between lead exposure and hypertension. However, there is suggestive but insufficient evidence to infer a causal relationship with clinical cardiovascular outcomes and heart rate variability. The findings have immediate public health implications, including the need to lower occupational safety standards for blood lead and establish criteria for screening elevated lead exposure in adults. Regulatory and public health interventions are also necessary to prevent and reduce lead exposure. Overall, the review emphasizes the importance of addressing lead exposure to mitigate its adverse effects on cardiovascular health.