The results from a prospective cohort study showed that higher concentrations of blood lead in older women increases the risk for death, especially from coronary heart disease (CHD). The authors observed the associations between lead and mortality previously in both occupational and community-based cohorts. Dr. Khalil and her team evaluated a cohort of 533 women aged 65 to 87 years (mean age, 72.5 ± 4.4 years; range, 68 – 89 years) who were enrolled in the Study of Osteoporotic Fractures at research centers in Baltimore, Maryland, and Monongahela Valley, Pennsylvania, from 1986 to 1988 and were followed up for more than 12 years. Blood lead concentrations were determined by atomic absorption spectrometry and categorized as either less than 8 µg/dL or 8 µg/dL or higher (0.384 µmol/L for both). Relative risk for all-cause and cause-specific mortality were determined through Cox proportional hazards regression analysis. Also, each participant completed a baseline questionnaire about education, smoking and/or alcohol use, walking for disease, diabetes, hypertension, and current estrogen use. Deaths were confirmed by death certificates, and hospital discharge summaries were obtained for 41 patients who died (33%). Study results showed that those with blood lead concentrations higher than 8 µg/dL had an increased risk for mortality and were 3 times more likely to die from CHD compared with participants who had blood lead concentrations lower than 8 µg/dL. The mean blood lead concentration of the women studied was 5.3 ± 2.3 µg/dL (range, 1 – 21 µg/dL). After 12.0 ± 3 years of greater than 95% complete follow-up, a total of 123 participants (23%) died. These women had a 7% higher mean (± standard deviation) blood lead concentration at 5.56 ± 3 µg/dL (0.27 ± 0.14 µmol/L) than survivors at 5.17 ± 2.0 µg/dL (0.25 ± 0.1 µmol/L; P = .09). In addition, those with blood lead concentrations of 8 µg/dL or higher had a 59% increased risk for multivariate adjusted all-cause mortality (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.02 – 2.49; P = .041) and a 3-fold higher risk for CHD mortality (HR, 3.08; 95% CI, 1.23 – 7.70; P = .016) compared with women with blood lead concentrations lower than 8 µg/dL. Compared with the survivors, women who died were older, more likely to smoke, and had hypertension. A lower proportion of women who died had reported walking for exercise. Participants with lead concentration of 8 µg/dL or higher had higher alcohol intake, were likely to smoke, and had 8% lower hip bone mineral density. There was no association between blood lead level and stroke, cancer, or noncardiovascular death. Study limitations include participation being limited to white women, so the findings may not apply to nonwhite women or men. Other limitations include that the presence of co-contaminants such as cadmium, which might be associated with cardiovascular disease, were not determined; factors that differ by lead concentrations were not measured, leading to a possible confounding of the results; and that a reliance on death certificates and discharge summaries available for only 33% of the participants may have resulted in some misclassification of cause of death.