Their model estimates that 5.5 million adults died from heart disease in 2019 because of lead exposure, 90 percent of them in low- and middle-income countries. It would mean that lead exposure is a bigger cause of heart disease than smoking or cholesterol, Larsen said. The World Bank researchers put the economic cost of lead exposure at $6 trillion in 2019, equivalent to seven percent of global gross domestic product. For the analysis, the researchers used estimates of blood lead levels in 183 countries taken from the landmark 2019 Global Burden of Disease study. "This is why poorer countries have so much lead poisoning," Fuller said.