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Association of Blood Heavy Metal Exposure with Atherosclerotic Cardiovascular Disease (ASCVD) Among White Adults: Evidence from NHANES 1999–2018

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Abstract

Cardiovascular diseases (CVD) are main public health concerns highly prevalent in industrialized societies where human health is threatened by a series of environmental pollutants, particularly heavy metal contaminants. We aimed to find out if blood heavy metals are associated with the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) in a nationally representative sample of US adults. We analyzed the cross-sectional data on blood heavy metals of 3268 non-Hispanic white participants aged 40–79 years from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. We introduced a risk estimation algorithm, namely the 2013 Pooled Cohort Equations (PCE), to assess the risk for ASCVD over a 10-year period. The 10-year risk for ASCVD was categorized as either reduced risk (< 7.5% risk) or elevated risk (≥ 7.5% risk). Blood lead, cadmium, and mercury were distributed into four quartiles. We used weighted multivariate logistic regression models and restricted cubic spline (RCS) regression to detect the association of blood heavy metal exposure with 10-year ASCVD risk. Following the adjustment of covariates, the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for elevated 10-year ASCVD risk for participants from the highest quartiles were 4.50 (2.88–7.02), 2.59 (1.68–4.00), and 1.06 (0.66–1.71) for blood cadmium, lead, and mercury compared to the lowest quartiles, respectively. The RCS plot demonstrated that blood cadmium was linearly and positively associated with 10-year ASCVD risk (P for nonlinearity = 0.112). According to our findings, non-Hispanic whites aged 40–79 years had a greater 10-year ASCVD risk as their blood lead and cadmium levels increased. Consequently, when establishing approaches for ASCVD prevention, blood heavy metals should be considered.

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Data Availability

The datasets used and/or analyzed during the current study are available from the NHANES website (https://www.cdc.gov/nchs/nhanes/index.htm).

Abbreviations

CVD:

Cardiovascular disease

ASCVD:

Atherosclerotic cardiovascular disease

CHD:

Coronary heart disease

NHANES:

National Health and Nutrition Examination Survey

SBP:

Systolic blood pressure

TC:

Total cholesterol

HDL-C:

High density lipoprotein cholesterol

BMI:

Body mass index

LDL-C:

Low-density lipoprotein cholesterol

CRP:

C-reactive protein

TG:

Triglyceride

UA:

Uric acid

eGFR:

Estimated glomerular filtration rate

RCS:

Restricted cubic spline

OR:

Odds ratio

CI:

Confidence interval

MI:

Myocardial infarction

ROS:

Reactive oxygen species

NO:

Nitric oxide

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Acknowledgements

Thanks to Zhang Jing (Shanghai Tongren Hospital) for his effort on the NHANES database. His outstanding work, NHANES R package and webpage, makes it easier for us to discover NHANES database.

Funding

This investigation was funded by grants from the National Natural Science Foundation of China (No. 81871359 and No. 82071944).

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Author notes

  1. Kai Wang and Yukang Mao contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China

    Kai Wang, Yukang Mao, Zheng Liu, Yan Sun, Yinzhang Ding & Jing Zhang

  2. Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, Jiangsu, China

    Yukang Mao

  3. Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China

    Yansong Li, Zhongming Li, Xianling Liu, Jian Hong & Di Xu

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Contributions

Kai WANG: Conceptualization, Methodology, Software, Formal analysis, Writing – original draft, Visualization. Yukang MAO: Conceptualization, Methodology, Writing – review & editing, Visualization. Miao LU: Formal analysis, Data curation, Validation. Zheng LIU: Formal analysis, Software, Writing – review & editing. Yansong LI: Formal analysis, Methodology. Zhongming LI: Formal analysis, Data curation. Yan SUN: Data curation, Writing – review & editing. Yinzhang DING: Data curation, Writing – review & editing. Xianling LIU: Data curation. Jian HONG: Project administration, Funding acquisition, Writing-review and editing. Di XU and Jing ZHANG: Conceptualization, Methodology, Project administration, Funding acquisition, Writing – review & editing, Supervision.

Corresponding authors

Correspondence to Di Xu or Jing Zhang.

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Ethics Approval and Consent to Participate

NHANES Institutional Review Board approved the ethical conduct of NHANES 1999–2018, and all participants provided informed consent. The study procedures were structured in line with the Declaration of Helsinki.

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The authors declare no competing interests.

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12011_2022_3537_MOESM1_ESM.jpg

Supplementary figure 1 Unweighted restricted cubic spline analysis for the association between blood heavy metals and 10-year ASCVD risk. (A) Blood cadmium. (B) Blood lead. (C) Total blood mercury. Analyses were adjusted for education, annual family income, alcohol intake, eGFR, C-reactive protein, hemoglobin, physical activity, BMI, waist, triglyceride, LDL-C and uric acid. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; eGFR, estimated glomerular filtration rate; LDL-C, low-density lipoprotein cholesterol (JPG 928 KB)

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Wang, K., Mao, Y., Liu, Z. et al. Association of Blood Heavy Metal Exposure with Atherosclerotic Cardiovascular Disease (ASCVD) Among White Adults: Evidence from NHANES 1999–2018. Biol Trace Elem Res 201, 4321–4333 (2023). https://doi.org/10.1007/s12011-022-03537-4

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