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Association Between the Copper-to-Zinc Ratio and Cardiovascular Disease Among Chinese Adults: A China Multi-ethnic Cohort (CMEC) Study

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Abstract

The impact of metal exposure on cardiovascular diseases has become an increasingly concerning topic. To date, few studies have investigated the relationship between the copper-to-zinc ratio and CVD (Cardiovascular disease). This China multi-ethnic cohort study explored the association between the copper-to-zinc ratio and CVD in Chinese adults. The study included a sample size of 9878 people. Logistic regression analysis was used to examine the correlation between urinary copper, urinary zinc, and the copper-to-zinc ratio and CVD prevalence. Restricted cubic spline (RCS) analysis was used to investigate the potential dose–response relationships among copper-to-zinc ratio, urinary copper, urinary zinc, and CVD prevalence. In addition, the least absolute shrinkage and selection operator (LASSO) regression method was used to identify significant risk factors associated with CVD, leading to the development of a nomogram. The predictive performance of the nomogram model for CVD was assessed using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Compared with the copper-to-zinc ratio in Q1, the copper-to-zinc ratio in Q4 was associated with CVD after adjusting for all potential confounders (Model 3) (Q4, odds ratio [OR] 0.608, 95% confidence interval [CI] 0.416–0.889, P = 0.010). After adjusting for all potential confounders (Model 3), urinary copper levels in Q4 were associated with CVD (Q4, odds ratio [OR] 0.627, 95% confidence interval [CI] 0.436–0.902, P = 0.012). No significant difference was found between urinary zinc levels and CVD. The RCS showed a linear dose–response relationship between the copper-to-zinc ratio and CVD (P for overall = 0.01). The nomogram based on the influencing factors examined with LASSO showed good predictive power, and the AUC was 76.3% (95% CI 73.7–78.9%). Our results suggest that there is a significant linear negative correlation between the copper-to-zinc ratio and CVD in Chinese adults and that it has good predictive value for CVD.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (No. 82173566) and the National Key R&D Program of China (No. 2017YFC0907301).The authors would like to acknowledge the efforts of all team members and participants involved in the China Multi-Ethnic Cohort (CMEC).

Funding

Funding was provided by the National Natural Science Foundation of China (No. 82173566) and the National Key R&D Program of China (NO.2017YFC0907301).

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Authors and Affiliations

  1. School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 561113, China

    Yili Shen, Yuxin Hu, Leilei Liu, Jianqin Zhong, Yuxin Zhang, Shenyan Wu, Cheng Chen & Feng Hong

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Contributions

Yili Shen contributed to Writing-original draft, methodology, investigation, and formal analysis. Feng Hong contributed to Writing–review and modifying, supervision, resources, funding, and project administration. Yuxin Hu contributed to Investigation and methology. Leilei Liu contributed to Investigation and methodology. Jianqin Zhong contributed to Investigation. Yuxin Zhang contributed to Investigation. Shenyan Wu contributed to Investigation and data curation. Cheng Chen contributed to Investigation.

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Correspondence to Feng Hong.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Sichuan University Medical Ethical Review Board (K2016038) and the Research Ethics Committee of The Affiliated Hospital of Guizhou Medical University (2018[094]). Informed consent was obtained from all subjects involved in the study. All authors have read, understood, and have complied as applicable with the statement on “Ethical responsibilities of Authors.”

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Shen, Y., Hu, Y., Liu, L. et al. Association Between the Copper-to-Zinc Ratio and Cardiovascular Disease Among Chinese Adults: A China Multi-ethnic Cohort (CMEC) Study. Cardiovasc Toxicol (2024). https://doi.org/10.1007/s12012-024-09904-y

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