Abstract
We sought to explore the association between heavy metal exposure and coronary heart disease (CHD) based on data from the US National Health and Nutrition Examination Survey (NHANES, 2003–2018). In the analyses, participants were all aged > 20 and had participated in heavy metal sub-tests with valid CHD status. The Mann–Kendall test was employed to assess the trends in heavy metals’ exposure and the trends in CHD prevalence over 16 years. Spearman's rank correlation coefficient and a logistics regression (LR) model were used to estimate the association between heavy metals and CHD prevalence. 42,749 participants were included in our analyses, 1802 of whom had a CHD diagnosis. Total arsenic, dimethylarsonic acid, monomethylarsonic acid, barium, cadmium, lead, and antimony in urine, and cadmium, lead, and total mercury in blood all showed a substantial decreasing exposure level tendency over the 16 years (all Pfor trend < 0.05). CHD prevalence varied from 3.53 to 5.23% between 2003 and 2018. The correlation between 15 heavy metals and CHD ranges from − 0.238 to 0.910. There was also a significant positive correlation between total arsenic, monomethylarsonic acid, and thallium in urine and CHD by data release cycles (all P < 0.05). The cesium in urine showed a negative correlation with CHD (P < 0.05). We found that exposure trends of total arsenic, dimethylarsonic acid, monomethylarsonic acid, barium, cadmium, lead, and antimony in urine and blood decreased. CHD prevalence fluctuated, however. Moreover, total arsenic, monomethylarsonic acid, and thallium in urine all showed positive relationships with CHD, while cesium in urine showed a negative relationship with CHD.
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References
Agarwala, A., Michos, E. D., Samad, Z., Ballantyne, C. M., & Virani, S. S. (2020). The use of sex-specific factors in the assessment of women’s cardiovascular risk. Circulation, 141, 592–599. https://doi.org/10.1161/CIRCULATIONAHA.119.043429
Al-Shaar, L., Satija, A., Wang, D. D., Rimm, E. B., Smith-Warner, S. A., Stampfer, M. J., Hu, F. B., & Willett, W. C. (2020). Red meat intake and risk of coronary heart disease among US men: Prospective cohort study. BMJ. https://doi.org/10.1136/BMJ.M4141
Balali-Mood, M., Naseri, K., Tahergorabi, Z., Khazdair, M. R., & Sadeghi, M. (2021). Toxic mechanisms of five heavy metals: mercury, lead, chromium, cadmium, and arsenic. Frontiers in Pharmacology. https://doi.org/10.3389/fphar.2021.643972
Boyd, R., McMullen, H., Beqaj, H., & Kalfa, D. (2022). Environmental exposures and congenital heart disease. Pediatrics. https://doi.org/10.1542/PEDS.2021-052151
Daniali, M., Nikfar, S., & Abdollahi, M. (2020). Antibiotic resistance propagation through probiotics. Expert Opinion on Drug Metabolism & Toxicology, 16, 1207–1215. https://doi.org/10.1080/17425255.2020.1825682
Duan, Q.-Q., Jiang, Z., Su, W.-M., Gu, X.-J., Wang, H., Cheng, Y.-F., Cao, B., Gao, X., Wang, Y., & Chen, Y.-P. (2023). Risk factors of amyotrophic lateral sclerosis: A global meta-summary. Frontiers in Neuroscience, 17, 1177431. https://doi.org/10.3389/fnins.2023.1177431
Fan, X., Li, A., Yan, Z., Geng, X., Lian, L., Lv, H., Gao, D., & Zhang, J. (2022). From iron metabolism to ferroptosis: Pathologic changes in coronary heart disease. Oxidative Med Cell Longevity. https://doi.org/10.1155/2022/6291889
Ganz, T., Aronoff, G. R., Gaillard, C. A. J. M., Goodnough, L. T., Macdougall, I. C., Mayer, G., Porto, G., Winkelmayer, W. C., & Wish, J. B. (2020). Iron administration, infection, and anemia management in CKD: Untangling the effects of intravenous iron therapy on immunity and infection risk. Kidney Medicine, 2, 341–353. https://doi.org/10.1016/j.xkme.2020.01.006
Hannon, B. A., Fairfield, W. D., Adams, B., Kyle, T., Crow, M., & Thomas, D. M. (2020). Use and abuse of dietary supplements in persons with diabetes. Nutrition & Diabetes. https://doi.org/10.1038/S41387-020-0117-6
Haschka, D., Hoffmann, A., & Weiss, G. (2021). Iron in immune cell function and host defense. Seminars in Cell & Developmental Biology, 115, 27–36. https://doi.org/10.1016/j.semcdb.2020.12.005
Heidenreich, P. A., Trogdon, J. G., Khavjou, O. A., Butler, J., Dracup, K., Ezekowitz, M. D., Finkelstein, E. A., Hong, Y., Johnston, S. C., Khera, A., Lloyd-Jones, D. M., Nelson, S. A., Nichol, G., Orenstein, D., Wilson, P. W. F., & Woo, Y. J. (2011). Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association. Circulation, 123, 933–944. https://doi.org/10.1161/CIR.0B013E31820A55F5
Hirsch, J. A., Leslie-Mazwi, T. M., Nicola, G. N., Oklu, R., Schoppe, K. A., Silva, E., & Manchikanti, L. (2015). The ICD-10 system: A gift that keeps on taking. Journal of NeuroInterventional Surgery, 7, 619–622. https://doi.org/10.1136/NEURINTSURG-2014-011321
Jia, X., Zhang, N., Zhao, Y., Wang, L., Zhang, C. Y., Li, X., Cao, K., & Gao, Y. (2020). A consecutive 4-year elevated air temperature shaped soil bacterial community structure and metabolic functional groups in the rhizosphere of black locust seedlings exposed to lead pollution. Science of the Total Environment. https://doi.org/10.1016/J.SCITOTENV.2020.139273
Jia, X., Gao, Y., Li, X., Zhao, Y., Wang, L., & Zhang, C. (2021). Effects of cadmium on soil nitrification in the rhizosphere of Robinia pseudoacacia L. seedlings under elevated atmospheric CO2 scenarios. Science of the Total Environment. https://doi.org/10.1016/J.SCITOTENV.2021.145023
Jilani, M. H., Javed, Z., Yahya, T., Valero-Elizondo, J., Khan, S. U., Kash, B., Blankstein, R., Virani, S. S., Blaha, M. J., Dubey, P., Hyder, A. A., Vahidy, F. S., Cainzos-Achirica, M., & Nasir, K. (2021). Social determinants of health and cardiovascular disease: Current state and future directions towards healthcare equity. Current Atherosclerosis Reports. https://doi.org/10.1007/S11883-021-00949-W
Kattamis, A., Kwiatkowski, J. L., & Aydinok, Y. (2022). Thalassaemia. Lancet, 399, 2310–2324. https://doi.org/10.1016/S0140-6736(22)00536-0
Krieger, N., Williams, D. R., & Moss, N. E. (2003). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378. https://doi.org/10.1146/annurev.publhealth.18.1.341
Lahm, H., Jia, M., Dreßen, M., Wirth, F., Puluca, N., Gilsbach, R., Keavney, B. D., Cleuziou, J., Beck, N., Bondareva, O., Dzilic, E., Burri, M., König, K. C., Ziegelmüller, J. A., Abou-Ajram, C., Neb, I., Zhang, Z., Doppler, S. A., Mastantuono, E., … Krane, M. (2021). Congenital heart disease risk loci identified by genome-wide association study in European patients. Journal of Clinical Investigation. https://doi.org/10.1172/JCI141837
Lennartson, A. (2015). Toxic thallium. Nature Chemistry, 7, 610. https://doi.org/10.1038/NCHEM.2286
Li, X., Zhao, Y., Zhang, D., Kuang, L., Huang, H., Chen, W., Fu, X., Wu, Y., Li, T., Zhang, J., Yuan, L., Hu, H., Liu, Y., Zhang, M., Hu, F., Sun, X., & Hu, D. (2023). Development of an interpretable machine learning model associated with heavy metals’ exposure to identify coronary heart disease among US adults via SHAP: Findings of the US NHANES from 2003 to 2018. Chemosphere. https://doi.org/10.1016/J.CHEMOSPHERE.2022.137039
Li, Z., Ma, Z., van der Kuijp, T. J., Yuan, Z., & Huang, L. (2014). A review of soil heavy metal pollution from mines in China: Pollution and health risk assessment. Science of the Total Environment, 468–469, 843–853. https://doi.org/10.1016/J.SCITOTENV.2013.08.090
Liu, X., Zhang, D., Wu, X., Tu, J., Gong, C., Li, Y., Cui, W., Chen, J., & Lu, S. (2022). Urinary metals as influencing factors of coronary heart disease among a population in Guangzhou, China. Ecotoxicology and Environmental Safety. https://doi.org/10.1016/J.ECOENV.2022.113746
Lu, T., Forgetta, V., Yu, O. H. Y., Mokry, L., Gregory, M., Thanassoulis, G., Greenwood, C. M. T., & Richards, J. B. (2020). Polygenic risk for coronary heart disease acts through atherosclerosis in type 2 diabetes. Cardiovascular Diabetology. https://doi.org/10.1186/S12933-020-0988-9
Marrugo-Madrid, S., Pinedo-Hernández, J., Paternina-Uribe, R., Marrugo-Negrete, J., & Díez, S. (2022). Health risk assessment for human exposure to mercury species and arsenic via consumption of local food in a gold mining area in Colombia. Environmental Research. https://doi.org/10.1016/J.ENVRES.2022.113950
Miller, C., Karimi, R., Zhang, Q., Yang, J., & Meliker, J. (2017). Mercury, eicosapentanoic acid and docosahexaenoic acid demonstrate limited effect on plasma paraoxonase-1 activity and blood pressure among avid seafood consumers in the Long Island Study of Seafood Consumption, NY, USA. International Journal of Hygiene and Environmental Health, 220, 373–377. https://doi.org/10.1016/J.IJHEH.2016.11.004
Morales, M., & Xue, X. (2021). Targeting iron metabolism in cancer therapy. Theranostics, 11, 8412–8429. https://doi.org/10.7150/THNO.59092
Mou, C., & Ren, J. (2020). Automated ICD-10 code assignment of nonstandard diagnoses via a two-stage framework. Artificial Intelligence in Medicine, 108, 101939. https://doi.org/10.1016/j.artmed.2020.101939
NHANES. (2013). NHANES 2013–2014 Laboratory Methods [WWW Document]. Centers for Disease Control and Prevention. https://wwwn.cdc.gov/nchs/nhanes/ContinuousNhanes/LabMethods.aspx?BeginYear=2013. Accessed 8.12.22.
NHANES. (2014). Survey Methods and Analytic Guidelines [WWW Document]. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/nhanes/survey_methods.htm. Accessed 8.12.22.
Pierezan, M. D., Dalla Nora, F. M., & Verruck, S. (2022). Correlation between As, Cd, Hg, Pb and Sn concentration in human milk and breastfeeding mothers’ food consumption: A systematic review and infants’ health risk assessment. Critical Reviews in Food Science and Nutrition. https://doi.org/10.1080/10408398.2022.2056869
Richter, F., Kloster, S., Wodschow, K., Hansen, B., Schullehner, J., Kristiansen, S. M., Petersen, M. M., Strandberg-Larsen, K., & Ersbøll, A. K. (2022). Maternal exposure to arsenic in drinking water and risk of congenital heart disease in the offspring. Environment International. https://doi.org/10.1016/j.envint.2021.107051
Sacks, D., Baxter, B., Campbell, B. C. V., Carpenter, J. S., Cognard, C., Dippel, D., Eesa, M., Fischer, U., Hausegger, K., Hirsch, J. A., Shazam Hussain, M., Jansen, O., Jayaraman, M. V., Khalessi, A. A., Kluck, B. W., Lavine, S., Meyers, P. M., Ramee, S., Rüfenacht, D. A., … Vorwerk, D. (2018). Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke. International Journal of Stroke, 13, 612–632. https://doi.org/10.1177/1747493018778713
Santos, H. O., Cadegiani, F. A., & Forbes, S. C. (2022). Nonpharmacological interventions for the management of testosterone and sperm parameters: A scoping review. Clinical Therapeutics, 44, 1129–1149. https://doi.org/10.1016/j.clinthera.2022.06.006
Skubała, P., & Zaleski, T. (2012). Heavy metal sensitivity and bioconcentration in oribatid mites (Acari, Oribatida) gradient study in meadow ecosystems. Science of the Total Environment, 414, 364–372. https://doi.org/10.1016/J.SCITOTENV.2011.11.006
Smieja-Król, B., Fiałkiewicz-Kozieł, B., Sikorski, J., & Palowski, B. (2010). Heavy metal behaviour in peat—A mineralogical perspective. Science of the Total Environment, 408, 5924–5931. https://doi.org/10.1016/J.SCITOTENV.2010.08.032
Wang, C., Pi, X., Yin, S., Liu, M., Tian, T., Jin, L., Liu, J., Li, Z., Wang, L., Yuan, Z., Wang, Y., & Ren, A. (2022). Maternal exposure to heavy metals and risk for severe congenital heart defects in offspring. Environmental Research. https://doi.org/10.1016/J.ENVRES.2022.113432
Wang, Y. J., Yan, J., Zou, X. L., Guo, K. J., Zhao, Y., Meng, C. Y., Yin, F., & Guo, L. (2017). Bone marrow mesenchymal stem cells repair cadmium-induced rat testis injury by inhibiting mitochondrial apoptosis. Chemico-Biological Interactions, 271, 39–47. https://doi.org/10.1016/j.cbi.2017.04.024
Wi, H., Kim, H., Oh, D., Bae, S., & Hwang, Y. (2019). Surface modification of poly(vinyl alcohol) sponge by acrylic acid to immobilize Prussian blue for selective adsorption of aqueous cesium. Chemosphere, 226, 173–182. https://doi.org/10.1016/J.CHEMOSPHERE.2019.03.101
Xiao, T., Guha, J., Boyle, D., Liu, C. Q., Zheng, B., Wilson, G. C., Rouleau, A., & Chen, J. (2004). Naturally occurring thallium: A hidden geoenvironmental health hazard? Environment International, 30, 501–507. https://doi.org/10.1016/J.ENVINT.2003.10.004
Xu, H., Luo, Y., Wang, P., Zhu, J., Yang, Z., & Liu, Z. (2019). Removal of thallium in water/wastewater: A review. Water Research. https://doi.org/10.1016/J.WATRES.2019.114981
Zhang, T., Liu, Q., Gao, W., Sehgal, S. A., & Wu, H. (2022). The multifaceted regulation of mitophagy by endogenous metabolites. Autophagy, 18, 1216–1239. https://doi.org/10.1080/15548627.2021.1975914
Acknowledgements
I would especially wish to thank Professor Dongsheng for his guidance and support. I want to express my gratitude to Esmé Murphy in particular for editing the essay.
Funding
This study was supported by the National Natural Science Foundation of China (Grant Nos. 82073646, 81973152, 82273707, and 82103940), the Postdoctoral Research Foundation of China (Grant No. 2021M692903), the Natural Science Foundation of Guangdong Province (Grant No. 2021A1515012503 and 2022A1515010503), the Natural Science Foundation of Shenzhen, China (Grant No. JCYJ20210324093612032), the Key project of Shenzhen Natural Science Foundation (Grant No. JCYJ20220818095818040), the Key R&D and promotion projects in Henan Province (Grant No. 232102311017), and the Nanshan District Science and Technology Program Key Project (Grant No. NS2022009).
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Under the guidance of Professor DH, all authors helped organize and arrange the data for the article, while XL completed the majority of the writing. DZ made a lot of helpful suggestions. YZ was in charge of assessing the article's reliability. All authors have agreed to the article's final draft.
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Li, X., Zhang, D., Zhao, Y. et al. Correlation of heavy metals’ exposure with the prevalence of coronary heart disease among US adults: findings of the US NHANES from 2003 to 2018. Environ Geochem Health 45, 6745–6759 (2023). https://doi.org/10.1007/s10653-023-01670-0
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DOI: https://doi.org/10.1007/s10653-023-01670-0