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Association of Urinary Strontium with Cardiovascular Disease Among the US Adults: A Cross-Sectional Analysis of the National Health and Nutrition Examination Survey

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Abstract

Previous studies have demonstrated the effects of environmental metals on the cardiovascular system. However, the relationship of strontium (Sr) to cardiovascular disease (CVD) in the general population has not been established. This cross-sectional study aimed to investigate the association between urinary Sr (U-Sr) and CVD in the US adults using data of 5255 participants from the National Health and Nutrition Examination Survey (NHANES) 2011–2016. Multivariable logistic regression and restricted cubic spline (RCS) regression were performed to assess the association between U-Sr and CVD. After multivariable adjustments, compared to the lowest quartile, the adjusted odds ratios (ORs) of CVD with 95% confidence intervals (CIs) across the quartiles were 0.65 (0.46, 0.92), 0.87 (0.61, 1.25), and 0.78 (0.55, 1.10). RCS plot revealed a nonlinear relationship between U-Sr levels and CVD (P for nonlinearity = 0.004). Threshold effect analysis identified the inflection point of U-Sr for the curve was 90.18 μg/g urinary creatinine (μg/g UCr). Each 1-unit increase in U-Sr was associated with a 1.1% decrease in CVD (OR 0.989; 95% CI 0.980–0.998) on the left side of the inflection point, but no significant association was observed on the right side of the inflection point. This study suggests a nonlinear association of U-Sr with CVD prevalence in the US general adults. These findings may have positive implications for the determination of appropriate Sr levels for public cardiovascular health. Given the cross-sectional study design, further prospective studies are warranted.

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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

AP:

Angina pectoris

BMI:

Body mass index

CHD:

Coronary heart disease

CHF:

Congestive heart failure

CI:

Confidence interval

CVD:

Cardiovascular disease

DAG:

Directed acyclic graph

HDL-C:

High-density lipoprotein cholesterol

ICP-MS:

Inductively coupled plasma mass spectrometry

NHANES:

National Health and Nutrition Examination Survey

PIR:

The ratio of family income to poverty

RCS:

Restricted cubic spline

TC:

Total cholesterol

UCr:

Urinary creatinine

U-Sr:

Urinary strontium

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Acknowledgements

The authors would like to thank all the National Health and Nutrition Examination Survey (NHANES) staff and participants for providing the publicly available data.

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  1. Sibo Wang and Jiateng Sun contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhou Road, Nanjing, 210029, China

    Sibo Wang, Jiateng Sun, Lingfeng Gu, Yaxin Wang, Chong Du, Hao Wang, Yao Ma & Liansheng Wang

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Contributions

Conceptualization: S.B.W, J.T.S, and L.S.W; Methodology: S.B.W, J.T.S, L.F.G, and Y.X.W; Formal analysis and investigation: S.B.W and C.D; Visualization: S.B.W, L.F.G, and Y.X.W; Writing—original draft preparation: S.B.W and J.T.S; Writing—review and editing: H.W and Y.M; Project administration: H.W and L.S.W; Supervision: L.S.W. All authors read and approved the final manuscript.

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Correspondence to Liansheng Wang.

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Wang, S., Sun, J., Gu, L. et al. Association of Urinary Strontium with Cardiovascular Disease Among the US Adults: A Cross-Sectional Analysis of the National Health and Nutrition Examination Survey. Biol Trace Elem Res 201, 3583–3591 (2023). https://doi.org/10.1007/s12011-022-03451-9

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