Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Department of Preventive Medicine in School of Public Health and Management and Center for Environment and Health in Water Source Area of South to North Water Diversion, Hubei University of Medicine, Shiyan, Hubei, China.
Environ Int. 2019 Aug;129:497-506. doi: 10.1016/j.envint.2019.05.038. Epub 2019 May 31.
Metals exposure from natural environment and pollution have been linked to cardiovascular disease (CVD). However, whether associations existing between plasma multiple metals and incident cardiovascular disease in patients with type 2 diabetes (T2D) is unknown.
We conducted a prospective cohort study to investigate whether plasma levels of metals are associated with incident CVD risk in patients with T2D.
In a prospective study of 3897 type 2 diabetes embedded in the Dongfeng-Tongji cohort, fasting blood samples were collected in 2008 at baseline and in 2013 in the first follow-up period. Plasma concentrations of 23 metals were measured by inductively coupled plasma mass spectrometry (ICP-MS). The associations between plasma metal concentrations and CVD risk in patients with T2D were investigated with Cox proportional hazards models.
During an average of 6.2 years follow-up, 1114 participants developed CVD. In the single-metal models adjusting for established cardiovascular risk factors, plasma zinc and selenium levels were negatively and strontium was positively associated with incident CVD risk in patients with T2D. Similar results were obtained in the multiple-metal model, the HRs (95% CIs) for zinc, selenium, and strontium comparing extreme quartiles were 0.78 (95% CI: 0.65-0.93; P trend = 0.011), 0.76 (95% CI: 0.64-0.91; P trend = 0.001), and 1.51 (95% CI: 1.26-1.81; P trend <0.001), respectively. In the joint association analyses of two metals, individuals with high plasma levels of zinc and selenium had significantly lower risk of incident CVD in patients with T2D than those with low levels (HR = 0.77, 95% CI: 0.65-0.91).
The present study suggested that plasma levels of zinc and selenium had an inverse association with incident CVD risk in patients with T2D, while strontium had a positive correlation. Plasma zinc and selenium combinedly decreased incident CVD risk in patients with T2D. Further research is still needed to verify these findings in other populations.
金属暴露于自然环境和污染与心血管疾病（CVD）有关。然而，目前尚不清楚 2 型糖尿病（T2D）患者血浆中多种金属与心血管疾病发病之间是否存在关联。
我们进行了一项前瞻性队列研究，以调查 T2D 患者血浆中金属水平与心血管疾病发病风险之间的关系。
在东风-同济队列中嵌入的 3897 例 2 型糖尿病患者的前瞻性研究中，于 2008 年基线和 2013 年首次随访期间采集空腹血样。采用电感耦合等离子体质谱法（ICP-MS）测量血浆中 23 种金属的浓度。采用 Cox 比例风险模型研究 T2D 患者血浆金属浓度与 CVD 风险之间的关系。
在平均 6.2 年的随访期间，1114 名参与者发生了 CVD。在调整了已确立的心血管危险因素的单金属模型中，血浆锌和硒水平与 T2D 患者的 CVD 发病风险呈负相关，锶呈正相关。在多金属模型中也得到了类似的结果，锌、硒和锶的极端四分位数的 HR（95%CI）分别为 0.78（95%CI：0.65-0.93；P 趋势=0.011）、0.76（95%CI：0.64-0.91；P 趋势=0.001）和 1.51（95%CI：1.26-1.81；P 趋势<0.001）。在两种金属的联合关联分析中，与低水平相比，T2D 患者血浆中锌和硒水平较高者 CVD 发病风险显著降低（HR=0.77，95%CI：0.65-0.91）。
本研究表明，T2D 患者血浆锌和硒水平与 CVD 发病风险呈负相关，而锶呈正相关。血浆锌和硒联合降低了 T2D 患者的 CVD 发病风险。需要进一步的研究来验证这些发现是否适用于其他人群。
