State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China.
State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China; Department of Maternal, Child, and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China.
Ecotoxicol Environ Saf. 2021 Jan 15;208:111433. doi: 10.1016/j.ecoenv.2020.111433. Epub 2020 Oct 15.
Evidence from previous studies has shown that exposure to metals is associated with cardiovascular disease (CVD). However, the association between metal mixtures and CVD risk and the potential mechanisms in epidemiologic studies remain unclear. The data of 14,795 adults who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2016 were analyzed. Multivariate logistic regression was performed to investigate the associations between urinary metal levels and CVDs. Weighted quantile sum (WQS) regression was performed to examine the effects of mixed metals on CVDs. Multivariate linear regression and mediation analysis were conducted to explore the associations between metals and blood lipids. Urinary cadmium (Cd) was significantly associated with an increased total CVD risk and with individual CVD risk. The odds ratio (OR) for CVD in the highest quartile of the WQS index was 1.43 (95% confidence interval [CI]: 1.19, 1.71). One augmented urinary Cd concentration unit (Log10) was associated with a 0.93 mg/dL decrease in HDL cholesterol, a 1.34 mg/dL increase in LDL cholesterol and a 1.30 mg/dL increase in total cholesterol in the fully adjusted model. Mediation analysis showed that HDL cholesterol mediated 4.91% of the association between urinary Cd and the prevalence of CVD. Our findings suggest that urinary Cd and metal mixtures were significantly and positively associated with CVD. The downregulation of HDL cholesterol might play a significant role in mediating Cd exposure-associated CVD risk increases.
先前的研究证据表明，金属暴露与心血管疾病（CVD）有关。然而，在流行病学研究中，金属混合物与 CVD 风险的关联以及潜在机制仍不清楚。分析了 14795 名参加美国国家健康和营养调查（NHANES）1999-2016 年的成年人的数据。采用多变量逻辑回归分析尿液金属水平与 CVD 的关系。采用加权总量（WQS）回归分析混合金属对 CVD 的影响。采用多元线性回归和中介分析探讨金属与血脂的关系。尿液中的镉（Cd）与总 CVD 风险增加以及个别 CVD 风险增加呈显著相关。WQS 指数最高四分位的 CVD 比值比（OR）为 1.43（95%置信区间[CI]：1.19，1.71）。完全调整模型中，尿液中 Cd 浓度单位（Log10）增加一个单位，与高密度脂蛋白胆固醇降低 0.93mg/dL、低密度脂蛋白胆固醇增加 1.34mg/dL、总胆固醇增加 1.30mg/dL有关。中介分析表明，高密度脂蛋白胆固醇介导了尿液 Cd 与 CVD 患病率之间 4.91%的关联。我们的研究结果表明，尿液 Cd 和金属混合物与 CVD 显著正相关。高密度脂蛋白胆固醇的下调可能在介导 Cd 暴露相关 CVD 风险增加方面发挥重要作用。
