The Affiliated Panyu Central Hospital, Guangzhou Medical University, Guangzhou, 511400, Guangdong, China.
The Second Nanning People's Hospital, Nanning, 530031, Guangxi, China.
BMC Public Health. 2024 Nov 6;24(1):3073. doi: 10.1186/s12889-024-20580-z.
Life's Essential 8 (LE8) is a novel assessment of cardiovascular health (CVH) by evaluating lifestyle, and reports of the associations between LE8 and urinary metals on mortality have been very limited. This study aimed to conduct a prospective cohort study and investigate the combined effects of metals and LE8 on mortality in U.S. adults.
This study enrolled participants with complete information on urinary metals, LE8, mortality status, and confounders from the National Health and Nutrition Examination Survey (2005-2018). The Cox regression model, adaptive lasso penalized regression, and restricted cubic spline were used to analyze the individual effects of metals and LE8 on all-cause mortality. The additive and multiplicative interaction scales and quantile g-computation were used to evaluate the interaction and combined effects. Stratified analyses were performed to clarify whether metals and LE8 interacted with other variables to influence all-cause mortality.
A total of 8017 participants were included in this study. The concentrations of cadmium, cobalt, lead, antimony, and thorium were greater in the low CVH group than in the high CVH group [median (µg/L): 0.29 vs. 0.19, 0.36 vs. 0.35, 0.48 vs. 0.39, 0.05 vs. 0.04, and 0.07 vs. 0.06]. The interaction between cadmium and LE8 was statistically significant, with a synergy index of 1.169 (95% CI: 1.004, 1.361). The stratified analyses showed that the interaction between age and LE8 had an impact on all-cause mortality (P for interaction = 0.004).
In this representative sample of the U.S. population, we found that the combined effect of cadmium, lead, thallium, and LE8 was positively associated with all-cause mortality. Furthermore, the interaction between cadmium and LE8 influenced all-cause mortality. So people should adopt healthy behaviors and reduce heavy metal exposure to minimize the risk of adverse health outcomes.
Life's essential 8（LE8）是一种评估心血管健康（CVH）的新方法，通过评估生活方式和报告 LE8 与尿金属之间的关联，对死亡率的研究非常有限。本研究旨在进行一项前瞻性队列研究，并调查美国成年人中金属和 LE8 对死亡率的综合影响。
本研究纳入了 National Health and Nutrition Examination Survey（2005-2018）中具有完整尿金属、LE8、死亡率状况和混杂因素信息的参与者。使用 Cox 回归模型、自适应套索惩罚回归和限制立方样条来分析金属和 LE8 对全因死亡率的个体影响。使用加性和乘法交互作用尺度和分位数 g 计算来评估交互作用和综合效应。进行分层分析以阐明金属和 LE8 是否与其他变量相互作用影响全因死亡率。
共有 8017 名参与者纳入本研究。低 CVH 组的镉、钴、铅、锑和钍浓度高于高 CVH 组[中位数（µg/L）：0.29 与 0.19，0.36 与 0.35，0.48 与 0.39，0.05 与 0.04，0.07 与 0.06]。镉和 LE8 之间的交互作用具有统计学意义，协同指数为 1.169（95%CI：1.004，1.361）。分层分析显示，LE8 与年龄之间的交互作用对全因死亡率有影响（交互作用 P 值=0.004）。
在这项美国人群的代表性样本中，我们发现镉、铅、铊和 LE8 的联合作用与全因死亡率呈正相关。此外，镉和 LE8 之间的相互作用影响全因死亡率。因此，人们应该采取健康的行为，减少重金属暴露，以最大限度地降低不良健康结果的风险。
