Associations of Exposure to 56 Serum Trace Elements with the Prevalence and Severity of Acute Myocardial Infarction: Omics, Mixture, and Mediation Analysis.

Several studies have reported associations between specific heavy metals and essential trace elements and acute myocardial infarction (AMI). However, there is limited understanding of the relationships between trace elements and AMI in real-life co-exposure scenarios, where multiple elements may interact simultaneously. This cross-sectional study measured serum levels of 56 trace elements using inductively coupled plasma mass spectrometry. We identified individual trace elements linked to AMI using four feature selection methods and evaluated their associations with AMI prevalence and severity through multiple-element logistic regression. Restricted cubic spline analysis was employed to examine non-linear associations. Additionally, we explored the associations between trace element mixtures and AMI prevalence and severity using Bayesian kernel machine regression (BKMR) and element risk score (ERS). Finally, we investigated the potential mechanisms linking trace element exposure to AMI. We detected stable positive associations and linear relationships between Cu and Rb and AMI prevalence and severity. Furthermore, lower Fe concentrations were associated with higher AMI prevalence, while higher Sb concentrations were linked to greater AMI severity. Both BKMR and ERS models indicated positive associations between trace element mixtures and AMI prevalence and severity. Mediation analysis suggested that high-sensitivity C-reactive protein partially mediated the associations between trace elements and AMI prevalence and severity. We provide the first epidemiological evidence of the associations between serum trace element mixtures and AMI prevalence and severity. Under conditions of trace element co-exposure, Cu, Rb, Fe, and Sb were closely associated with AMI. Additionally, our results indicate that hsCRP (inflammation) may be a potential mechanism linking trace elements to AMI.