Lin Zebin, Dong Yongqi, Di Xinlong, Bai Yang, Tang Jianmin, Lai Guike, Wang Shengfang, Wang Xiaohu, Liu Yuhao, Zhao Yipin
Department of Geriatrics, Zhongshan Hospital Xiamen University, 201 Hubin South Road, Xiamen, Fujian, China.
Wushan County People's Hospital of Chongqing, No.168, Guangdongxi Road, Wushan County, Chongqing, China.
BMC Public Health. 2025 May 26;25(1):1935. doi: 10.1186/s12889-025-23177-2.
Environmental heavy metal exposure is a potential yet understudied risk factor for heart failure (HF), a global health burden with rising prevalence. While toxic metals like cadmium (Cd), mercury (Hg), and arsenic (As) are linked to cardiovascular diseases, their roles in HF incidence and prognosis remain unclear.
The associations between heavy metals and HF outcomes were analyzed using NHANES 2003-2018 data (n = 11,592). Metals were measured in blood (Cd, Hg, Pb) and urine (As, Hg, others) using inductively coupled plasma mass spectrometry (ICP-MS). Confounding factors were addressed through propensity score matching (PSM). HF incidence was evaluated using logistic regression, while mortality was assessed via Cox regression. Mechanistic pathways were explored through causal mediation analysis.
After PSM (n = 987, 337 HF cases), blood Cd showed a positive association with HF incidence (OR:1.35, 95%CI:1.05-1.72), while urinary Hg (OR:0.78, 95%CI:0.63-0.98) and As (OR:0.84, 95%CI:0.72-0.99) exhibited protective effects. Urinary As correlated with elevated cardiovascular mortality in HF patients (HR:1.19, 95%CI:1.04-1.35). Mediation analysis indicated Cd's effect on HF was mediated via CHD/OMI, whereas Hg's protection involved reduced CHD/OMI incidence. As directly lowered HF risk without mediation.
These findings underscore cadmium's role as a risk factor and the paradoxical effects of mercury and arsenic: low to moderate concentrations of Hg/As may reduce HF risk through indirect pathways (e.g., reduced CHD/OMI for Hg) or direct cardioprotective mechanisms (for As), yet arsenic's association with mortality highlights its long-term cardiovascular toxicity. Findings advocate for preventive strategies targeting metal exposure and further research integrating cumulative biomarkers.
环境重金属暴露是心力衰竭（HF）一个潜在但尚未充分研究的风险因素，心力衰竭是一种全球患病率不断上升的健康负担。虽然镉（Cd）、汞（Hg）和砷（As）等有毒金属与心血管疾病有关，但其在心力衰竭发病率和预后中的作用仍不清楚。
使用2003 - 2018年美国国家健康与营养检查调查（NHANES）数据（n = 11,592）分析重金属与心力衰竭结局之间的关联。使用电感耦合等离子体质谱法（ICP - MS）测量血液（Cd、Hg、Pb）和尿液（As、Hg等）中的金属。通过倾向得分匹配（PSM）解决混杂因素。使用逻辑回归评估心力衰竭发病率，通过Cox回归评估死亡率。通过因果中介分析探索作用机制途径。
经过PSM（n = 987，337例HF病例）后，血液Cd与HF发病率呈正相关（OR：1.35，95%CI：1.05 - 1.72），而尿Hg（OR：0.78，95%CI：0.63 - 0.98）和As（OR：0.84，95%CI：0.72 - 0.99）表现出保护作用。尿As与HF患者心血管死亡率升高相关（HR：1.19，95%CI：1.04 - 1.35）。中介分析表明，Cd对HF的影响通过冠心病/心肌梗死（CHD/OMI）介导，而Hg的保护作用涉及降低CHD/OMI发病率。As直接降低HF风险，无中介作用。
这些发现强调了镉作为风险因素的作用以及汞和砷的矛盾效应：低至中等浓度的Hg/As可能通过间接途径（如Hg降低CHD/OMI）或直接心脏保护机制（As）降低HF风险，但砷与死亡率的关联突出了其长期心血管毒性。研究结果倡导针对金属暴露的预防策略以及进一步整合累积生物标志物的研究。
