Cai Lipeng, Yan Jiangrong, Sun Lei, Dan Weichao
Department of Cardiology, The Third People's Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou, China.
Department of Transfusion, The Third People's Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou, China.
Front Public Health. 2025 Jun 5;13:1588078. doi: 10.3389/fpubh.2025.1588078. eCollection 2025.
Most epidemiological studies have focused on the association between single metal exposure and cardiovascular disease risk, utilizing a single-pollutant model for analysis. However, multiple metals may interact with each other, leading to misjudgment of health risks. This study sought to ascertain both the independent and combined effects of various blood heavy metal concentrations on all-cause mortality and cardiovascular mortality in patients with DM.
Patients (≥20 years) with DM from the NHANES (2011-2018) were selected. To explore the relationships of exposure to individual metals, including cadmium (Cd), mercury (Hg), manganese (Mn), lead (Pb), and selenium (Se), with all-cause mortality and cardiovascular mortality, weighted logistic regression and RCS analysis were leveraged. The WQS model was utilized to estimate the effects of combined blood metal exposures.
1,798 patients with DM were included. In the unadjusted model, ln-transformed blood Pb level (OR = 2.3, 95% CI: 1.70-3.10, < 0.001) and ln-transformed Cd level (OR = 1.54, 95% CI: 1.27-1.87, < 0.001) demonstrated positive associations with the all-cause mortality risk. According to RCS analysis, a nonlinear dose-response relationship was noted between Pb, Cd, Se, and the all-cause mortality risk (p-nonlinear < 0.05), while Hg and Mn showed linear relationships (p-nonlinear > 0.05).
According to this study, a high blood concentration of a combination of heavy metals is a significant risk factor for both cardiovascular disease and all-cause mortality of patients with diabetes, with Pb contributing a relatively higher proportion to these risks.
大多数流行病学研究聚焦于单一金属暴露与心血管疾病风险之间的关联，采用单污染物模型进行分析。然而，多种金属可能相互作用，导致对健康风险的判断失误。本研究旨在确定各种血液重金属浓度对糖尿病患者全因死亡率和心血管死亡率的独立及联合影响。
选取了来自美国国家健康与营养检查调查（2011 - 2018年）中年龄≥20岁的糖尿病患者。为了探究个体金属暴露，包括镉（Cd）、汞（Hg）、锰（Mn）、铅（Pb）和硒（Se）与全因死亡率和心血管死亡率之间的关系，运用了加权逻辑回归和限制立方样条分析。采用加权分位数和法（WQS）模型来估计血液中多种金属联合暴露的影响。
纳入了1798例糖尿病患者。在未调整模型中，对数转换后的血液铅水平（OR = 2.3，95% CI：1.70 - 3.10，< 0.001）和对数转换后的镉水平（OR = 1.54，95% CI：1.27 - 1.87，< 0.001）与全因死亡风险呈正相关。根据限制立方样条分析，铅、镉、硒与全因死亡风险之间存在非线性剂量反应关系（p - 非线性 < 0.05），而汞和锰呈线性关系（p - 非线性 > 0.05）。
根据本研究，血液中高浓度的重金属组合是糖尿病患者心血管疾病和全因死亡的重要危险因素，其中铅对这些风险的贡献比例相对较高。
