Association between heavy metal exposure and heart failure incidence and mortality: insights from NHANES data (2003–2018)
Abstract Background 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 inci...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12889-025-23177-2 |
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| author | Zebin Lin Yongqi Dong Xinlong Di Yang Bai Jianmin Tang Guike Lai Shengfang Wang Xiaohu Wang Yuhao Liu Yipin Zhao |
| author_facet | Zebin Lin Yongqi Dong Xinlong Di Yang Bai Jianmin Tang Guike Lai Shengfang Wang Xiaohu Wang Yuhao Liu Yipin Zhao |
| author_sort | Zebin Lin |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusion 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. |
| format | Article |
| id | doaj-art-22966bd125d844b69b2a36fb0b6b7ea1 |
| institution | DOAJ |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-22966bd125d844b69b2a36fb0b6b7ea12025-08-20T03:22:11ZengBMCBMC Public Health1471-24582025-05-0125111310.1186/s12889-025-23177-2Association between heavy metal exposure and heart failure incidence and mortality: insights from NHANES data (2003–2018)Zebin Lin0Yongqi Dong1Xinlong Di2Yang Bai3Jianmin Tang4Guike Lai5Shengfang Wang6Xiaohu Wang7Yuhao Liu8Yipin Zhao9Department of Geriatrics, Zhongshan Hospital Xiamen UniversityWushan County People’s Hospital of ChongqingDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhengzhou UniversityDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhengzhou UniversityDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhengzhou UniversityDepartment of Geriatrics Cardiology, The Second Affiliated Hospital, School of Medicine, Xi’an Jiaotong UniversityDepartment of Cardiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital Heart CenterDepartment of Cardiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital Heart CenterDepartment of Cardiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital Heart CenterDepartment of Cardiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital Heart CenterAbstract Background 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. Methods 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. Results 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. Conclusion 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.https://doi.org/10.1186/s12889-025-23177-2Heavy metalsHeart failureCardiovascular disease |
| spellingShingle | Zebin Lin Yongqi Dong Xinlong Di Yang Bai Jianmin Tang Guike Lai Shengfang Wang Xiaohu Wang Yuhao Liu Yipin Zhao Association between heavy metal exposure and heart failure incidence and mortality: insights from NHANES data (2003–2018) BMC Public Health Heavy metals Heart failure Cardiovascular disease |
| title | Association between heavy metal exposure and heart failure incidence and mortality: insights from NHANES data (2003–2018) |
| title_full | Association between heavy metal exposure and heart failure incidence and mortality: insights from NHANES data (2003–2018) |
| title_fullStr | Association between heavy metal exposure and heart failure incidence and mortality: insights from NHANES data (2003–2018) |
| title_full_unstemmed | Association between heavy metal exposure and heart failure incidence and mortality: insights from NHANES data (2003–2018) |
| title_short | Association between heavy metal exposure and heart failure incidence and mortality: insights from NHANES data (2003–2018) |
| title_sort | association between heavy metal exposure and heart failure incidence and mortality insights from nhanes data 2003 2018 |
| topic | Heavy metals Heart failure Cardiovascular disease |
| url | https://doi.org/10.1186/s12889-025-23177-2 |
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