Urinary metals as influencing factors of coronary heart disease among a population in Guangzhou, China

Association between mixture exposure to metals in urine and cognitive function in older adults in the United States: NHANES 2011-2014

AIMS

The effects of exposure to individual metals on cognitive function have been widely reported, but research on the effects of metal mixtures is rare. This study aims to investigate the association of exposure to both individual metals and multiple metals in urine on cognitive function in US elderly.

METHODS

Data derived from the National Health and Nutrition Examination Survey 2011-2014 were utilized in this cross-sectional study. A total of 13 urinary metals were determined using inductively coupled plasma mass spectrometry. Cognitive function assessments included the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning test, the CERAD word recall test, the animal fluency test, and the Digit Symbol Substitution test (DSST). To assess the relationships between multiple metal exposures and cognitive performance, linear regression and Bayesian kernel machine regression (BKMR) and the weighted quantile sum (WQS) regression models were employed.

RESULTS

A total of 1018 older adults were included. The participants' mean scores on the CERAD word learning test, the CERAD word recall test, the animal fluency test, and the DSST were 19.04 ± 4.62, 5.96 ± 2.30, 16.71 ± 5.57 and 45.56 ± 17.07, respectively. There were 10 metals with detection rates higher than 80 %. The linear regression model revealed that higher levels of barium (Ba), cadmium (Cd), lead (Pb), and tungsten (W) were associated with a decline in cognitive function scores. Conversely, increased levels of molybdenum (Mo), cobalt (Co), strontium (Sr), and thallium (Tl) were associated with improved cognitive function scores. Furthermore, BKMR model demonstrated that the slope of the dose-response curve between Mo and animal fluency test score decreased with increasing concentrations of Cd, suggesting an interaction effect of Mo and Cd exposure on cognitive function. WQS regression model demonstrated a significant negative association between exposure to metal mixtures and DSST score (β=-2.42, p < 0.001).

CONCLUSIONS

Our study suggests significant associations between several metals, such as Ba, Cd, Pb, W, Mo, Co, Sr and Tl, and cognitive function in older adults. Moreover, there is an interaction between Mo and Cd on cognitive function under metal co-exposure conditions. Prospective studies are needed to confirm the potential causal relationship.

Recent advancements in the application of multi-elemental profiling and ionomics in cardiovascular diseases

BACKGROUND

Trace elements and minerals are crucial for human growth and health, whose imbalance is associated with a variety of diseases. Recently, multi-elemental profiling and ionomics have been rapidly developed and widely used to study the distribution, variation, and interactions of various elements in diverse physiological and pathological conditions. By utilizing high-throughput elemental analytical techniques and bioinformatics approaches, researchers can uncover the relationship between the metabolism and balance of different elements and numerous human diseases.

METHODS

The presented work reviews recent advances in multi-elemental and ionomic profiling of human biological samples for several major types of cardiovascular diseases.

RESULTS

Research indicates distinct and dynamic patterns of ion contents in these diseases. Accumulation of copper and environmental toxic metals as well as deficiencies in zinc and selenium appear to be the most significant risk factors for the majority of cardiovascular diseases, suggesting that an imbalance in these elements may play a role in the development of these illnesses. Furthermore, each type of cardiovascular disease exhibits a relatively unique distribution of ions in biofluid and hair samples from patients, potentially serving as indicators for the specific disease.

CONCLUSION

Multi-elemental profiling and ionomics not only enhance our understanding of the association between elemental dyshomeostasis and the development of cardiovascular diseases but also facilitate the discovery of novel diagnostic and prognostic markers for these conditions.

Myocardial deposition of aluminum, arsenic, cadmium, and lead accelerates heart failure and alters UPRmt in humans

In the myocardium of control subjects and patients undergoing heart transplantation or left ventricular assist device implantation (LVAD), we analyzed concentrations of Al, As, Cd, Pb, and Ni using inductively coupled plasma mass spectrometry. Myocardial generation of oxidative-stress-induced lipid peroxidation was analyzed by quantifying concentration of 4-Hydroxynonenal (4-HNE) with ELISA and pro-apoptotic DAPK2 gene expression was determined with quantitative RT-PCR. Compared to six control hearts, myocardial samples of 128 individuals undergoing heart transplantation or LVAD implantation exhibited a moderate increase in deposition of five tested non-essential elements, which was significantly increased only for Cd and cumulative deposition of Al, As, Cd, and Pb. Patients with higher cumulative deposition of Al, As, Cd, and Pb, underwent heart transplantation or LVAD implantation at a younger age than those with lower cumulative deposition, which was not observed in individual elements. Also, Al, As, and Ni exhibited a positive correlation with DAPK2 expression. Moreover, Al, As, Cd, and Ni showed positive correlations and Pb negative correlations with several mitochondrial quality control (MQC) genes. None of the elements showed correlation with 4-HNE generation in the myocardium. There was no difference in tested non-essential element deposition between dilated and ischemic cardiomyopathy. In conclusion, patients with higher cumulative deposition of Al, As, Cd, and Pb in the myocardium underwent heart transplantation or LVAD implantation at a younger age, indicating that they may accelerate heart failure, which is associated with induction of DAPK2 expression. Deposition of Al, As, Cd, Ni, and Pb also altered the expression of several MQC genes.

Urinary heavy metals and overall survival of advanced high-grade serous ovarian cancer: A nested case-control study in China

BACKGROUND

Environmental pollution has emerged as a significant determinant in ovarian cancer prognosis. However, limited evidence exists regarding the correlations between heavy metals and ovarian cancer prognosis.

OBJECTIVE

To elucidate the relationship between urinary heavy metals and their mixtures with overall survival (OS) of advanced high-grade serous ovarian cancer (HGSOC).

METHODS

Within the Ovarian Cancer Follow-Up Study, we conducted a nested case-control study. A sum of 159 deceased patients and an equal number of alive patients were included, matched by sample date, body mass index, and age at diagnosis. Urinary concentrations of five heavy metals were quantified: arsenic (As), cadmium (Cd), chromium (Cr), mercury (Hg), and lead (Pb). Conditional logistic regression models were employed to calculate odds ratios (ORs) and their 95 % confidence intervals (CIs). To elucidate joint effects, we utilized quantile g-computation and Bayesian kernel machine regression models.

RESULTS

For the multivariable adjusted conditional logistic regression model, significant associations were found between high urinary levels of As (OR=1.99, 95 %CI: 1.05-3.79), Cd (OR=2.56, 95 %CI: 1.29-5.05), Hg (OR=2.24, 95 %CI: 1.09-4.62), and Pb (OR=3.80, 95 %CI: 1.75-8.27) and worse OS of HGSOC, comparing the highest tertile to the lowest. Analysis of joint effects showed that elevated concentrations of heavy metal mixtures were related to poor OS of HGSOC. Pb exhibited the highest contribution to the overall association within the metal mixtures.

CONCLUSIONS

High urinary heavy metal concentrations were linked to worse OS of HGSOC. Future research is necessary to validate our findings.

Association Between the Copper-to-Zinc Ratio and Cardiovascular Disease Among Chinese Adults: A China Multi-ethnic Cohort (CMEC) Study

The impact of metal exposure on cardiovascular diseases has become an increasingly concerning topic. To date, few studies have investigated the relationship between the copper-to-zinc ratio and CVD (Cardiovascular disease). This China multi-ethnic cohort study explored the association between the copper-to-zinc ratio and CVD in Chinese adults. The study included a sample size of 9878 people. Logistic regression analysis was used to examine the correlation between urinary copper, urinary zinc, and the copper-to-zinc ratio and CVD prevalence. Restricted cubic spline (RCS) analysis was used to investigate the potential dose-response relationships among copper-to-zinc ratio, urinary copper, urinary zinc, and CVD prevalence. In addition, the least absolute shrinkage and selection operator (LASSO) regression method was used to identify significant risk factors associated with CVD, leading to the development of a nomogram. The predictive performance of the nomogram model for CVD was assessed using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Compared with the copper-to-zinc ratio in Q1, the copper-to-zinc ratio in Q4 was associated with CVD after adjusting for all potential confounders (Model 3) (Q4, odds ratio [OR] 0.608, 95% confidence interval [CI] 0.416-0.889, P = 0.010). After adjusting for all potential confounders (Model 3), urinary copper levels in Q4 were associated with CVD (Q4, odds ratio [OR] 0.627, 95% confidence interval [CI] 0.436-0.902, P = 0.012). No significant difference was found between urinary zinc levels and CVD. The RCS showed a linear dose-response relationship between the copper-to-zinc ratio and CVD (P for overall = 0.01). The nomogram based on the influencing factors examined with LASSO showed good predictive power, and the AUC was 76.3% (95% CI 73.7-78.9%). Our results suggest that there is a significant linear negative correlation between the copper-to-zinc ratio and CVD in Chinese adults and that it has good predictive value for CVD.

Urinary metals and their associations with DNA oxidative damage among e-waste recycling workers in Hong Kong

Recycling electronic waste (e-waste) poses risks of metal exposure, potentially leading to health impairments. However, no previous study has focused on this issue in Hong Kong. Therefore, from June 2021 to September 2022, this study collected urine samples from 101 e-waste workers and 100 office workers in Hong Kong to compare their urinary levels of metals using ICP-MS. Among the 15 included metals (with detection rates above the 70 % threshold), eight showed significantly higher urinary concentrations (unit: μg/g creatinine) in e-waste workers compared to office workers: Li (25.09 vs. 33.36), Mn (1.78 vs. 4.15), Ni (2.10 vs. 2.77), Cu (5.81 vs. 9.23), Zn (404.35 vs. 431.52), Sr (151.33 vs. 186.26), Tl (0.35 vs. 0.43), and Pb (0.69 vs. 1.16). E-waste workers in Hong Kong generally exhibited lower metal levels than those in developing regions but higher than their counterparts in developed areas. The urine level of 8-hydroxy-2-deoxyguanosine (8-OHdG) was determined by HPLC-MS/MS, and no significant difference was found between the two groups. Multiple linear regression models revealed no significant association between individual metal and urinary 8-OHdG concentrations. However, the metal mixture was identified to marginally elevate the 8-OHdG concentrations (1.12, 95 %CI: 0.04, 2.19) by quantile g‑computation models, with Mn and Cd playing significant roles in such effect. In conclusion, while the metal levels among Hong Kong e-waste workers compared favorably with their counterparts in other regions, their levels were higher than those of local office workers. This underscores the need for policymakers to prioritize attention to this unique industry.

What Can We Learn from the Scalp Hair's Trace Element Content? The Relationship with the Advancement of Coronary Artery Disease

Background: Multiple risk factors for coronary artery disease have been identified without answering one of the leading questions related to the extent of the involvement of the epicardial arteries. Trace elements are involved in various stages of atherosclerotic lesion formation and may play a significant role in the advancement of coronary artery disease. Methods: A total of 157 (92 (59%) men and 65 (41%) women) patients with a median age of 71 (65-75) years presenting with chronic coronary syndrome were enrolled in the prospective single-center analysis. The coronary angiography results were compared with the concentration of trace elements in scalp hair. Results: Through Spearman analysis, a positive correlation between the number of diseased coronary arteries and hair trace element concentration was found for sodium (r = 0.198, p = 0.013), vanadium (r = 0.164, p = 0.040), chromium (r = 0.242, p = 0.002), and nickel (r = 0.176, p = 0.026). A negative relationship was noted between magnesium (r = -0.237, p = 0.003) and calcium (r = -0.217, p = 0.007) and the extent of epicardial lesions. Conclusions: Scalp hair trace element analysis indicates the possible modulatory role of trace elements in advancing coronary artery disease. Since a significant correlation with one- and two-vessel but not with three-vessel disease was noted, it might be considered an "all or nothing" phenomenon. A positive correlation between the number of diseased coronary arteries and sodium, vanadium, chromium, and nickel and an inverse correlation with magnesium and calcium were noted. The presented analysis is hypothesis-generating, and further studies are necessary to corroborate the results from a clinical perspective.

Human Health Effects of Oral Exposure to Chromium: A Systematic Review of the Epidemiological Evidence

The toxicity and carcinogenicity of hexavalent chromium via the inhalation route is well established. However, a scientific debate has arisen about the potential effects of oral exposure to chromium on human health. Epidemiological studies evaluating the connection between ingested chromium and adverse health effects on the general population are limited. In recent years, a wealth of biomonitoring studies has emerged evaluating the associations between chromium levels in body fluids and tissues and health outcomes. This systematic review brings together epidemiological and biomonitoring evidence published over the past decade on the health effects of the general population related to oral exposure to chromium. In total, 65 studies were reviewed. There appears to be an inverse association between prenatal chromium exposure and normal fetal development. In adults, parameters of oxidative stress and biochemical alterations increase in response to chromium exposure, while effects on normal renal function are conflicting. Risks of urothelial carcinomas cannot be overlooked. However, findings regarding internal chromium concentrations and abnormalities in various tissues and systems are, in most cases, controversial. Environmental monitoring together with large cohort studies and biomonitoring with multiple biomarkers could fill the scientific gap.

Study on the correlation and interaction between metals and dyslipidemia: a case-control study in Chinese community-dwelling elderly

Previous studies on the association between metals and dyslipidemia are not completely consistent. There are few studies investigating the relationship between mixed metal exposure and dyslipidemia as well as the effects of metals on dyslipidemia in community-dwelling elderly. To evaluate the correlations and interaction effect between the urinary concentrations of metals and the risk of dyslipidemia in community-dwelling elderly. We designed a case-control study to assess the correlation between urine metals and dyslipidemia in elderly people in the Yinchuan. The urinary levels of 13 metals, including calcium, vanadium, iron, cobalt, zinc, copper, arsenic, selenium, molybdenum, cadmium, tellurium, and thallium, were measured by inductively coupled plasma-mass spectrometry (ICP-MS), and the blood biochemical analyzer was used to measure the blood lipid levels of 3384 senior individuals from four different areas of Yinchuan city. Logistic regression and restricted cubic splines (RCS) were used to explore the correlation and dose-response relationship between urinary metals and the risk of dyslipidemia. Least absolute shrinkage and selection operator (LASSO) regression was used to select metals, and then weighted quantile sum (WQS) regression was used to explore the weight of each metal in mixed metals. Bayesian kernel machine regression (BKMR) was used to explore the interactions between metals on dyslipidemia risk. (1) After selection by LASSO regression, in the multi-metal model, compared with the lowest quartile, the adjusted ORs (95%CI) of the highest quartiles were 0.47 (0.37-0.60) for Fe, 1.43 (1.13-1.83) for Zn, 1.46 (1.11-1.92) for As, 0.59 (0.44-0.80) for Se, 1.53 (1.18-2.00) for Mo, and 1.36 (1.07-1.73) for Te. (2) In the WQS regression model, Fe and Mo accounted for the largest weight in the negative and positive effects of dyslipidemia, respectively. (3) In the BKMR model, there may be a positive interaction between Te and Se on dyslipidemia. Among the mixed metals, Fe, As, Se, Mo, and Te were associated with the prevalence of dyslipidemia, with Fe and Mo contributing the most. There may be certain interactions between Te and Se.

Maternal urinary metal(loid)s and risk of preterm birth: A cohort study in the Tibetan Plateau

Maternal metal(loid)s exposure has been related to preterm birth (PTB), but the results are still inconclusive. Previous studies have mainly discussed the harmful metal(loid)s, neglecting beneficial ones. We examined the association of maternal metal(loid)s with PTB and gestational age (GA) in a birth cohort from the Tibetan Plateau. We measured 29 metal(loid)s in urine samples from 1081 pregnant women in the third trimester. Information regarding demographics, socioeconomic status, diet, medication, and lifestyle was collected through standardized interviews. The associations of single metal(loid)s with PTB or GA were evaluated using a generalized linear mixed-effects model or linear mixed-effects model. Elastic net and Bayesian kernel machine regressions were used to explore the joint associations. Magnesium (Mg), Copper (Cu), and Tin (Sn) were the main "harmful" metal(loid)s positively and negatively associated with PTB or GA, respectively. Mg was the dominant "harmful" metal(loid)s associated with PTB in a J-shape. A one-fold increase in Mg was associated with a 38% increased risk of PTB [OR (95% CI) = 1.38 (1.15, 1.65), PFDR＜0.05] and 0.17 weeks shortening of GA [β (95% CI) = -0.25 (-0.35, -0.14), PFDR＜0.05]. Cesium (Cs), rubidium (Rb), and Molybdenum (Mo) were the main "beneficial" metals. Cs dominated the "beneficial" associations and was negatively associated with PTB in a linear manner. A one-fold increase in Cs was associated with a 67% decreased risk of PTB [OR (95% CI) = 0.43 (0.27, 0.67), PFDR＜0.05] and 0.24 weeks of prolonged GA [β (95% CI) = 0.35 (0.13, 0.56), PFDR＜0.05]. Ethnicity and living altitude modified the association of Mg and Cu with PTB or GA. In conclusion, Maternal urinary metal(loid)s were bi-directionally associated with PTB in a population in the Tibetan Plateau. Mg and Cs were the dominant "harmful" and "beneficial" metal(loid)s, respectively.

Correlation of heavy metals' exposure with the prevalence of coronary heart disease among US adults: findings of the US NHANES from 2003 to 2018

We sought to explore the association between heavy metal exposure and coronary heart disease (CHD) based on data from the US National Health and Nutrition Examination Survey (NHANES, 2003-2018). In the analyses, participants were all aged > 20 and had participated in heavy metal sub-tests with valid CHD status. The Mann-Kendall test was employed to assess the trends in heavy metals' exposure and the trends in CHD prevalence over 16 years. Spearman's rank correlation coefficient and a logistics regression (LR) model were used to estimate the association between heavy metals and CHD prevalence. 42,749 participants were included in our analyses, 1802 of whom had a CHD diagnosis. Total arsenic, dimethylarsonic acid, monomethylarsonic acid, barium, cadmium, lead, and antimony in urine, and cadmium, lead, and total mercury in blood all showed a substantial decreasing exposure level tendency over the 16 years (all Pfor trend < 0.05). CHD prevalence varied from 3.53 to 5.23% between 2003 and 2018. The correlation between 15 heavy metals and CHD ranges from - 0.238 to 0.910. There was also a significant positive correlation between total arsenic, monomethylarsonic acid, and thallium in urine and CHD by data release cycles (all P < 0.05). The cesium in urine showed a negative correlation with CHD (P < 0.05). We found that exposure trends of total arsenic, dimethylarsonic acid, monomethylarsonic acid, barium, cadmium, lead, and antimony in urine and blood decreased. CHD prevalence fluctuated, however. Moreover, total arsenic, monomethylarsonic acid, and thallium in urine all showed positive relationships with CHD, while cesium in urine showed a negative relationship with CHD.

Cadmium exposure caused cardiotoxicity in common carps (Cyprinus carpio L.): miR-9-5p, oxidative stress, energetic impairment, mitochondrial division/fusion imbalance, inflammation, and autophagy

Cadmium (Cd), a toxic heavy metal pollutant, is a threat to human and eatable fish health. Common carps are widely cultivated and eaten by humans. However, there are no reports about Cd-damaged common carp hearts. Our experiment attempted to investigate the cardiotoxicity of Cd to common carps by establishing a common carp Cd exposure model. Our results showed that Cd injured hearts. Moreover, Cd treatment induced autophagy via miR-9-5p/Sirt1/mTOR/ULK1 pathway. Cd exposure caused oxidant/antioxidant imbalance and oxidative stress; and led to energetic impairment. Energetic impairment partook in oxidative stress-mediated autophagy through AMPK/mTOR/ULK1 pathway. Furthermore, Cd caused mitochondrial division/fusion imbalance and resulted in inflammatory injury via NF-κB-COX-2-PTGEs and NF-κB-COX-2-TNF-α pathways. Oxidative stress mediated mitochondrial division/fusion imbalance, further induced inflammation and autophagy via OPA1/NF-κB-COX-2-TNF-α-Beclin1 and OPA1/NF-κB-COX-2-TNF-α/P62 pathways under Cd treatment. Taken together, miR-9-5p, oxidative stress, energetic impairment, mitochondrial division/fusion imbalance, inflammation, and autophagy participated in the mechanism of Cd-cardiotoxicity to common carps. Our study revealed harmful effect of Cd on hearts, and provided new information for researches of environmental pollutant toxicity.

Fear of recurrence in elderly patients with coronary heart disease: the current situation and influencing factors according to a questionnaire analysis

Objective

Fear of recurrence is a common psychosocial sequela among patients with heart disease. Analyses of coronary heart disease, particularly in elderly patients, are relatively rare. This study aimed to investigate the current situation in this context, as well as the influencing fear factors concerning recurrence in elderly patients with coronary heart disease.

Methods

A total of 200 elderly outpatients with coronary heart disease were recruited to participate in this survey from a tertiary hospital in Baoding (China). The questionnaires included items from the Disease Progression Simplified Scale, the Simplified Coping Style Questionnaire, and the Social Support Rating Scale (SSRS). Univariate and multivariate regression analyses were adopted to investigate the influencing factors on the fear of recurrence.

Results

The fear of recurrence score in elderly patients with coronary heart disease was (38.46 ± 8.13), among which 119 cases (59.5%) scored higher than 34 points. The SSRS total average score was (34.89 ± 9.83) points. Positive coping style and social support were negatively correlated with the total score of recurrence fear (r =  − 0.621, − 0.413, both P < 0.001). There was a positive correlation between negative coping style and the total score of recurrence fear (r = 0.232, P < 0.001). Multiple linear regression analysis showed that the course of the disease, the number of disease recurrence cases, active coping, and social support were relevant factors in fear of recurrence (all P < 0.05).

Conclusion

The detection rate of fear of recurrence in elderly patients with coronary heart disease was relatively high but could be reduced by active interventions and enhancing social support.