Contaminant Metals as Cardiovascular Risk Factors: A Scientific Statement From the American Heart Association

Area of Science:

• Environmental Health
• Cardiovascular Medicine
• Toxicology

Background:

• Environmental pollutants, particularly particulate air pollution, are known cardiovascular disease (CVD) risk factors.
• Emerging evidence highlights nonessential metals (lead, cadmium, arsenic) as significant global contributors to CVD.
• Human exposure to these metals occurs via air, water, soil, and food.

Purpose of the Study:

• To review the impact of nonessential metal exposure on cardiovascular health.
• To summarize the mechanisms by which metals induce cardiovascular damage.
• To discuss the epidemiological evidence linking metal exposure to specific cardiovascular outcomes and public health implications.

Main Methods:

• Literature review of epidemiological studies and toxicological research.
• Analysis of mechanisms including oxidative stress, inflammation, and epigenetic changes.
• Examination of associations between lead, cadmium, and arsenic exposure and CVD incidence and mortality.

Main Results:

• Metals induce oxidative stress, inflammation, endothelial dysfunction, hypertension, dyslipidemia, and cardiac remodeling.
• Exposure is linked to atherosclerosis, coronary artery stenosis, calcification, ischemic heart disease, stroke, heart failure, and peripheral artery disease.
• Epidemiological data associate lead, cadmium, and arsenic exposure with increased cardiovascular death, primarily from ischemic heart disease.

Conclusions:

• Nonessential metals are critical environmental risk factors for cardiovascular disease.
• Public health strategies to reduce metal exposure are effective in decreasing CVD mortality.
• Targeted interventions including improved monitoring and chelation therapy are needed to mitigate the burden of metal-induced CVD, particularly in vulnerable populations.