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Associations Between Urinary Metal Levels and Incident Heart Failure: A Multi-Cohort Analysis.

Irene Martinez-Morata1, Arce Domingo-Relloso2, Melanie Mayer2

  • 1Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.

JACC. Heart Failure
|June 18, 2025
PubMed
Summary

Environmental metal exposure, including cadmium, molybdenum, and zinc, is linked to increased heart failure (HF) risk. Reducing exposure to these metals may lower the incidence of HF.

Keywords:
biomarkersheart failuremeta-analysismetalspreventionurinary metals

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Area of Science:

  • Environmental health
  • Cardiovascular epidemiology
  • Toxicology

Background:

  • Environmental metals are established cardiovascular disease risk factors.
  • The specific contribution of metal exposure to heart failure (HF) risk is not well understood.
  • Investigating metal exposure in diverse populations is crucial for public health.

Purpose of the Study:

  • To prospectively assess the association between urinary metal levels and incident HF.
  • To analyze data from three diverse cohorts: the Multi-Ethnic Study of Atherosclerosis (MESA), the Strong Heart Study (SHS), and the Hortega Study.
  • To evaluate both individual metals and a mixture of metals in relation to HF risk.

Main Methods:

  • Longitudinal follow-up of 6,601 (MESA), 2,917 (SHS), and 1,300 (Hortega) adults for up to 20 years.
  • Measurement of urinary metal panel at baseline, with adjustments for urine dilution.
  • Application of Cox proportional hazards and Cox elastic-net models for multi-adjusted hazard ratio estimation, including pooled meta-analysis.

Main Results:

  • A total of 1,001 participants developed incident HF.
  • Elevated urinary levels of cadmium, molybdenum, and zinc were significantly associated with increased HF risk (pooled HRs per doubling of dose: 1.15, 1.13, and 1.22, respectively).
  • The multi-metal mixture was also associated with higher HF incidence, particularly in the MESA and SHS cohorts.

Conclusions:

  • Urinary metal levels serve as significant risk factors for heart failure across diverse populations.
  • Findings support the public health strategy of reducing environmental metal exposure to mitigate HF risk.
  • Further research should focus on mechanisms linking specific metals to HF pathophysiology.