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Relationship between trace elements status and atrial fibrillation in patients with valvular heart diseases

Xiang Liu1,2, Yijia Shao3, Zirui Huang1,2

  • 1Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.

Frontiers in Cardiovascular Medicine
|November 24, 2025
PubMed

Insights

Trace element levels in urine are linked to atrial fibrillation (AF) in patients with valvular heart disease (VHD). Higher copper and mercury, with lower strontium and lithium, were associated with AF, suggesting a role in disease development.

Area of Science:

  • Cardiology
  • Environmental Health
  • Trace Element Research

Background:

  • Atrial fibrillation (AF) combined with valvular heart disease (VHD) presents a growing global health challenge with significant morbidity and mortality.
  • Trace element concentrations have been implicated in AF pathogenesis, but their role in VHD patients remains unexplored.

Purpose of the Study:

  • To investigate the association between urinary trace element profiles and the presence of AF in patients with VHD.
  • To explore the joint effects of multiple trace elements on AF risk within this specific patient population.

Main Methods:

  • Urine samples and clinical data were collected from 144 participants (72 with VHD and AF, 72 with VHD alone).
  • Analysis included 12 trace elements (lithium, manganese, cobalt, copper, zinc, arsenic, selenium, strontium, cadmium, mercury, thallium, lead).
  • Quantile g-computation was employed to assess the combined impact of trace elements on AF, with internal validation via bootstrap resampling.

Main Results:

  • Patients with VHD and AF exhibited reduced urinary strontium (Sr) and elevated manganese (Mn), copper (Cu), and mercury (Hg) levels compared to controls.
  • The quantile g-computation model revealed a significant association between the mixture of 12 urinary trace elements and AF in VHD patients (adjusted OR: 2.051; p=0.011).
  • Copper and mercury showed positive partial effects, while strontium and lithium demonstrated negative partial effects on AF risk.

Conclusions:

  • Elevated urinary copper and reduced strontium levels were prominent findings in VHD patients with AF.
  • These specific trace elements (Cu, Sr) are hypothesized to play a significant role in the development or progression of AF in the context of VHD.
  • Further investigation is warranted to elucidate the causal mechanisms linking these trace elements to AF in valvular heart disease.
Abstract

Keywords:
atrial fibrillationexposurerisk factortrace elementvalvular heart disease

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