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Platelet count partially mediates the association between mixed metal exposure and atherosclerotic cardiovascular

Li-Jun Li1, Ying Liu2, Jia Wei2

  • 1The Second Affiliated Hospital, School of Public Health, School of Basic Medicine, Hengyang Medical School, University of South China, Hengyang, Hunan, China; The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China.

Ecotoxicology and Environmental Safety
|May 12, 2026
PubMed

Insights

Mixed metal exposure, particularly cadmium, strontium, and thallium, increases atherosclerotic cardiovascular disease (ASCVD) risk. Platelet count partially mediates this association, highlighting a novel pathway for ASCVD development.

Area of Science:

  • Environmental Health
  • Cardiovascular Disease Epidemiology
  • Toxicology

Background:

  • Platelets play a known role in atherosclerotic cardiovascular disease (ASCVD).
  • The impact of mixed metal exposure on ASCVD risk and its relationship with platelet count is not well understood.
  • Understanding these interactions is crucial for public health and clinical practice.

Purpose of the Study:

  • To investigate the association between exposure to a mixture of metals and ASCVD risk.
  • To examine the potential mediating role of platelet count (PLT) in the relationship between metal mixtures and ASCVD.
  • To identify specific metals contributing to ASCVD risk through PLT.

Main Methods:

  • Case-control study design.
  • Weighted Quantile Sum (WQS) regression and Bayesian Kernel Machine Regression (BKMR) to analyze plasma metal mixtures and ASCVD risk.
  • LASSO regression and adjusted linear regression to identify key metals and their association with platelet count.
  • Mediation analysis to quantify the role of PLT.

Main Results:

  • A nine-metal mixture was significantly associated with increased ASCVD risk (OR = 1.89).
  • Cadmium (Cd), strontium (Sr), and thallium (Tl) were identified as major contributors to ASCVD risk.
  • Cd, Sr, and Tl were positively associated with platelet count (PLT).
  • PLT partially mediated the association between Cd, Sr, Tl, and ASCVD risk (mediation proportions: 3.7%, 8.4%, 4.9% respectively).

Conclusions:

  • Mixed metal exposure is a significant risk factor for ASCVD.
  • Cadmium, strontium, and thallium are key metals driving this association.
  • Platelet count plays a modest, partial mediating role in the pathway from metal exposure to ASCVD risk.

Keywords:
ASCVDBKMRMediation analysisMixed metal exposurePlatelet count

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