■接触金属与心血管疾病(CVD)终点和死亡率有关,然而,未来的证据仅限于砷,镉,和铅。在这项研究中,我们评估了来自MESA(动脉粥样硬化多种族研究)的不同种族的美国成年人人群中尿中金属与心血管事件和全因死亡率的前瞻性关联.
■我们包括6599名参与者(平均[SD]年龄,62.1[10.2]年;53%的女性)在基线(2000年至2001年)时可获得尿金属,随后一直持续到2019年12月。我们使用Cox比例风险模型来估计调整后的危险比和95%CI的心血管疾病和全因死亡率的基线尿镉水平,钨,和铀(非必要金属),还有钴,铜,和锌(必需金属)。使用CoxElastic-Net计算了6种金属作为混合物的联合关联和相应的10年生存概率。
■随访期间,1162名参与者发展为CVD,1844名参与者死亡。在由行为和临床指标调整的模型中,与最高四分位数和最低四分位数相比,心血管事件和全因死亡率的HR(95%CI)为,镉分别为1.25(1.03,1.53)和1.68(1.43,1.96);钨为1.20(1.01,1.42)和1.16(1.01,1.33);铀为1.32(1.08,1.62)和1.32(1.12,1.56);钴为1.24(1.03,1.48)和1.37(1.19,1.58);1.42(1.18,1.21),1.50镉和铜的两个终点均为正线性剂量反应。这6种尿中金属混合物的四分位间距(IQR)增加的校正HR(95%CI)和相应的10年生存概率差异(95%CI)为1.29(1.11,1.56)和-1.1%(-2.0,-0.05),所有原因的死亡率为1.66(1.47,1.91)和-2.0%(-2.6-1.5)。
■这项针对美国成年人的流行病学研究表明,尿中金属含量与CVD风险和死亡率增加有关。这些发现可以为改善心血管健康的新型预防策略的开发提供信息。
UNASSIGNED: Exposure to metals has been associated with cardiovascular disease (CVD) end points and mortality, yet prospective evidence is limited beyond arsenic, cadmium, and lead. In this
study, we assessed the prospective association of urinary metals with incident CVD and all-cause mortality in a racially diverse population of US adults from MESA (Multi-Ethnic
Study of Atherosclerosis).
UNASSIGNED: We included 6599 participants (mean [SD] age, 62.1 [10.2] years; 53% female) with urinary metals available at baseline (2000 to 2001) and followed through December 2019. We used Cox proportional hazards models to estimate the adjusted hazard ratio and 95% CI of CVD and all-cause mortality by baseline urinary levels of cadmium, tungsten, and
uranium (nonessential metals), and cobalt, copper, and zinc (essential metals). The joint association of the 6 metals as mixture and the corresponding 10-year survival probability was calculated using Cox Elastic-Net.
UNASSIGNED: During follow-up, 1162 participants developed CVD, and 1844 participants died. In models adjusted by behavioral and clinical indicators, the HR (95% CI) for incident CVD and all-cause mortality comparing the highest with the lowest quartile were, respectively: 1.25 (1.03, 1.53) and 1.68 (1.43, 1.96) for cadmium; 1.20 (1.01, 1.42) and 1.16 (1.01, 1.33) for tungsten; 1.32 (1.08, 1.62) and 1.32 (1.12, 1.56) for
uranium; 1.24 (1.03, 1.48) and 1.37 (1.19, 1.58) for cobalt; 1.42 (1.18, 1.70) and 1.50 (1.29, 1.74) for copper; and 1.21 (1.01, 1.45) and 1.38 (1.20, 1.59) for zinc. A positive linear dose-response was identified for cadmium and copper with both end points. The adjusted HRs (95% CI) for an interquartile range (IQR) increase in the mixture of these 6 urinary metals and the corresponding 10-year survival probability difference (95% CI) were 1.29 (1.11, 1.56) and -1.1% (-2.0, -0.05) for incident CVD and 1.66 (1.47, 1.91) and -2.0% (-2.6, -1.5) for all-cause mortality.
UNASSIGNED: This epidemiological
study in US adults indicates that urinary metal levels are associated with increased CVD risk and mortality. These findings can inform the development of novel preventive strategies to improve cardiovascular health.