The impact of urinary metal exposure on cardiac injury measured by four high-sensitivity troponin assays in US adults: A nationwide cross-sectional study.

BACKGROUND

Existing research primarily focuses on cardiovascular disease risks, with limited studies on the impact of metals on cardiac injury. This study aims to investigate the associations between urinary metal exposure and cardiac injury biomarkers, specifically high-sensitivity cardiac troponin I (Hs-cTnI) and T (Hs-cTnT), in US adults.

METHODS

We analyzed data from 3,865 adults in the National Health and Nutrition Examination Survey (1999-2004) using weighted quantile sum (WQS) regression, quantile g-computation (Qgcomp), multivariate logistic regression, and Bayesian kernel machine regression (BKMR) to examine correlations between 9 urinary metals and cardiac injury biomarkers (Hs-cTnI and Hs-cTnT).

RESULTS

Increased Abbott Hs-cTnI was significantly associated with higher levels of Cd (OR: 1.26, 95% CI: 1.11, 1.42) and lead (Pb) (OR: 1.17, 95% CI: 1.01, 1.34) in multivariate logistic regression. Furthermore, Cd (85.90%), Pb (8.01%), and tungsten (W) (3.34%) were the most weighted metals in the Abbott Hs-cTnI WQS models. For the Qgcomp model analysis of Ortho Hs-cTnI, Siemens Hs-cTnI, Abbott Hs-cTnI, and Hs-cTnT, the positive direction metal was Cd (0.2986, 0.6520, 0.7638 and 0.3648, respectively). Based on the results of BKMR, the components that had the highest conditional posterior inclusion probability of Hs-cTnT were Cd (1.000), and antimony (Sb) (1.000) among metal mixtures. Systolic blood pressure mediated the highest proportion of mediating effects in cardiac injury biomarkers.

CONCLUSION

Altogether, our findings indicate that exposure to a metal combination in the urine is associated with an increased risk of cardiac injury. Meanwhile, this association may be predominantly influenced by Cd.