Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2024.07.020 Dr. Katlyn E. McGraw et al.
Points
- The study examined the relationship between metal exposure and coronary artery calcification (CAC) progression, a marker of cardiovascular disease, in 6,418 participants from the Multi-Ethnic Study of Atherosclerosis (MESA).
- Urinary levels of metals such as cadmium, tungsten, uranium, cobalt, copper, and zinc were measured, with CAC tracked over ten years using linear mixed-effect models.
- Higher levels of urinary cadmium, tungsten, uranium, and cobalt were strongly associated with increased CAC, with participants in the highest quartile of cadmium exposure showing a 75% higher CAC over the ten years.
- Copper and zinc also showed associations with CAC, though their effects were attenuated after adjusting for clinical factors.
- The study suggests that metal exposure, both essential and nonessential, may contribute to atherosclerosis progression, comparable to traditional cardiovascular risk factors, and calls for further research on metals as modifiable risk factors for heart disease.
Summary
This study investigates the relationship between metal exposure and coronary artery calcification (CAC) progression, a subclinical marker of cardiovascular disease (CVD). The study involved 6,418 participants from the Multi-Ethnic Study of Atherosclerosis (MESA), who had their urinary levels of metals such as cadmium, tungsten, uranium, cobalt, copper, and zinc measured at baseline, and 1 to 4 repeated measurements of CAC over ten years. Linear mixed-effect models assessed associations between baseline urinary metal levels and CAC at baseline and over time, adjusting for various sociodemographic, clinical, and lifestyle factors.
At baseline, the median CAC score was 6.3, and higher urinary metal levels were associated with significantly elevated CAC levels. Participants in the highest quartile of urinary cadmium had 51% higher CAC at baseline (95% CI: 32%-74%) and 75% higher CAC over the ten years (95% CI: 47%-107%), compared with those in the lowest quartile. Similar increases were observed for tungsten, uranium, and cobalt, with corresponding 10-year increases of 45% (95% CI: 23%-71%), 39% (95% CI: 17%-64%), and 47% (95% CI: 25%-74%), respectively. Copper and zinc also showed associations with CAC, but their estimates were attenuated after adjusting for clinical factors, with copper decreasing from 55% to 33% and zinc from 85% to 57%.
The results suggest that exposure to both nonessential and essential metals is associated with the progression of atherosclerosis, as reflected in increased CAC levels. These associations were comparable to those of traditional CVD risk factors, highlighting the potential role of metal exposure in the progression of coronary artery disease. This study underscores the need for further research into metal exposure as a modifiable risk factor for CVD. It suggests that reducing exposure to certain metals could be a strategy for preventing atherosclerosis progression.
Link to the article: https://www.sciencedirect.com/science/article/pii/S0735109724079610
References McGraw, K. E., Schilling, K., Glabonjat, R. A., Galvez-Fernandez, M., Domingo-Relloso, A., Martinez-Morata, I., Jones, M. R., Nigra, A., Post, W. S., Kaufman, J., Tellez-Plaza, M., Valeri, L., Brown, E. R., Kronmal, R. A., Barr, R. G., Shea, S., Navas-Acien, A., & Sanchez, T. R. (2024). Urinary metal levels and coronary artery calcification: Longitudinal evidence in the multi-ethnic study of atherosclerosis. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2024.07.020
