According to a study published in JACC, the flagship journal of the American College of Cardiology, metal exposure from environmental pollution has been associated with increased calcium buildup in coronary arteries at a level that is comparable to other traditional risk factors such as smoking.
Considering metal exposure as a risk factor
“Our findings highlight the importance of considering metal exposure as a significant risk factor for atherosclerosis and CVD,” said Katlyn E. McGraw, PhD, a postdoctoral research scientist at Columbia University Mailman School of Public Health and lead author of the study. “This could lead to new prevention and treatment strategies that target metal exposure.”
“This groundbreaking study underscores the critical associations of metal exposure from environmental pollution to cardiovascular health,” said Harlan M. Krumholz, the Harold H. Hines, Jr. Professor at Yale and Editor-in-Chief of JACC. “It challenges us to broaden our approach to CVD prevention beyond traditional risk factors and to advocate for stronger environmental regulations, and it underscores the need for continued research in this critical area.”
Atherosclerosis occurs when the arteries become narrowed and hardened due to plaque buildup, this can restrict blood flow and cause clots to form. Atherosclerosis is an underlying cause of stroke, heart attacks, and peripheral artery disease, the most common forms of cardiovascular disease. Additionally, Atherosclerosis causes coronary artery calcium which can be non-invasively measured to predict cardiac events.
While exposure to environmental pollutants like metals is a newly recognized risk factor for cardiovascular disease, there isn’t much research on its association with coronary artery calcium. This study investigated how urinary metal levels, biomarkers of metal exposure, and internal doses of metals impact coronary artery calcium.
Measuring urinary metals
For this study data was utilized from the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort of 6,418 participants between the ages of 45 to 84 years old who were free of any clinical cardiovascular diseases to measure urinary metals levels. Both non-essential (cadmium, tungsten, uranium) and essential (cobalt, copper, zinc) metals were examined which are common in American populations and associated with cardiovascular disease.
According to the researchers, their findings provided adequate evidence that metal exposure may be associated with atherosclerosis over 10 years by increasing coronary calcification, and the associations between metals and coronary artery calcium progression were comparable to those for traditional risk factors (like smoking, diabetes, and cholesterol).
When comparing the highest to the lowest quartile of urinary cadmium, coronary artery calcium levels were 51% higher at baseline and 75% higher over the 10-year time frame. For urinary tungsten, uranium, and cobalt, the corresponding coronary artery calcium levels over the 10-year period were 45%, 39%, and 47% higher, respectively. For copper and zinc, the corresponding estimates dropped from 55% to 33% and from 85% to 57%, respectively, after adjustment for clinical factors.
The urinary metal levels were found to vary by demographic characteristics. Older participants, Chinese participants, and those with less education had higher urinary metal levels. Those from Los Angeles had significantly higher levels of urinary tungsten and uranium, as well as higher levels of cobalt, copper, and cadmium.
Environmental risk to cardiovascular health
“Pollution is the greatest environmental risk to cardiovascular health,” McGraw said. “Given the widespread occurrence of these metals due to industrial and agricultural activities, this study calls for heightened awareness and regulatory measures to limit exposure and protect cardiovascular health.”
“The field of environmental cardiovascular medicine, exemplified by this research, offers an emerging frontier in cardiovascular disease prevention and treatment,” said Sadeer Al-Kindi, MD, Associate Director of Cardiovascular Prevention and Wellness at the Houston Methodist DeBakey Heart and Vascular Center in an accompanying editorial comment. “Addressing environmental risk factors like metal exposure will significantly reduce the global burden of cardiovascular disease and address long-standing health disparities.”
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