Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb;25(2):282-293.
doi: 10.1007/s12012-024-09955-1. Epub 2025 Jan 28.

Associations Between Lead and Cadmium Exposure and Subclinical Cardiovascular Disease in U.S. Adults

Lin Liu  1 , Aimin Xu  1   2 , Bernard M Y Cheung  3   4   5   6
Affiliations

Associations Between Lead and Cadmium Exposure and Subclinical Cardiovascular Disease in U.S. Adults

Lin Liu et al. Cardiovasc Toxicol. 2025 Feb.

Abstract

The impact of lead and cadmium exposure on subclinical cardiovascular disease (CVD), indicated by elevated high-sensitivity cardiac troponin (hs-cTnT) and N-terminal pro b-type natriuretic peptide (NT-proBNP) remains uncertain. We analyzed data from participants aged 20 and older, without overt CVD, in the National Health and Nutrition Examination Survey (NHANES; 1999-2004). Elevated lead and cadmium levels were defined as 3.5 μg/dL and 1.0 μg/L (inductively coupled plasma mass spectrometry) and 3.8 μg/dL and 0.9 μg/L (atomic absorption spectrometry), respectively. Elevated hs-cTnT was ≥ 19 ng/L, and elevated NT-proBNP was ≥ 125 pg/mL. Multivariate logistic regression estimated the odds ratios (OR) and 95% confidence intervals (CI) for elevated biomarkers. Among 10,197 participants (mean age 48.8 years; 50.3% female), 5.3% had elevated hs-cTnT and 19.4% had elevated NT-proBNP. Elevated blood lead was associated with increased ORs for elevated hs-cTnT (OR 1.45, 95% CI 1.15-1.84) and NT-proBNP (OR 1.66, 95% CI 1.40-1.97). The corresponding ORs (95% CI) for elevated blood cadmium were 1.33 (1.02, 1.74) and 1.39 (1.18, 1.65). The effect of elevated blood lead on NT-proBNP was particularly pronounced among non-Hispanic Blacks (OR [95% CI], 3.26 [2.24, 4.74]) compared to Mexican Americans (1.46 [0.99, 2.17]) and non-Hispanic Whites (1.31 [1.02, 1.68]) and was stronger in individuals with impaired kidney function (OR [95% CI], 2.31 [1.43, 3.75]) compared to those with normal kidney function (1.44 [1.18, 1.75]). This study first reveals the association between lead and cadmium exposure and subclinical CVD, underscoring the need for targeted preventive measures to reduce cardiovascular risk and improve health outcomes.

Keywords: Cadmium; Heavy metals; Lead; NT-proBNP; Troponin.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no competing interests. Ethical Approval: The survey protocol was approved by the Research Ethics Review Board of the National Center for Health Statistics ( https://www.cdc.gov/nchs/nhanes/irba98.htm ), and NHANES has obtained written informed consent from all participants. Consent for Publication: Not applicable.

Figures

Fig. 1
Fig. 1
Odd Ratios (95% Confidence interval) of Elevated Hs-cTnT and NT-proBNP by Blood Lead and Cadmium. Hs-cTnT, high sensitivity cardiac troponin, NT-proBNP, N-terminal pro b-type natriuretic peptide. Atomic absorption spectrometry was used in NHANES, 1999–2002, inductively coupled plasma mass spectrometry was used in NHANES, 2003–2004. Elevated NT-proBNP was defined as blood NT-proBNP ≥ 125 pg/ml. Elevated hs-cTnT was defined as blood hs-cTnT ≥ 19 ng/L. Restrict cubic spline with knots set at the 25th, 50th, and 75th percentiles were used to fit the models. Model 1 crude model. Model 2 adjusted for age, gender, race/ethnicity, smoking status, systolic blood pressure, body mass index, total cholesterol, hemoglobin A1c, estimated glomerular rate, diabetes, anti-diabetic drug, hypertension, anti-hypertensive drug, and statin.
Fig. 2
Fig. 2
Odd Ratios (95% Confidence interval) of Elevated Hs-cTnT and NT-proBNP by Blood Lead in Subgroups. Odd ratios for elevated lead compared to not elevated were presented. Hs-cTnT, high sensitivity cardiac troponin, NT-proBNP, N-terminal pro b-type natriuretic peptide, BMI, body mass index, eGFR, estimated glomerular rate. Elevated NT-proBNP was defined as blood NT-proBNP ≥ 125 pg/ml. Elevated hs-cTnT was defined as blood hs-cTnT ≥ 19 ng/L. Models were adjusted for age, gender, race/ethnicity, smoking status, systolic blood pressure, body mass index, total cholesterol, hemoglobin A1c, estimated glomerular rate, diabetes, anti-diabetic drug, hypertension, anti-hypertensive drug, and statin. *P value for the interaction term was significant at Bonferroni corrected p value (0.008 for race/ethnicity and 0.05 for eGFR). P-values for Pairwise comparison: Non-Hispanic Black vs. Mexican American, 0.006, Non-Hispanic Black vs. Non-Hispanic White, < 0.001, Non-Hispanic Black vs. Other, < 0.001
Fig. 3
Fig. 3
Odd Ratio (95% Confidence interval) of Elevated Hs-cTnT and NT-proBNP by Blood Cadmium in Subgroups. Odd ratios for elevated cadmium compared to not elevated were presented. Hs-cTnT, high sensitivity cardiac troponin, NT-proBNP, N-terminal pro b-type natriuretic peptide, BMI, body mass index, eGFR, estimated glomerular rate. Elevated NT-proBNP was defined as blood NT-proBNP ≥ 125 pg/ml. Elevated hs-cTnT was defined as blood hs-cTnT ≥ 19 ng/L. Models were adjusted for age, gender, race/ethnicity, smoking status, systolic blood pressure, body mass index, total cholesterol, hemoglobin A1c, estimated glomerular rate, diabetes, anti-diabetic drug, hypertension, anti-hypertensive drug, and statin
See this image and copyright information in PMC

References

    1. Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A. Z., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J., Catapano, A. L., Chugh, S. S., Cooper, L. T., Coresh, J., & Group, G. N. J. G. B. O. C. D. W. (2020). Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 study. Journal of the American College of Cardiology,76(25), 2982–3021. 10.1016/j.jacc.2020.11.010 - PMC - PubMed
    1. Lamas, G. A., Bhatnagar, A., Jones, M. R., Mann, K. K., Nasir, K., Tellez-Plaza, M., Ujueta, F., & Navas-Acien, A. (2023). Contaminant metals as cardiovascular risk factors: A scientific statement from the american heart association. Journal of the American Heart Association,12(13), e029852. 10.1161/jaha.123.029852 - PMC - PubMed
    1. Tchounwou, P. B., Yedjou, C. G., Patlolla, A. K., & Sutton, D. J. (2012). Heavy metal toxicity and the environment. Exp Suppl,101, 133–164. 10.1007/978-3-7643-8340-4_6 - PMC - PubMed
    1. Andersson, C., Enserro, D., Sullivan, L., Wang, T. J., Januzzi, J. L., Jr., Benjamin, E. J., Vita, J. A., Hamburg, N. M., Larson, M. G., Mitchell, G. F., & Vasan, R. S. (2016). Relations of circulating GDF-15, soluble ST2, and troponin-I concentrations with vascular function in the community: The framingham heart study. Atherosclerosis,248, 245–251. 10.1016/j.atherosclerosis.2016.02.013 - PMC - PubMed
    1. Ndumele, C. E., Rangaswami, J., Chow, S. L., Neeland, I. J., Tuttle, K. R., Khan, S. S., Coresh, J., Mathew, R. O., Baker-Smith, C. M., Carnethon, M. R., Despres, J. P., Ho, J. E., Joseph, J. J., Kernan, W. N., Khera, A., Kosiborod, M. N., Lekavich, C. L., Lewis, E. F., Lo, K. B., & American Heart, A. (2023). Cardiovascular-kidney-metabolic health: A presidential advisory from the american heart association. Circulation,148(20), 1606–1635. 10.1161/CIR.0000000000001184 - PubMed

MeSH terms

LinkOut - more resources