Associations Between Metals and Nonmetals in Drinking Water, Cardiovascular Events, and Diet

Abstract

Background: Metals and nonmetals in drinking water could potentially influence cardiovascular health. The relationship between poor-quality drinking water, major adverse cardiovascular events (MACE), and diet is not well studied.

Objectives: The aim of this study was to determine whether long-term exposure to metals (copper, manganese, aluminum, zinc, and cadmium) and nonmetals (selenium, sulfate, and nitrate-nitrogen) in drinking water was associated with MACE outcomes, and whether the dietary patterns could modify the association between long-term exposure to low-quality drinking water and MACE.

Methods: Data from a prospective population-based cohort from Yinzhou District, Ningbo (follow-up between 2016 and 2022) were linked to Yinzhou Health Information System. MACE endpoints included acute myocardial infarction (AMI), heart failure, stroke, angina, and cardiovascular death. Effect modification of the associations between exposure and MACE by dietary factors was determined.

Results: In the final cohort of 24,212 participants, 57 had an AMI; 886 developed heart failure; 733 had a stroke; 23 had angina; and 134 had a cardiovascular death. An increased risk of: 1) AMI was seen with exposure to copper, aluminum, cadmium, and selenium; 2) stroke with exposure to zinc, copper, and selenium; 3) angina with exposure to zinc and copper; and 4) cardiovascular death with exposure to zinc and aluminum in drinking water. Consuming fish, white meat, and grain products attenuated MACE outcomes induced by metals and nonmetals in drinking water.

Conclusions: In this study, long-term exposure to higher metallic and nonmetallic elements in drinking water was associated with an increased risk of MACE. Specific dietary patterns modified the associations. Further studies are needed in this area.

Keywords: diet modification; environmental epidemiology; major adverse cardiovascular events (MACE); metals and nonmetals in drinking water.

Graphical abstract

Central Illustration

Diet Modified the Association of Metals and Nonmetals in Drinking Water With MACE Abbreviations as in Figure 1.

Figure 1

Stratified Analyses for Associations of Long-Term Exposure to Metals and Nonmetals in Drinking Water With MACE Incidence by Age, BMI, Education Level, and Income Level (A) HRs for cardiovascular death; (B) HRs for HF; (C) HRs for stroke. The model adjusted for age, education, BMI, annual household income, current smoking status, current alcohol consumption status, current tea consumption, medical history of diabetes and dyslipidemia, vegetable consumption, fruit consumption, marine fish consumption, lake fish consumption, red meat consumption, white meat consumption, and grain product consumption. The dashed line represents HR of 1. AMI and angina were not shown in Figure 1 due to limited cases. AMI = acute myocardial infarction; BMI = body mass index; HF = heart failure; MACE = major adverse cardiovascular events.

Figure 2

The Moderating Effects of Dietary Supplementation on the Prospective Associations of Long-Term Exposure to Metals and Nonmetals in Drinking Water With MACE Incidence (A) HRs for cardiovascular death; (B) HRs for HF; (C) HRs for stroke. The model adjusted for age, education, BMI, annual household income, current smoking status, current alcohol consumption status, current tea consumption, medical history of diabetes and dyslipidemia, vegetable consumption, fruit consumption, marine fish consumption, lake fish consumption, red meat consumption, white meat consumption, and grain product consumption. AMI and angina were not shown in Figure 1 due to limited case. Abbreviations as in Figure 1.