ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutrition and Metabolism
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1614771
Association between blood cobalt ion concentrations and anemia and cardiovascular diseases: novel evidence of toxicity resulting from metal implants
Provisionally accepted
- 1Second Affiliated Hospital of Jilin University, Changchun, Jilin Province, China
- 2Department of Orthopaedics, China-Japan Union Hospital, Jilin University, Changchun, China
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Background Cobalt ions released from metal objects pose potential systemic toxicity risks, yet comprehensive epidemiological evidence linking blood cobalt ion concentrations with anemia and cardiovascular disease (CVD) remains limited. This study aims to investigate these associations and explores exposure thresholds.Methods Utilizing data from the National Health and Nutrition Examination Survey 2015-2018. Outcomes included anemia, angina pectoris, arrhythmia, heart attack, heart failure, myocardial infarction, and stroke. We first used multivariate linear regression to demonstrate that metal implants are associated with elevated blood cobalt ion concentrations. Afterwards, multivariable logistic regression, restricted cubic splines, and threshold effect analyses were applied to evaluate dose-response relationships between cobalt ion concentrations and disease.Participants with metal implants exhibited 0.42 nmol/L higher blood cobalt concentrations than those without (95% confidence interval [CI]: 0.33-0.51). Each 1 nmol/L increase in cobalt was associated with a 36% higher anemia risk (adjusted odds ratio [OR]: 1.36, 95% CI: 1.31-1.41). Nonlinear relationships were observed for CVD (inflection point: 3.94 nmol/L), with cobalt ion concentrations below this threshold showing stronger associations (OR: 1.27, 95% CI: 1.12-1.45). Cobalt exposure increased risks of angina pectoris, arrhythmia, heart attack, heart failure, and stroke (all P < 0.05), but not myocardial infarction. Stratified analyses revealed heightened susceptibility in males.Conclusions Metal object-derived cobalt exposure demonstrates significant dosedependent associations with anemia and multiple CVD subtypes. These findings underscore the systemic toxicity of cobalt ions and advocate for enhanced clinical surveillance of blood cobalt levels in patients with metal implants.
Keywords: Metal implants, Blood cobalt ion concentrations, Anemia, cardiovascular disease, Epidemiological evidence
Received: 19 Apr 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Xu, Chen, Wang, Tang, Xiao and Qin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jianlin Xiao, Department of Orthopaedics, China-Japan Union Hospital, Jilin University, Changchun, China
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