ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1588078
The Independent and Combined Effects of Blood Heavy Metal Concentrations on All-Cause Mortality and Cardiovascular Mortality in Adult Patients with Diabetes Mellitus
Provisionally accepted
- 1The Third People’s Hospital of Huizhou, Affiliated Hospital of Guangzhou Medical University, Huizhou, Guangdong Province, China
- 2Huizhou Affiliated Hospital of Sun Yat-sen University, Huizhou, China
- 3Guoyao North Hospital, Baotou, China
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Background: Most epidemiological studies have focused on the association between single metal exposure and cardiovascular disease risk, utilizing a single-pollutant model for analysis. However, multiple metals may interact with each other, leading to misjudgment of health risks. This study sought to ascertain both the independent and combined effects of various blood heavy metal concentrations on all-cause mortality and cardiovascular mortality in patients with DM.Methods: Patients (≥20 years) with DM from the NHANES (2011 - 2018) were selected. To explore the relationships of exposure to individual metals, including cadmium (Cd), mercury (Hg), manganese (Mn), lead (Pb), and selenium (Se), with all-cause mortality and cardiovascular mortality, weighted logistic regression and RCS analysis were leveraged. The WQS model was utilized to estimate the effects of combined blood metal exposures. Results: 1,798 patients with DM were included. In the unadjusted model, ln-transformed blood Pb level (OR = 2.3, 95% CI: 1.70-3.10, p < 0.001) and ln-transformed Cd level (OR = 1.54, 95% CI: 1.27-1.87, p < 0.001) demonstrated positive associations with the all-cause mortality risk. According to RCS analysis, a nonlinear dose-response relationship was noted between Pb, Cd, Se, and the all-cause mortality risk (p-nonlinear < 0.05), while Hg and Mn showed linear relationships (p-nonlinear > 0.05).Conclusion: According to this study, a high blood concentration of a combination of heavy metals is a significant risk factor for both cardiovascular disease and all-cause mortality of patients with diabetes, with Pb contributing a relatively higher proportion to these risks.
Keywords: Heavy metals in blood, Diabetes Mellitus, All-cause mortality, Cardiovascular mortality, Environmental Health
Received: 05 Mar 2025; Accepted: 26 May 2025.
Copyright: © 2025 Cai, Yan, Sun and Dan. 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: Li peng Cai, The Third People’s Hospital of Huizhou, Affiliated Hospital of Guangzhou Medical University, Huizhou, 516002, Guangdong Province, China
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