Abstract
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.