Epidemiological insights into the risk of valvular heart disease associated with multiple metal and metalloid internal exposure

Valvular heart disease (VHD) is a common cardiovascular disease, particularly among the elderly, and its social burden is increasing with the aging population in China. Numerous studies have shown that trace element imbalances and exposure to metals and metalloids may negatively affect the cardiovascular system. However, studies on the effects of exposure to mixed metals and metalloids on VHD are limited, and the existing evidence is inconsistent. Therefore, we investigated the concentrations of 12 metals and metalloids in the urine of VHD patients and healthy adults from China based on a case-control study, while also exploring the single and combined effects of these metals and metalloids on VHD. The results showed that zinc (Zn) and strontium (Sr) concentrations were the highest in both case and control groups. Compared to controls, VHD patients had significantly higher urinary concentrations of manganese (Mn), cobalt (Co), Zn, cadmium (Cd), mercury (Hg), and lead (Pb), along with lower concentrations of lithium (Li), copper (Cu), and thallium (Tl) (<i>P</i> < 0.05). Furthermore, logistic regression analyses showed that urinary concentrations of Li, Mn, Cu, Zn, Sr, Hg, Tl, and Pb were positively associated with the heightened risk of VHD. The Bayesian Kernel Machine Regression model further revealed a strong positive correlation between multiple metal and metalloid exposure and the incidence of VHD. Notably, Pb and Hg were potential risk factors for VHD, while Li and Cu may be protective factors. More epidemiologic investigations and toxicological studies are needed in the future to explore and validate the negative effects of metals and metalloids on VHD.