Association of Blood Heavy Metal Concentrations with Angiographic Coronary Artery Disease in a Consecutive Single-Center Cardiac Catheterization Cohort

Environmental heavy metal exposure is increasingly recognized as a potentially important but underappreciated contributor to cardiovascular disease, yet its relationship to directly observed coronary artery disease (CAD) remains poorly defined. In this single-center cohort of 52 consecutive adults undergoing cardiac catheterization at an urban Chicago tertiary care center, we paired elemental exposure profiles with direct angiographic assessment in a racially diverse, socioeconomically vulnerable population. While no individual metal independently explained obstructive CAD, circulating metal exposure patterns were more revealing: Bayesian Kernel Machine Regression demonstrated that increasing overall metal burden was associated with worse coronary phenotypes, suggesting that environmental exposures may act collectively rather than in isolation. Lead and mercury emerged as the strongest contributors and were enriched relative to National Health and Nutrition Examination Survey (NHANES) reference populations. Taken together, these findings offer early but meaningful evidence that environmental toxicant burden may represent an underrecognized layer of cardiovascular risk, particularly in urban communities where industrial history, aging infrastructure, and socioeconomic disadvantage intersect. This work highlights the importance of viewing cardiovascular disease not only through the lens of traditional risk factors, but also through the environments in which patients live.