Environmental heavy metals and cardiovascular diseases: Status and future direction

Synthesis and application of bismuth nanoparticle-loaded longan porous carbon for simultaneous electrochemical determination of Pb(II) and cd(II) in seafoods

The discarded longan shell-derived porous carbon material (LPC) served as a scaffold for synthesizing bismuth nanoparticle-loaded longan porous carbon nanocomposite (BiNPs@LPC) via a hydrothermal method. Then BiNPs@LPC was utilized to modify screen-printed carbon electrodes (SPCE) for simultaneous detection of Pb(II) and Cd(II) by square wave anodic stripping voltammetry (SWASV). The material was thoroughly characterized by scanning electron microscopy, X-ray diffraction, Raman spectra, Brunauer-Emmett-Teller analysis, electrochemical impedance spectroscopy and cyclic voltammetry. BiNPs@LPC exhibited abundant porous structures, high surface area, and numerous active sites, which could improve significantly response sensitivity. Under optimal conditions, the peak currents of Pb(II) and Cd(II) exhibited favorable linear relationships with the concentration within a range of 0.1-150 μg L-1, with detection limits (S/N = 3) of 0.02 μg L-1 and 0.03 μg L-1, respectively. BiNPs@LPC/SPCE demonstrated remarkable selectivity, stability and repeatability. The proposed method was successfully applied for the detection of Pb(II) and Cd(II) in seafoods achieving satisfying recovery of 97.8%-108.3% and 96.7%-106.4%. These excellent test properties were coupled with convenience for batch preparation of the modified electrodes, highlighting its potential for practical applications in heavy metal detection of real samples.

2024 Guidelines of the Taiwan Society of Cardiology on the Primary Prevention of Atherosclerotic Cardiovascular Disease --- Part I

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide and in Taiwan. It is highly prevalent and has a tremendous impact on global health. Therefore, the Taiwan Society of Cardiology developed these best-evidence preventive guidelines for decision-making in clinical practice involving aspects of primordial prevention including national policies, promotion of health education, primary prevention of clinical risk factors, and management and control of clinical risk factors. These guidelines cover the full spectrum of ASCVD, including chronic coronary syndrome, acute coronary syndrome, cerebrovascular disease, peripheral artery disease, and aortic aneurysm. In order to enhance medical education and health promotion not only for physicians but also for the general public, we propose a slogan (2H2L) for the primary prevention of ASCVD on the basis of the essential role of healthy dietary pattern and lifestyles: "Healthy Diet and Healthy Lifestyles to Help Your Life and Save Your Lives". We also propose an acronym of the modifiable risk factors/enhancers and relevant strategies to facilitate memory: " ABC2D2EFG-I'M2 ACE": Adiposity, Blood pressure, Cholesterol and Cigarette smoking, Diabetes mellitus and Dietary pattern, Exercise, Frailty, Gout/hyperuricemia, Inflammation/infection, Metabolic syndrome and Metabolic dysfunction-associated fatty liver disease, Atmosphere (environment), Chronic kidney disease, and Easy life (sleep well and no stress). Some imaging studies can be risk enhancers. Some risk factors/clinical conditions are deemed to be preventable, and healthy dietary pattern, physical activity, and body weight control remain the cornerstone of the preventive strategy.

Investigating the temporal link between PM2.5 exposure and acceleration of myocardial ischemia reperfusion injury: Emphasizing the hazardous presence of metals in inhaled air

Exposure to PM2.5 is widely acknowledged to induce cardiotoxic effects, leading to decreased myocardial tolerance to revascularization procedures and subsequent ischemia reperfusion injury (IR). However, the temporal relationship between PM2.5 exposure and vulnerability to IR, along with the underlying mechanisms, remains unclear and is the focus of this study. Female Wistar rats were exposed to PM2.5 at a concentration of 250 μg/m³ for 3 h daily over varying durations (7, 14, and 21 days), followed by IR induction. Our results demonstrated a significant increase in cardiac injury, as evidenced by increased infarct size and elevated cardiac injury markers, starting from day 14 of PM2.5 exposure, accompanied by declined cardiac function. These adverse effects were associated with apoptosis and impaired mitochondrial function, including reduced bioenergetics, mitochondrial DNA copy number and quality control mechanisms, along with inactivation of the PI3K/AKT/AMPK signalling pathways. Furthermore, analysis of myocardial tissue revealed elevated metal accumulation, particularly within mitochondria. Chelation of PM2.5 -associated metals using EDTA significantly mitigated the toxic effects on cardiac IR pathology, as confirmed in both rat myocardium and H9c2 cells. These findings suggest that metals in PM2.5 play a crucial role in inducing cardiotoxicity, impairing myocardial resilience to stress through mitochondrial accumulation and dysfunction.

Metal mixture exposures and serum lipid levels in childhood: the Rhea mother-child cohort in Greece

BACKGROUND

Growing evidence suggests that cardiovascular disease develops over the lifetime, often beginning in childhood. Metal exposures have been associated with cardiovascular disease and important risk factors, including dyslipidemia, but prior studies have largely focused on adult populations and single metal exposures.

OBJECTIVE

To investigate the individual and joint impacts of multiple metal exposures on lipid levels during childhood.

METHODS

This cross-sectional study included 291 4-year-old children from the Rhea Cohort Study in Heraklion, Greece. Seven metals (manganese, cobalt, selenium, molybdenum, cadmium, mercury, and lead) were measured in whole blood using inductively coupled plasma mass spectrometry. Serum lipid levels included total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol. To determine the joint and individual impacts of child metal exposures (log2-transformed) on lipid levels, Bayesian kernel machine regression (BKMR) was employed as the primary multi-pollutant approach. Potential effect modification by child sex and childhood environmental tobacco smoke exposure was also evaluated.

RESULTS

BKMR identified a positive association between the metal mixture and both total and LDL cholesterol. Of the seven metals examined, selenium (median 90.6 [IQR = 83.6, 96.5] µg/L) was assigned the highest posterior inclusion probability for both total and LDL cholesterol. A difference in LDL cholesterol of 8.22 mg/dL (95% CI = 1.85, 14.59) was observed when blood selenium was set to its 75th versus 25th percentile, holding all other metals at their median values. In stratified analyses, the positive association between selenium and LDL cholesterol was only observed among boys or among children exposed to environmental tobacco smoke during childhood.

IMPACT STATEMENT

Growing evidence indicates that cardiovascular events in adulthood are the consequence of the lifelong atherosclerotic process that begins in childhood. Therefore, public health interventions targeting childhood cardiovascular risk factors may have a particularly profound impact on reducing the burden of cardiovascular disease. Although growing evidence supports that both essential and nonessential metals contribute to cardiovascular disease and risk factors, such as dyslipidemia, prior studies have mainly focused on single metal exposures in adult populations. To address this research gap, the current study investigated the joint impacts of multiple metal exposures on lipid concentrations in early childhood.

Heavy Metal Exposure and Cardiovascular Disease

Heavy metals are harmful environmental pollutants that have attracted widespread attention due to their health hazards to human cardiovascular disease. Heavy metals, including lead, cadmium, mercury, arsenic, and chromium, are found in various sources such as air, water, soil, food, and industrial products. Recent research strongly suggests a connection between cardiovascular disease and exposure to toxic heavy metals. Epidemiological, basic, and clinical studies have revealed that heavy metals can promote the production of reactive oxygen species, which can then exacerbate reactive oxygen species generation and induce inflammation, resulting in endothelial dysfunction, lipid metabolism distribution, disruption of ion homeostasis, and epigenetic changes. Over time, heavy metal exposure eventually results in an increased risk of hypertension, arrhythmia, and atherosclerosis. Strengthening public health prevention and the application of chelation or antioxidants, such as vitamins and beta-carotene, along with minerals, such as selenium and zinc, can diminish the burden of cardiovascular disease attributable to metal exposure.

Impact of welding occupation on serum aluminium level and its association with physical health, cognitive function, and quality of life: a cross-sectional study

OBJECTIVE

There is an occupational health concern about welders' inhalation of toxic aluminium fumes. We investigated whether serum aluminium level (SAL) and demographic variables can significantly predict physical health parameters, cognition, and quality of life (QoL) among welders.

METHODS

The cross-sectional study involved 100 age- and location-matched men (50 welders and 50 non-welders). SAL obtained using a graphite furnace atomic absorption spectrometer, and data collected using blood pressure and body mass index (BMI) apparatuses, biodata form, pain rating scale, General Practitioner Assessment of Cognition, WHOQoL-BREF, and Nordic musculoskeletal symptoms (MSS) questionnaire were analysed using independent samples t test, chi-square, Pearson's correlation, and hierarchical linear regression.

RESULTS

Welders had significantly higher SAL (mean difference [MD] = 1.77 µg/L, p < 0.001), lower QoL (MD = 3.92, p = 0.039), and higher prevalence of MSS on the neck (χ2 = 10.187, p = 0.001), shoulder (χ2 = 9.007, p = 0.003), upper back (χ2 = 6.832, p = 0.009), and knee (χ2 = 12.190, p < 0.001) than non-welders. There was a significant bivariate association between SAL, systolic blood pressure (β = 0.313, p = 0.002), and BMI (β = 0.279, p = 0.005), but not pain intensity, cognition, or QoL. SAL remained a significant predictor of systolic blood pressure after adjustment for physical health and QoL parameters (β = 0.191, p = 0.044). The association between SAL and social QoL became significant after adjustment for physical health and other QoL domains (β = - 0.210, p = 0.032) and demographic variables (β = - 0.233, p = 0.046).

CONCLUSION

Welders had significantly higher SAL, musculoskeletal symptoms, blood pressure, and lower QoL than non-welders. SAL was associated with adverse physical health parameters and social-related QoL, not cognition. We recommend routine aluminium bioavailability and physical health checks among welders.

Potentially toxic elements in soil-plant-water-animal continuum in a mining area from Northwestern Mexico: animal exposure pathways and health risks for children

Mining increases environmental concentrations of potentially toxic elements (PTEs) accumulating in organisms and spreading in the human food chain-their presence in milk is of great human health concern. Pathways were identified by which these elements reach raw milk from farms within a mining area in Northwestern Mexico; health risks for dairy cattle and children were also evaluated. Water from river and cattle waterers, as well as, soils showed that PTE concentrations generally below the Mexican and international limits; cattle forage concentrations were above the World Health Organization limits. Al, Mg, Mo, Ni and Zn were recorded in raw milk samples from the mining area, showing that Cd, Co, Cr, Cu, Pb and V are transferred from soil to plants but not accumulated in raw milk. Zn concentrations in raw milk exceeded the permissible limit; milk from farms without mining operations (comparison site) showed the presence of Al, Cr and Cu. In cattle tail hair, PTE did not correlate with raw milk concentrations. Metal accumulation in milk was higher through water consumption than that accumulated through forage consumption. Daily intakes (DI) of Al, Mg and Zn in cows could represent a risk for their health. The observed biotransference was higher than in other parts of Mexico, and the calculated DI and hazard quotients indicate no adverse health effects for children. However, the hazard Index values indicate that exposure to multiple PTE represents a risk for children. Management measures should be performed to control the cumulative risks to protect young children's health.

Blood Homocysteine Levels Mediate the Association Between Blood Lead Levels and Cardiovascular Mortality

Lead is a heavy, toxic metal and its exposure to humans can lead to increased risk of cardiovascular disease development and mortality. Lead exposure has been shown to induce hyperhomocysteinemia (HHCy) which may be a major pathogenic risk for the risk of CVDs. The aim of this study was to investigate whether homocysteine (Hcy) mediates the effect of lead on cardiovascular mortality. A total of 17,915 adults aged ≥ 20 who participated in the National Health and Nutrition Examination Survey (1999 to 2006). Information on mortality was ascertained via probabilistic matching to the death certificates from the National Death Index recorded up to December 31, 2015. Cox proportional hazards regression was performed to assess the association between blood lead levels and mortality. Mediation via Hcy was examined using a logit model. During a mean follow-up of 11.6 years, the incidences of CVD mortality were 0.73, 2.18, 3.03 and 4.94 per 1000 person-years across quarterlies of blood lead levels from low to high. Following multivariable adjustment, blood lead levels were strongly associated with CVD mortality in all mortality models (p-trend < 0.001). This association remained statistically significant after further adjusting for quartiles of homocysteine (model 3; HR 1.38 (95% CI 1.01-1.89) p-trend < 0.001). Furthermore, blood lead levels increased the odds of CVD mortality via homocysteine (indirect effect) (OR 1.42 (95% CI 1.30-1.55)), demonstrating the mediatory effect of homocysteine. This the first study that demonstrates that increased homocysteine mediates nearly half of CVD mortality related to blood lead levels.

Pollutants in aquatic system: a frontier perspective of emerging threat and strategies to solve the crisis for safe drinking water

Water is an indispensable natural resource and is the most vital substance for the existence of life on earth. However, due to anthropogenic activities, it is being polluted at an alarming rate which has led to serious concern about water shortage across the world. Moreover, toxic contaminants released into water bodies from various industrial and domestic activities negatively affect aquatic and terrestrial organisms and cause serious diseases such as cancer, renal problems, gastroenteritis, diarrhea, and nausea in humans. Therefore, water treatments that can eliminate toxins are very crucial. Unfortunately, pollution treatment remains a difficulty when four broad considerations are taken into account: effectiveness, reusability, environmental friendliness, and affordability. In this situation, protecting water from contamination or creating affordable remedial techniques has become a serious issue. Although traditional wastewater treatment technologies have existed since antiquity, they are both expensive and inefficient. Nowadays, advanced sustainable technical approaches are being created to replace traditional wastewater treatment processes. The present study reviews the sources, toxicity, and possible remediation techniques of the water contaminants.

Heavy Metal Pollution in the Environment and Its Impact on Health: Exploring Green Technology for Remediation

Along with expanding urbanization and industrialization, environmental pollution which negatively affects the surroundings, has been rising quickly. As a result, induces heavy metal contamination which poses a serious threat to living organisms of aquatic and soil ecosystems. Therefore, they are a need to ameliorate the effects cost by cost pollution on the environment. In this review, we explore methods employed to mitigate the effects caused by heavy metals on the environment. Many techniques employed to manage environmental pollution are tedious and very costly, necessitating the use of alternative management strategies to resolve this challenge. In this concept, bioremediation is viewed as a future technique, due to its environmental friendliness and cost-effective measures aligned with sustainable or climate-smart agriculture to manage contaminants in the environment. The technique involves the use of living entities such as bacteria, fungi, and plants to deteriorate toxic substances from the rhizosphere. Currently, bioremediation is thought to be the most practical, dependable, environmentally benign, and long-lasting solution. Although bioremediation involves different techniques, they are still a need to find the most efficient method for removing toxic substances from the environment. This review focuses on the origins of heavy metal pollution, delves into cost-effective and green technological approaches for eliminating heavy metal pollutants from the environment, and discusses the impact of these pollutants on human health.

Oxidative potential of metal-polluted urban dust as a potential environmental stressor for chronic diseases

Oxidative stress (OS) associated with metals in urban dust has become a public health concern. Chronic diseases linked to general inflammation are particularly affected by OS. This research analyzes the spatial distribution of metals associated with OS, the urban dust´s oxidative potential (OP), and the occurrence of diseases whose treatments are affected by OS. We collected 70 urban dust samples during pre- and post-monsoon seasons to achieve this. We analyzed particle size distribution and morphology by scanning electron microscopy, as well as metal(loid)s by portable X-ray fluorescence, and OP of dust in artificial lysosomal fluid by using an ascorbic acid depletion assay. Our results show that the mean concentration of Fe, Pb, As, Cr, Cu, and V in pre-monsoon was 83,984.6, 98.4, 23.5, 165.8, 301.3, and 141.9 mg kg^-1, while during post-monsoon was 50,638.8, 73.9, 16.7, 124.3, 178.9, and 133.5 mg kg^-1, respectively. Impoverished areas with the highest presence of cardiovascular, cancer, diabetes, and respiratory diseases coincide with contaminated areas where young adults live. We identified significant differences in the OP between seasons. OP increases during the pre-monsoon (from 7.8 to 237.5 nmol AA min^-1) compared to the post-monsoon season (from 1.6 to 163.2 nmol AA min^-1). OP values are much higher than measured standards corresponding to contaminated soil and urban particulate matter, which means that additional sources beside metals cause the elevated OP. The results show no risk from chronic exposure to metals; however, our results highlight the importance of studying dust as an environmental factor that may potentially increase oxidative stress.

Disease-associated metabolic pathways affected by heavy metals and metalloid

Increased exposure to environmental heavy metals and metalloids and their associated toxicities has become a major threat to human health. Hence, the association of these metals and metalloids with chronic, age-related metabolic disorders has gained much interest. The underlying molecular mechanisms that mediate these effects are often complex and incompletely understood. In this review, we summarize the currently known disease-associated metabolic and signaling pathways that are altered following different heavy metals and metalloids exposure, alongside a brief summary of the mechanisms of their impacts. The main focus of this study is to explore how these affected pathways are associated with chronic multifactorial diseases including diabetes, cardiovascular diseases, cancer, neurodegeneration, inflammation, and allergic responses upon exposure to arsenic (As), cadmium (Cd), chromium (Cr), iron (Fe), mercury (Hg), nickel (Ni), and vanadium (V). Although there is considerable overlap among the different heavy metals and metalloids-affected cellular pathways, these affect distinct metabolic pathways as well. The common pathways may be explored further to find common targets for treatment of the associated pathologic conditions.

Short-term exposure to some heavy metals carried with PM10 and cardiovascular system biomarkers during dust storm

This study aimed to evaluate the effect of short-term exposure to heavy metals (HM) extracted from PM10 on CB in workers' population in an outdoor space located in southern Iran during a dust storm. At first, 44 healthy and non-smoking workers were selected. Then PM10 and Blood samples were collected before and after the dust storm. Finally, HMs associated with PM10 measured by ICP-MS and its effect on the CB, including fibrinogen, CRP, TNF-α, and BP were estimated by ANOVA, Pearson correlation, and Odd Ratio (OR) in SPSS23. Based on the results, the concentration of PM10 and extracted HM such as Cr, As, and Cd was higher than the WHO/EPA standards in dust storms they increased the CB and BP remarkably. Moreover, the level of fibrinogen, blood pressure (BP) and TNF-α in dust storms were higher than in normal conditions (p < 0.05, OR > 3). In addition, As and Cd decreased fibrinogen concentration and systolic BP, respectively. Whereas, TNF-α was associated with concentration of Pb (R = - 0.85) on normal days. Consequently, the HM on PM10 such as As, interferes with the level of investigated CB. These results considered a potential risk for the residents in the southern regions of Iran.

Chemical characteristics of bottom ash from biomedical waste incinerators in Ghana

Biomedical waste (BMW) incineration is the most used alternative disposal method in developing countries, such as Ghana. The improper disposal of incinerator-generated bottom ash (BA) is a significant concern due to the hazardous nature of waste. A study was conducted at Tema Hospital (TGH) and Asuogyaman Hospital (VRAH) incinerator sites. The BA samples were sent to the Council for Scientific and Industrial Research, Institute of Industrial Research, Ghana. The BA samples were weighed with fisher analytical balance, ground, and sieved with standard grade meshes of 120, 100, and 80 to determine the BA particle size distribution. The chemical composition and heavy metals were analysed using X-ray fluorescence spectrometry (XRF) and atomic absorption spectroscopy (AAS) techniques. The results indicated the chemical composition of the analysed BA samples was CaCO₃ (49.90%), CaO (27.96%) and MgCO₃ (6.02%) for TGH and CaCO₃ (48.30%), CaO (27.07%), and SiO₂ (6.10%) for VRAH, respectively. The mean concentration (M) (kg m^-3) and standard deviation (SD) for TGH in the BA were 7.082 ± 0.478 (Ti), 4.657 ± 0.127 (Zn) and 4.271 ± 1.263 (Fe), while that of VRAH consisted of 10.469 ± 1.588 (Ti), 7.896 ± 2.154 (Fe) and 4.389 ± 0.371 (Zn). Therefore, the heavy metals' mean concentration at the BA is above the WHO permissible limits of soil, i.e., 0.056 kg m^-3 (Ti), 0.085 kg m^-3 (Pb), 0.100 kg m^-3 (Cr) and 0.036 kg m^-3 (Cu). Furthermore, the heavy metal mean concentrations of TGH and VRAH present in the BA analysed samples were ranked in descending order: Ti > Zn > Fe and Ti > Fe > Zn, respectively. It is therefore recommended that BA must be properly disposed of because of the hazardous nature of heavy metals present in the analysed samples, which are able to cause environmental and public health issues.

Metallomics in pulmonary arterial hypertension patients

Pulmonary arterial hypertension (PAH) prevalence is increasing worldwide, and the prognosis is poor with 5-year survival < 50% in high risk patients. The relationship between metal exposure/essential metal dyshomeostasis and PAH/right ventricular dysfunction is less investigated. The aim of this study is to investigate vegetable consumptions and metal levels between PAH patients and controls. This was a prospective, single center pilot study. Questionnaires were completed by all study subjects (20 PAH patients and 10 healthy controls) on smoking, metal exposure risks, metal supplements, and vegetable consumptions. Blood and urine samples were collected to measure 25 metal levels in blood, plasma, and urine using an X Series II quadrupole inductively coupled plasma mass spectrometry. Statistical analysis was conducted using SAS 9.5 and results with p value < 0.05 were considered significant. Vegetables consumptions (broccoli risk ratio [RR] = 0.4, CI = (0.2, 0.9)], cabbage [RR = 0.2, CI = (0.1, 0.8)], and brussel sprouts [RR = 0.2, CI = (0.1, 0.5)]) are associated with less risks of PAH. In the plasma samples, silver (p < 0.001), and copper (p = 0.002) levels were significantly higher in PAH patients. There was significant positive correlation between cardiac output and cardiac index with plasma levels of silver (r = 0.665, p = 0.001 and r = 0.678 p = 0.001), respectively. There was significant correlation between mixed venous saturation, 6-min walk distance, and last BNP with plasma levels of chromium (r = -0.520, p = 0.022; r = -0.55, p = 0.014; r = 0.463, p = 0.039), respectively. In conclusion, there are significant differences between PAH and control groups in terms of vegetable consumptions and metal concentrations. Silver and chromium levels are correlated with clinical indicators of PAH severities.

Association of Blood Heavy Metal Exposure with Atherosclerotic Cardiovascular Disease (ASCVD) Among White Adults: Evidence from NHANES 1999-2018

Cardiovascular diseases (CVD) are main public health concerns highly prevalent in industrialized societies where human health is threatened by a series of environmental pollutants, particularly heavy metal contaminants. We aimed to find out if blood heavy metals are associated with the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) in a nationally representative sample of US adults. We analyzed the cross-sectional data on blood heavy metals of 3268 non-Hispanic white participants aged 40-79 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. We introduced a risk estimation algorithm, namely the 2013 Pooled Cohort Equations (PCE), to assess the risk for ASCVD over a 10-year period. The 10-year risk for ASCVD was categorized as either reduced risk (< 7.5% risk) or elevated risk (≥ 7.5% risk). Blood lead, cadmium, and mercury were distributed into four quartiles. We used weighted multivariate logistic regression models and restricted cubic spline (RCS) regression to detect the association of blood heavy metal exposure with 10-year ASCVD risk. Following the adjustment of covariates, the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for elevated 10-year ASCVD risk for participants from the highest quartiles were 4.50 (2.88-7.02), 2.59 (1.68-4.00), and 1.06 (0.66-1.71) for blood cadmium, lead, and mercury compared to the lowest quartiles, respectively. The RCS plot demonstrated that blood cadmium was linearly and positively associated with 10-year ASCVD risk (P for nonlinearity = 0.112). According to our findings, non-Hispanic whites aged 40-79 years had a greater 10-year ASCVD risk as their blood lead and cadmium levels increased. Consequently, when establishing approaches for ASCVD prevention, blood heavy metals should be considered.

Metal Exposure, Smoking, and the Risk of COPD: A Nested Case-Control Study in a Chinese Occupational Population

Chronic obstructive pulmonary disease (COPD) was the third leading cause of death worldwide in 2019, with a significant disease burden. We conducted a nested case-control study using data from the China Metal-Exposed Workers Cohort Study (Jinchang Cohort) and assessed the associations of exposure to metals and tobacco smoking with the risk of COPD. We used the logistic regression model and the interaction multiplication model to assess the independent and combined effects of heavy metal and smoke exposure on COPD. The cumulative incidence of COPD was 1.04% in 21,560 participants during a median of two years of follow-up. The risk of COPD was significantly elevated with an increase in the amount of tobacco smoked daily (p < 0.05), the number of years of smoking (p_trend < 0.05), and the number of packs of cigarettes smoked per year (p_trend < 0.01). Compared with the low metal exposure group, the adjusted OR was 1.22 (95% CI: 0.85-1.76) in the medium exposure group (mining/production workers) and 1.50 (95% CI: 1.03-2.18) in the high exposure group; smoking and metal exposure had a combined effect on the incidence of COPD (p_interaction < 0.01), with an OR of 4.60 for those with >40 pack-years of smoking who also had the highest metal exposures. Both exposures to metals and smoking were associated with the risk of COPD, and there was an interaction between the two exposures for the risk of COPD.

Dietary Inflammatory Index and Cardiometabolic Risk in Ecuadorian School-Age Children

BACKGROUND

Cardiometabolic diseases and metabolic syndrome (MetS) are becoming increasingly prevalent in low- and middle-income countries (LMICs). Cardiometabolic diseases and MetS are closely associated with low-grade systemic inflammation, which may be modified by diet. Previous studies have focused on the association of dietary inflammation with MetS and cardiometabolic risk in adult populations, but few studies have examined this issue in children, especially in LMICs.

METHODS

We conducted a cross-sectional study to explore the association of dietary inflammation with cardiometabolic risk components and MetS in urban Ecuadorian children aged 6-12 years old (n = 276). A semi-quantitative food frequency questionnaire (FFQ) was used to collect data on child dietary intake. Dietary inflammation was evaluated using an energy-adjusted Dietary Inflammatory Index (DII), divided into quartiles. Data were also collected on cardiometabolic risk indicators including blood lipids, blood pressure (BP), blood glucose, body mass index, and waist circumference. Data were analyzed using multivariable linear and logistic regression.

RESULTS

Child DII scores ranged from -4.87 (most anti-inflammatory) to 4.75 (most pro-inflammatory). We transformed the continuous scores into quartiles (Q): Q1 was the most anti-inflammatory (-4.87 to -3.35), Q2 was anti-inflammatory (-3.34 to -1.45), Q3 was pro-inflammatory (-1.44 to 1.08), and Q4 was the most pro-inflammatory (1.09 to 4.75). In the covariate-adjusted model, DII scores were positively associated with total blood cholesterol (p = 0.027), triglycerides (p = 0.034), and diastolic BP (p = 0.013). In addition, for every one-unit increase in DII score, MetS increased by 1.20 in the covariate-adjusted model (95% CI = 1.01,1.43).

CONCLUSIONS

The findings suggest that more pro-inflammatory diets may contribute to poorer cardiometabolic health in school-age children. This is important because even small increases in child blood pressure, blood cholesterol, and glucose levels over time can damage health and lead to earlier progression to conditions such as hypertension and atherosclerosis.

Indoor Secondary Pollutants Cannot Be Ignored: Third-Hand Smoke

Smoking has been recognized by the World Health Organization (WHO) as the fifth highest threat to humanity. Smoking, a leading disease promoter, is a major risk factor for non-communicable diseases (NCDs) such as cancer, cardiovascular disease, diabetes, and chronic respiratory diseases. NCDs account for 63% of all deaths worldwide. Passive smoking is also a health risk. Globally, more than a third of all people are regularly exposed to harmful smoke. Air pollution is a common global problem in which pollutants emitted into the atmosphere undergo a series of physical or chemical reactions to produce various oxidation products, which are often referred to as secondary pollutants. Secondary pollutants include ozone (O₃), sulfur trioxide (SO₃), nitrogen dioxide (NO₂), and respirable particulate matter (PM). It is worth mentioning that third-hand smoke (THS), formed by the reaction of nicotine with second-hand smoke (SHS) caused by indoor O₃ or nitrous acid (HONO), is a major indoor secondary pollutant that cannot be ignored. As a form of indoor air pollution that is relatively difficult to avoid, THS exists in any corner of the environment where smokers live. In this paper, we summarize the important research progress on the main components, detection, and toxicity of THS and look forward to future research directions. Scientific understanding of THS and its hazards will facilitate smoking bans in indoor and public places and raise public concern for how to prevent and remove THS.

Comparison of the Concentrations of Heavy Metals in PM2.5 Analyzed in Three Different Global Research Institutions Using X-ray Fluorescence

This inter-lab study aimed to evaluate the comparability of heavy metal concentrations in the same samples using three X-ray fluorescence spectrometers (XRFs) in three different global re-search institutions, namely a collaboration lab between Soonchunhyang University (Asan, Korea). and PAN (a branch of Malvern PANalytical, Seoul, Korea), RTI (Research Triangle Institute, NC, U.S.A), and Aerosol laboratory in Harvard University, Boston, U.S.A. Indoor air filter samples were collected from 8 homes using 3 filters in each household (n = 24) of individuals with asthma, and the same filter samples were sequentially analyzed separately in the collaboration lab Soonchunhyang-PAN, Harvard University, and RTI. Results showed the detection rates of most heavy metals (n = 25 metals) across the three institutions to be approximately 90%. Of the 25 metals, 16 showed coefficient of determination (R²) 0.7 or higher (10 components had 0.9 or higher) implying high correlation among institutions. Therefore, this study demonstrated XRF as a useful device, ensuring reproducibility and compatibility in the measurement of heavy metals in PM2.5, collected from indoor air filters of asthmatics’ residents.

Identifying Effects of Urinary Metals on Type 2 Diabetes in U.S. Adults: Cross-Sectional Analysis of National Health and Nutrition Examination Survey 2011-2016

Growing evidence supports the associations of metal exposures with risk of type 2 diabetes (T2D), but the methodological limitations overlook the complexity of relationships within the metal mixtures. We identified and estimated the single and combined effects of urinary metals and their interactions with prevalence of T2D among 3078 participants in the NHANES 2011-2016. We analyzed 15 urinary metals and identified eight metals by elastic-net regression model for further analysis of the prevalence of T2D. Bayesian kernel machine regression and the weighted quantile sum (WQS) regression models identified four metals that had greater importance in T2D, namely cobalt (Co), tin (Sn), uranium (U) and strontium (Sr). The overall OR of T2D was 1.05 (95% CI: 1.01-1.08) for the positive effects and 1.00 (95% CI: 0.98-1.02) for the negative effect in the WQS models. We observed positive (Poverall = 0.008 and Pnon-linear = 0.100 for Co, Poverall = 0.011 and Pnon-linear = 0.138 for Sn) and inverse (Poverall = 0.001, Pnon-linear = 0.209 for Sr) linear dose-response relationships with T2D by restricted cubic spline analysis. Both additive and multiplicative interactions were found in urinary Sn and Sr. In conclusion, urinary Co, Sn, U and Sr played important roles in the development of T2D. The levels of Sn might modify the effect of Sr on T2D risk.

Exposure to Metal Mixtures in Association with Cardiovascular Risk Factors and Outcomes: A Scoping Review

Since the National Institute of Environmental Health Sciences (NIEHS) declared conducting combined exposure research as a priority area, literature on chemical mixtures has grown dramatically. However, a systematic evaluation of the current literature investigating the impacts of metal mixtures on cardiovascular disease (CVD) risk factors and outcomes has thus far not been performed. This scoping review aims to summarize published epidemiology literature on the cardiotoxicity of exposure to multiple metals. We performed systematic searches of MEDLINE (PubMed), Scopus, and Web of Science to identify peer-reviewed studies employing statistical mixture analysis methods to evaluate the impact of metal mixtures on CVD risk factors and outcomes among nonoccupationally exposed populations. The search was limited to papers published on or after 1998, when the first dedicated funding for mixtures research was granted by NIEHS, through 1 October 2021. Twenty-nine original research studies were identified for review. A notable increase in relevant mixtures publications was observed starting in 2019. The majority of eligible studies were conducted in the United States (n = 10) and China (n = 9). Sample sizes ranged from 127 to 10,818. Many of the included studies were cross-sectional in design. Four primary focus areas included: (i) blood pressure and/or diagnosis of hypertension (n = 15), (ii) risk of preeclampsia (n = 3), (iii) dyslipidemia and/or serum lipid markers (n = 5), and (iv) CVD outcomes, including stroke incidence or coronary heart disease (n = 8). The most frequently investigated metals included cadmium, lead, arsenic, and cobalt, which were typically measured in blood (n = 15). The most commonly utilized multipollutant analysis approaches were Bayesian kernel machine regression (BKMR), weighted quantile sum regression (WQSR), and principal component analysis (PCA). To our knowledge, this is the first scoping review to assess exposure to metal mixtures in relation to CVD risk factors and outcomes. Recommendations for future studies evaluating the associations of exposure to metal mixtures with risk of CVDs and related risk factors include extending environmental mixtures epidemiologic studies to populations with wider metals exposure ranges, including other CVD risk factors or outcomes outside hypertension or dyslipidemia, using repeated measurement of metals to detect windows of susceptibility, and further examining the impacts of potential effect modifiers and confounding factors, such as fish and seafood intake.

Impacts of Environmental Insults on Cardiovascular Aging

PURPOSE OF REVIEW

With cardiovascular disease (CVD) being the top cause of deaths worldwide, it is important to ensure healthy cardiovascular aging through enhanced understanding and prevention of adverse health effects exerted by external factors. This review aims to provide an updated understanding of environmental influences on cardiovascular aging, by summarizing epidemiological and mechanistic evidence for the cardiovascular health impact of major environmental stressors, including air pollution, endocrine-disrupting chemicals (EDCs), metals, and climate change.

RECENT FINDINGS

Recent studies generally support positive associations of exposure to multiple chemical environmental stressors (air pollution, EDCs, toxic metals) and extreme temperatures with increased risks of cardiovascular mortality and morbidity in the population. Environmental stressors have also been associated with a number of cardiovascular aging-related subclinical changes including biomarkers in the population, which are supported by evidence from relevant experimental studies. The elderly and patients are the most vulnerable demographic groups to majority environmental stressors. Future studies should account for the totality of individuals' exposome in addition to single chemical pollutants or environmental factors. Specific factors most responsible for the observed health effects related to cardiovascular aging remain to be elucidated.

Environmental exposure to metals and the risk of high blood pressure: a cross-sectional study from NHANES 2015-2016

Exposure to metal pollution can be caused from inhalation, ingestion, or absorption from air, water, or food. Chronic exposure to trace amounts of metals can lead to high blood pressure, or hypertension, and other chronic diseases. The rationale of our study was to determine if there was a correlation between nineteen forms of urinary metal concentrations and high blood pressure, defined as ≥ 130 mm Hg systolic or ≥ 80 mm Hg diastolic, in the adult US population, to understand the possible impacts of metal exposure on humans. Five types of urinary arsenic species and fourteen types of urinary metals were studied to examine their correlation with high blood pressure. We used the dataset from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) for the study. A specialized complex survey design analysis package was used in analyzing the NHANES data. We used pairwise t tests and the logit regression models to study the correlation between urinary arsenic (five types) and urinary metal (fourteen types) concentrations and high blood pressure. The total study population analyzed included 4037 adults aged 20 years and older, of whom 57.9% of males and 51.7% of females had high blood pressure. Urinary arsenous acid (OR: 2.053, 95% CI: 1.045, 4.035), tin (OR: 1.983, 95% CI: 1.169, 3.364), and cesium (OR: 2.176, 95% CI: 1.013, 4.675) were associated with increased odds of high blood pressure. The other four types of urinary arsenic and twelve types of urinary metals were not associated with high blood pressure. Our results determined that exposure to environmental metals such as arsenous acid, tin, and cesium can be associated with high blood pressure. Further investigation is suggested to support our findings.

Disorders of the Reproductive Health of Cattle as a Response to Exposure to Toxic Metals

The aim of this review is to comprehensively present disorders of the reproductive system in cattle exposed to contact with toxic metals. Toxic metals are a common environmental pollutant and can come from mines, smelters, fossil fuel combustion, or volcanic eruptions. Metals have the ability to bioaccumulate in living organisms, thus contaminating the food chain and may pose a threat to humans. They accumulate mainly in the liver and kidneys, but also in muscles and fat tissue. Toxic metals such as lead (Pb), arsenic (As), mercury (Hg), and cadmium (Cd) have a negative impact on the fertility of animals; they can lead to abortions, premature calving, or oocyte dysfunction. Moreover, in the male reproductive system, they disrupt spermatogenesis, and cause apoptosis of sperm and oxidative damage. The main source of exposure of livestock to toxic metals is through the consumption of feed or contaminated water. It is important to monitor the level of heavy metals in animal products to prevent human poisoning. Toxic metal biomonitoring can be performed by testing urine, blood, milk, plasma, or hair. Chromium (Cr), arsenic (As), and cadmium (Cd) are excreted in the urine, while lead can be detected by examining the blood of animals, while in milk, arsenic (As), cadmium (Cd), nickel (Ni), and lead (Pb) can be detected. Moreover, toxic metals do not biodegrade in the environment. To purify soil and waters, remediation methods, e.g., biological or chemical, should be used.

Low-level lead exposure promotes hepatic gluconeogenesis and contributes to the elevation of fasting glucose level

BACKGROUND

Lead (Pb) is considered an endocrine-disrupting chemical. However, few studies have investigated the effects of low-level Pb exposure on plasma glucose levels. Herein, we aimed to investigate whether low-level Pb exposure causes elevated plasma glucose levels and the possible mechanisms involved.

METHODS

We conducted a cross-sectional study of 5747 participants from 16 sites in China. The participants underwent measurements of anthropometric factors, blood lead level (BLL) and fasting plasma glucose (FPG). Wistar rats were exposed to 0.05% Pb through drinking water or fed with a high-fat diet (HFD) for 28 weeks. The relevant parameters of glucose homeostasis, hepatic glucose production (HGP) and gene expression levels of hepatic gluconeogenesis enzymes, including phosphoenolpyruvate carboxy kinase (PEPCK), glucose-6-phosphatase (G6PC) and fructose-1,6-bisphosphatase (FBP1), were measured. In addition, gene expression levels of gluconeogenesis enzymes were also measured in HepG2 cells administered with different concentrations of lead acetate for 24 h.

RESULTS

In humans, after adjusting for confounders, the odds of having High_FPG (≥5.6 mmol/L) were significantly increased by 25% in the participants in the fourth BLL quartile (OR 1.25, 95% CI 1.05, 1.49). In the animals exposed to 0.05% Pb, FPG, HGP and hepatic gene expression levels of PEPCK, G6PC and FBP1 were increased. In addition, the mRNA expression levels of PEPCK, G6PC and FBP1 in HepG2 cells were also increased in response to Pb exposure.

CONCLUSIONS

These findings support the possibility that low-level Pb exposure may increase HGP by affecting key enzymes of hepatic gluconeogenesis, eventually resulting in impaired FPG and hyperglycemia.

Dietary Inflammatory Index and Cardiometabolic Risk in Ecuadorian Women

Low-grade systemic inflammation is implicated in metabolic syndrome (MetS) and cardiometabolic diseases. Diet is hypothesized to be an important low-grade inflammation modifier. However, few studies have examined the association of dietary inflammation with MetS and cardiometabolic risk in Latin American populations and their findings are inconsistent. Our cross-sectional study examined the association of dietary inflammatory potential with MetS and cardiometabolic risk components in 276 urban Ecuadorian women. Dietary inflammation was evaluated using an energy-adjusted Dietary Inflammatory Index (E-DII), divided into quartiles (Q). E-DII scores ranged from −4.89 (most anti-inflammatory) to 4.45 (most pro-inflammatory). Participants in the most pro-inflammatory (Q4) compared to the least inflammatory E-DII quartile (Q1) had a 4.4 increased adjusted odds for MetS (95% C.I. = 2.0, 9.63; p < 0.001). Every one-unit increase in E-DII was associated with a 1.4 increase in MetS (95% CI = 1.22, 1.52; p < 0.001). In other adjusted models, the most pro-inflammatory E-DII quartile (Q4) was positively associated with total blood cholesterol and triglycerides (p < 0.001), LDL-c (p = 0.007), diastolic blood pressure (p< 0.002), mean arterial pressure (p < 0.006), waist circumference (p < 0.008), and Framingham risk score (p < 0.001). However, the previously identified associations with pulse wave velocity and BMI were no longer evident in the models. These findings suggest that more pro-inflammatory diets may contribute to poorer cardiometabolic health. Promoting healthier diets with a lower inflammatory potential may help to prevent or slow development of cardiometabolic disorders.

Environmental pollution and diabetes mellitus

Diabetes mellitus (DM) is a chromic metabolic disease that affects a large segment of the population worldwide. Physical inactivity, poor nutrition, and genetic predisposition are main risk factors for disease development. In the last decade, it was clear to the scientific community that DM development is linked to a novel disease inducer that was later defined as diabetogenic factors of pollution and endocrine disrupting agents. Environmental pollution is exponentially increasing in uncontrolled manner in several countries. Environmental pollutants are of diverse nature and toxicities, including polyaromatic hydrocarbons (PAHs), pesticides, and heavy metals. In the current review, we shed light on the impact of each class of these pollutants and the underlined molecular mechanism of diabetes induction and biological toxicities. Finally, a brief overview about the connection between coronavirus disease 2019 and diabetes pandemics is presented.

Heart Failure and PAHs, OHPAHs, and Trace Elements Levels in Human Serum: Results from a Preliminary Pilot Study in Greek Population and the Possible Impact of Air Pollution

Cardiovascular diseases (CVDs) have been associated with environmental pollutants. The scope of this study is to assess any potential relation of polycyclic aromatic hydrocarbons (PAHs), their hydroxylated derivatives, and trace elements with heart failure via their direct determination in human serum of Greek citizens residing in different areas. Therefore, we analyzed 131 samples including cases (heart failure patients) and controls (healthy donors), and the respective demographic data were collected. Significantly higher concentrations (p < 0.05) were observed in cases' serum regarding most of the examined PAHs and their derivatives with phenanthrene, fluorene, and fluoranthene being the most abundant (median of >50 μg L-1). Among the examined trace elements, As, Cd, Cu, Hg, Ni, and Pb were measured at statistically higher concentrations (p < 0.05) in cases' samples, with only Cr being significantly higher in controls. The potential impact of environmental factors such as smoking and area of residence has been evaluated. Specific PAHs and trace elements could be possibly related with heart failure development. Atmospheric degradation and smoking habit appeared to have a significant impact on the analytes' serum concentrations. PCA-logistic regression analysis could possibly reveal common mechanisms among the analytes enhancing the hypothesis that they may pose a significant risk for CVD development.

Social and environmental risks as contributors to the clinical course of heart failure

Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.

Long-term electronic cigarette exposure induces cardiovascular dysfunction similar to tobacco cigarettes: role of nicotine and exposure duration

Electronic cigarette (e-cig) vaping (ECV) has been proposed as a safer alternative to tobacco cigarette smoking (TCS); however, this remains controversial due to a lack of long-term comparative studies. Therefore, we developed a chronic mouse exposure model that mimics human vaping and allows comparison with TCS. Longitudinal studies were performed to evaluate alterations in cardiovascular function with TCS and ECV exposure durations of up to 60 wk. For ECV, e-cig liquid with box-mod were used and for TCS, 3R4F-cigarettes. C57/BL6 male mice were exposed 2 h/day, 5 days/wk to TCS, ECV, or air control. The role of vape nicotine levels was evaluated using e-cig-liquids with 0, 6, or 24 mg/mL nicotine. Following 16-wk exposure, increased constriction to phenylephrine and impaired endothelium-dependent and endothelium-independent vasodilation were observed in aortic segents, paralleling the onset of systemic hypertension, with elevations in systemic vascular resistance. Following 32 wk, TCS and ECV induced cardiac hypertrophy. All of these abnormalities further increased out to 60 wk of exposure, with elevated heart weight and aortic thickness along with increased superoxide production in vessels and cardiac tissues of both ECV and TCS mice. While ECV-induced abnormalities were seen in the absence of nicotine, these occurred earlier and were more severe with higher nicotine exposure. Thus, long-term vaping of e-cig can induce cardiovascular disease similar to TCS, and the severity of this toxicity increases with exposure duration and vape nicotine content.NEW & NOTEWORTHY A chronic mouse exposure model that mimics human e-cigarette vaping and allows comparison with tobacco cigarette smoking was developed and utilized to perform longitudinal studies of alterations in cardiovascular function. E-cigarette exposure led to the onset of cardiovascular disease similar to that with tobacco cigarette smoking. Impaired endothelium-dependent and endothelium-independent vasodilation with increased adrenergic vasoconstriction were observed, paralleling the onset of systemic hypertension and subsequent cardiac hypertrophy. This cardiovascular toxicity was dependent on exposure duration and nicotine dose.

Arsenic, cadmium, mercury, and lead levels in hair and urine in first-year RUDN University students of different geographic origins

The objective of the present study was to assess the markers of arsenic, cadmium, mercury, and lead exposure in first-year RUDN University students of different geographic origins. A total of 274 first-year students of the RUDN University originating from Russia (n = 65), Asia (n = 57), Middle East (n = 84), Africa (n = 40), and Latin America (n = 28) were enrolled in the present study. Evaluation of As, Cd, Hg, and Pb levels in urine and hair was performed using inductively coupled plasma-mass spectrometry. The obtained data demonstrate that hair As levels in foreign students exceed that in Russian examinees. The highest Cd and Pb levels were detected in subjects from Africa and Latin America, whereas hair Hg content was significantly higher in Latin America students. Urinary Cd levels in foreign students exceeded those in Russian counterparts. In turn, the highest Hg concentration in urine was revealed in students originating from Middle East and especially Latin America. Urinary Pb levels were found to be the highest in students from Africa. Multiple regression analysis demonstrated that Asian, African, and Latin American origins were considered as a significant predictor of hair Hg content. Higher urinary Hg levels were associated with Asia, Middle East, and Latin American origins. Prior habitation in Africa and Asia was considered as predictor of higher hair Pb and urinary Cd levels. The observed difference may be indicative of geographic difference in toxic metal exposure patterns.