RESUMO
The cardiovascular system is highly sensitive to toxic metal exposure and trace element dysregulation. However, previous findings relating to metal exposure and coronary heart disease (CHD) have partially been conflicting and difficult to exhibit the combined effect of metal mixtures. This case-control study investigated urinary concentrations of ten metal/metalloids among clinically-diagnosed CHD patients and healthy adults during May to December 2021 in Guangzhou, China. We found that cadmium (Cd) status in urine from CHD patients was remarkably higher than its reference, while chromium (Cr), nickel (Ni), copper (Cu) and selenium (Se) concentrations were lower (p < 0.05). Spearman correlation analysis showed that urinary arsenic (As) and Se were highly correlated (rs=0.830, p < 0.001), indicating their similar sources. Principal component analysis (PCA) exhibited denser distribution of Cd-Sn in cases than in controls. Logistic regression analysis exhibited significant associations between urinary Cd (adjusted OR: 1.965, 95% CI: 1.222-3.162), Se (0.787, 95% CI: 0.695-0.893), Ni (0.493, 95% CI: 0.265-0.916) and CHD risk. Quantile g-computation showed negative joint effect of metal mixtures on CHD (adjusted OR: 0.383, 95% CI: 0.159-0.932) (p < 0.05), suggesting the need for supplementing essential trace elements. The negative partial effect was primarily attributed to Se and Ni, while positive partial effect was mainly due to tin (Sn) and Cd. Nevertheless, we also found a quantile increase of Cd-Sn level was negatively correlated with 8.26% (95% CI: 3.44-13.08%) decrease of high-density lipoprotein cholesterol (p < 0.001), and 71.2% of the joint effect attributed to Cd. Based on random forest, Se, Cd and Ni were found to be the dominant influencing factors of CHD. The role of Ni in CHD is yet to be uncovered, while excessive Cd exposure and low Se status among CHD patients need to be mitigated.