Effects Of Personal Metals Exposure Levels And Their Interations With Sleep-related Behaviors On Arteriosclerotic Cardiovascular Disease Risk

Part One Associations between personal metals exposure levels,sleep-related behaviors and ASCVD riskObjective: The present study aimed to estimate personal metals exposure levels and evaluate the associations between personal metals exposure levels,sleep-related behaviors and atherosclerotic cardiovascular diseases(ASCVD)risk.Methods: The participants involved in this study were from the baseline(n=9411)of the Shenzhen Aging Related Disorder Cohort.The inhabitants with age ≥60 years old were recruited from the 51 community health service centers in a district of Shenzhen city,China.After removing individuals with ASCVD and exclusing ones with missing data on the studied variables,4901 ones were finally included in this study.Urinary concentrations of 24 metals were measured by inductively coupled plasma mass spectrometry.We assessed estimated daily intakes of the metals based on the parameters including urinary metals concentrations and urinary excretion rates of the metals.Logistic regression models were used to analyze the associations between urinary metals concentrations and sleep-related behaviors(including nap duration,later bedtime,required time to fall asleep and subjective sleep quality).Multivariate linear regression models were used to analyze the associations between individual-level exposure to single metal or single sleep-related behavior and 10-year ASCVD risk.Results: Logistic regression models showed that urinary Zn concentrations were positively associated with the risk of long nap duration of >30min,long time(>15min)required to fall asleep or poor subjective sleep quality.Urinary Se concentrations were negatively associated with the risk of long time(15-30min)required to fall asleep or poor subjective sleep quality.Urinary Sr or Sn concentrations were positively associated with the risk of long nap duration of >30min.Multiple linear regression models indicated that among individuals with different sleep duration,individual-level exposure to Cu,Zn and Sb,nap duration or the time required to fall asleep were positively associated with the 10-year ASCVD risk,but individual-level exposure to Se,Sr and Sn were negatively associated with the 10-year ASCVD risk.Conclusions: Among the elderly,there was a positive association between urinary Zn levels and nap duration or the time required to fall asleep and a negative asscociation between urinary Se levels and subjective sleep quality.Increased individual-level exposure to Cu,Zn or Sb or decreased individual-level exposure to Se,Sr or Sn may increase 10-year ASCVD risk.Part two Interactions of personal metals exposure levels and sleep-related behaviors on ASCVD riskObjective: The present study aimed to evaluate the interactional effects of personal metals exposure levels and sleep-related beharviors on 10-year atherosclerotic cardiovascular diseases(ASCVD)risk.Methods: Among the baseline population(n=9411)of the Shenzhen Aging Related Disorder Cohort,4901 individualswere finally involved in this study,after removing individuals with ASCVD and exclusing ones with missing data on the studied variables.The participants completed the questionnaires and physical examination.We conducted an elastic net regression to select variables associated with 10-year ASCVD risk(sleep-related behaviors,personal metals exposure levels and their interactions),and further dentified the factors influencing ASCVD risk using multiple linear regression model.Furthmore,we quantified the dose-response relationship between personal metals exposure levels and ASCVD risk using restricted cubic spline,and analyzed the interactional effect of individual-level Zn exposure and the time required to fall asleep on ASCVD risk using Logistic regression models.Results: Pearson correlation analysis showed that the correlation coefficients for each pair of urinary individual metal concentrations and estimated daily intake of individual metals ranged from 0.1 to 0.7(all P<0.05).Multiple linear regression models indicated that among individuals with different sleep durations,urinary Zn concentrations,estimated daily intake of Zn or nap duration,the time required to fall asleep was positively associated with ASCVD risk(all P<0.05).Restricted cubic spline models analysis showed the non-linear relationship between urinary Zn concentrations or estimated daily intake of Zn and ASCVD risk among individuals with less than 7 hours of sleep per night(both P<0.05)as well as between urinary Zn concentrations and ASCVD risk only among individuals with 7-8 hours of sleep per night(P<0.05).Logistic regression models indicated the positive multiplicative interactions of higher urinary Zn concentrations(i.e.,above the median level of urinary Zn for individuals with sleep durations of <7h(>385.77μg/L),7-8h(>426.87μg/L)or >8h(>448.93μg/L)and the time required to fall asleep(>30min)on increased risk of ASCVD among individuals with <7h of sleep each night(OR=2.42,95%CI: 1.80-3.04),7-8h of sleep each night(OR=1.60,95%CI: 1.21-1.99)or >8h of sleep each night(OR=1.42,95%CI: 1.00-1.84)as well as the positive multiplicative interaction of high estimated daily intake(>260.71μg/kg/d)of Zn and a long time required to fall asleep(>30min)on increased risk of ASCVD among individuals with less than 7 hours of sleep each night(OR=2.33,95%CI: 1.67-2.99).Conclusions: Unhealthy sleep behaviors(such as long-duration napping of >30min or a long time required to fall asleep of >30min)were associated with increased risk of ASCVD.We revealed a non-linear relationship between individual-level Zn exposure(urinary Zn concentrations,estimated daily intake of Zn)and ASCVD risk as well as the multiplicative interaction of individual-level Zn exposure(urinary Zn concentration of >385.77μg/L or estimated daily intake of Zn of >260.71μg/kg/d)with the time(>30min)required to fall asleep on increased risk of ASCVD.