Plasma Metal Concentrations With Incident Coronary Heart Disease And Type 2 Diabetes In Chinese Adults

Objective:Circulating metals from both the natural environment and pollution have been linked to cardiovascular disease.However,few prospective studies have investigated the associations between exposure to multiple metals and incident coronary heart disease?CHD?and diabetes.We conducted two nested case–control studies in the prospective Dongfeng-Tongji cohort,to investigate the prospective association between plasma metal concentrations with incident CHD and diabetes.Methods:The prospective Dongfeng-Tongji cohort enrolled 27,009 participants during 2008-2010.A total of 1621 incident CHD cases were identified through December 31,2013,and 1621 controls were randomly selected from participants free of major cardiovascular disease at baseline and follow-up visits?matched on age and sex?.Incident diabetes were identified using the following criteria:fasting glucose?7.0 mmol/l;or hemoglobin A1c?HbA1c??6.5%;or self-reported diagnosis or use of anti-diabetic medication during the follow-up visits in 2013.Similarly,1039controls?age and sex matched?were selected from participants free of diabetes at baseline and during follow-up.We measured baseline fasting plasma concentrations of 23 metals and used conditional logistic regression models to estimate odds ratios?ORs?of CHD and diabetes for metal concentrations categorized according to quartiles in controls.Result:Five metals?titanium,arsenic,selenium,aluminum,and barium?were significantly associated with CHD(FDR adjusted P_trend<0.05)based on trend tests from single metal multivariable models adjusted for established cardiovascular risk factors.When all five were included in the same model,adjusted ORs for barium and aluminum were close to the null,whereas associations with titanium,arsenic,and selenium were similar to estimates from single-metal models,and ORs comparing extreme quartiles were 1.32(95%CI:1.03,1.69;P_trend=0.04),1.78(95%CI:1.29,2.46;P_trend=0.001),and 0.67(95%CI:0.52,0.85;P_trend=0.001),respectively.For diabetes,the multivariable adjusted ORs?95%CIs?across quartiles of metal concentrations were as follows:titanium,1.00,0.92,1.31,1.38(1.00,1.91,P_trend=0.011);selenium,1.00,1.08,1.45,1.27(0.93,1.74,P_trend=0.05);and antimony,1.00,0.79,0.77,0.60(0.44,0.83,P_trend=0.002).Arsenic was significantly associated with diabetes in the crude model(ORs comparing extreme quartiles 1.30;1.02,1.65;P_trend=0.006),but was not significant after adjustment for socio-demographic factors.Conclusions:Our study suggested that incident CHD was positively associated with plasma levels of titanium and arsenic,and inversely associated with selenium.Titanium and selenium were positively while antimony was negatively associated with incident diabetes.Additional research is needed to confirm these findings in other populations.