A groundbreaking multi-cohort study conducted by researchers at Columbia University’s Mailman School of Public Health has revealed compelling evidence that exposure to certain metals, detected through urinary biomarkers, is significantly associated with an increased risk of heart failure (HF). Published in the Journal of the American College of Cardiology, the study is the most extensive investigation of its kind to date, bolstering the case for more substantial public health efforts aimed at mitigating environmental metal exposure. Although metals such as arsenic, cadmium, and molybdenum have previously been implicated in cardiovascular pathology, their specific role in heart failure—a condition with high mortality and rising prevalence—has remained insufficiently explored until now.
The study’s methodological innovation lies in its approach to examining metals not in isolation, as has been common in prior research, but as a composite mixture, thereby capturing a more accurate representation of real-world exposure. “Most previous studies have assessed individual metals in isolation. By examining metals as a mixture, our analysis more closely reflects real-world exposure patterns,” explained Dr Irene Martinez-Morata, the study’s lead author and a postdoctoral research scientist in Environmental Health Sciences at Columbia Mailman. The analysis involved a robust sample of over 10,000 adults from multiple countries, encompassing diverse racial, geographic, and ethnic backgrounds. After rigorous adjustment for traditional heart failure risk factors such as diabetes, hypertension, and obesity, a consistent association was found between elevated levels of urinary metals and increased incidence of heart failure.
The researchers aggregated data from three large-scale longitudinal cohorts with over two decades of follow-up: the Multi-Ethnic Study of Atherosclerosis (MESA), encompassing adults aged 18 to 85 from six urban-suburban regions in the United States; the Strong Heart Study (SHS), which focuses on American Indian adults from various rural communities across Oklahoma, Arizona, and the Dakotas; and the Hortega Study, a general population cohort from Spain. In total, 10,861 participants were included: 6,644 from MESA, 2,917 from SHS, and 1,300 from Hortega. Across the pooled dataset, over a thousand individuals developed heart failure during the follow-up period, and left ventricular function was assessed in a subset to understand cardiac performance dynamics better.
Urinary levels of five specific metals—arsenic, cadmium, molybdenum, selenium, and zinc—were analysed using advanced machine learning techniques to evaluate their combined effect as a mixture. The results were striking. The metal mixture was linked with a 55% increased risk of heart failure among SHS participants, a 38% increased risk in the MESA cohort, and an 8% increased risk in the Hortega cohort. When the metals were analysed individually, a doubling of urinary cadmium levels—commonly found in tobacco, industrial waste, and certain contaminated foods—was associated with a 15% higher risk of heart failure. Likewise, a doubling of molybdenum and zinc levels was linked to 13% and 22% increases in risk, respectively, even though these metals are considered essential for physiological functions in trace amounts.
The disproportionately high risk observed in the SHS cohort, composed of rural American Indian communities, suggests environmental injustice rooted in longstanding exposure to contaminant metals. “The strongest association between the 5-metal mixture and HF risk was seen in the SHS cohort,” Dr Martinez-Morata noted. “This population faces a historically high burden of contaminant metal exposure and cardiovascular disease and public health action is urgently needed.” Such disparities point to systemic environmental inequalities, often stemming from proximity to mining operations, industrial pollution, and underregulated infrastructure that leads to contaminated drinking water and soil.
The sources of toxic metal exposure are multifaceted, ranging from ambient air pollution and industrial emissions to dietary intake through crops grown in contaminated soils. Even seemingly benign consumer goods or nutritional supplements may contain elevated levels of essential metals, such as zinc and selenium, which, in excessive quantities, can become toxic. Smoking devices and vaping tools are also significant contributors to metal exposure. The researchers emphasise that while certain metals are essential for human health in small amounts, chronic exposure to high concentrations—especially from multiple sources simultaneously—poses a significant health risk.
Dr Ana Navas-Acien, chair of the Department of Environmental Health Sciences and senior author of the study, reinforced the central conclusion: “We consistently found higher urinary levels of cadmium, molybdenum and zinc linked to increased heart failure risk. Even after adjusting for diabetes—a known HF risk factor—the zinc association remained significant.” These findings place metal exposure alongside traditional cardiovascular risk factors, highlighting the urgent need for integrating environmental health assessments into cardiovascular disease prevention strategies.
In conclusion, this study represents a significant step forward in environmental cardiology, providing robust evidence that exposure to a mixture of urinary metals substantially increases the risk of heart failure. With its large, diverse sample size, high-quality longitudinal data, and advanced analytical framework, the study presents a compelling case for more rigorous monitoring of environmental metal exposures and targeted public health interventions, especially in vulnerable communities with a history of industrial contamination. As ongoing research continues to illuminate the underlying biological mechanisms, the implications for public policy, clinical guidelines, and community-level health initiatives are profound. The findings confirm that protecting cardiovascular health requires a concerted effort to reduce environmental metal exposure across all populations.
More information: Irene Martinez-Morata et al, Associations Between Urinary Metal Levels and Incident Heart Failure: A Multi-Cohort Analysis, Journal of the American College of Cardiology. DOI: 10.1016/j.jchf.2025.03.046
Journal information: Journal of the American College of Cardiology Provided by Columbia University’s Mailman School of Public Health
