ArticleJournal of the American Heart Association2019
Does Information on Blood Heavy Metals Improve Cardiovascular Mortality Prediction?
Article in Journal of the American Heart Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 46 citations in OpenAlex.
- Urinary Metal Levels after Repeated Edetate Disodium Infusions: Preliminary Findings.International journal of environmental research and public health · 2020Trial
- NHANES and the rise of environmental cardiology: Metals, mortality, and the maturation of preventive evidence.American journal of preventive cardiology · 2026Article
- Association of the glucose-to-lymphocyte ratio with all-cause and cardiovascular disease mortality in U.S. adults: A population-based cohort study.Clinics (Sao Paulo, Brazil) · 2026Article
- Article
- Interpretable Machine Learning in Heavy Metal-Associated Cardiovascular and Metabolic Disease: A Review of Current Methodologies, Toxicological Insights, and Clinical Implications.Cardiovascular toxicology · 2026Review
- Incorporating geospatial environmental exposure indicators in individual hypertension risk prediction: a multi-stage machine learning pipeline.Journal of exposure science & environmental epidemiology · 2026Article
- Association of glucose to lymphocyte ratio with the risk of death in patients with atherosclerotic cardiovascular disease.Scientific reports · 2025Article
- Associations of serum lead with colorectal cancer: data from NHANES 1999-2020.Journal of Cancer · 2025Article
- Use of biomarkers of metals to improve prediction performance of cardiovascular disease mortality.Environmental health : a global access science source · 2024Article
- Portable x-ray fluorescence for bone lead measurement: Current approaches and future directions.Current environmental health reports · 2024Review
- Do we underestimate risk of cardiovascular mortality due to lead exposure?The Science of the total environment · 2024Article
- Association between Blood Lead Levels and Silent Myocardial Infarction in the General Population.Journal of clinical medicine · 2024Article
- Contaminant Metals as Cardiovascular Risk Factors: A Scientific Statement From the American Heart Association.Journal of the American Heart Association · 2023Article
- The role of exposure to per- and polyfluoroalkyl substances in racial/ethnic disparities in hypertension: Results from the study of Women's health across the nation.Environmental research · 2023Article
- Commentary on the Risk Assessment of Lead by the Food Safety Commission of Japan.Food safety (Tokyo, Japan) · 2022Article
- Per- and Polyfluoroalkyl Substances and Incident Hypertension in Multi-Racial/Ethnic Women: The Study of Women's Health Across the Nation.Hypertension (Dallas, Tex. : 1979) · 2022Article
- Metals and risk of incident metabolic syndrome in a prospective cohort of midlife women in the United States.Environmental research · 2022Article
- Perfluoroalkyl Substances and Incident Natural Menopause in Midlife Women: The Mediating Role of Sex Hormones.American journal of epidemiology · 2022Article
- Lead exposure is non-linearly associated with subclinical myocardial injury in the general population without cardiovascular disease.Frontiers in public health · 2022Article
- Trends in global burden of diseases attributable to lead exposure in 204 countries and territories from 1990 to 2019.Frontiers in public health · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
Background To evaluate whether blood markers of lead, cadmium, and mercury can improve prediction for cardiovascular disease (CVD) mortality when added individually, jointly, or as an integrative index/Environmental Risk Score (ERS), in a model with established risk factors. Methods and Results Our study sample comprised 16 028 adults aged ≥40 years who were enrolled in the National Health and Nutrition Examination Survey 1999-2012 and followed up through December 31, 2015. The study sample was randomly split into training for the ERS construction (n=8043) and testing for the evaluation of prediction performance (n=7985). ERS was computed using elastic-net penalized Cox's model based on the selected metal predictors predicting CVD mortality. During median follow-up of 7.2 years, 517 died from CVD. In the training set, linear terms of cadmium and mercury, squared terms of lead and mercury, and all 3 pairwise interactions were selected by elastic-net for ERS construction. In the testing set, the C-statistic increased from 0.845 when only established CVD risk factors were in the model to 0.854 when the ERS was additionally added to the model. Addition of all linear, squared, and pairwise interaction terms of blood metals to the Cox's models improved C-statistic from 0.845 to 0.857. The improvement remained significant when it was assessed by net reclassification improvement and integrated discrimination improvement. Conclusions Our findings suggest that blood markers of toxic metals can improve CVD risk prediction over the established risk factors and highlight their potential utility for CVD risk assessment, prevention, and precision health.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.