Evidence map›Paper›PMID 40532446›Full record

ArticleJACC. Heart failure2025

Associations Between Urinary Metal Levels and Incident Heart Failure: A Multi-Cohort Analysis.

Irene Martinez-Morata, Arce Domingo-Relloso, Melanie Mayer, Kathrin Schilling, Ronald A Glabonjat, Katlyn McGraw, Tiffany R Sanchez, Joel D Kaufman, Dhananjay Vaidya, Wendy Post and 17 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in JACC. Heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Associations between multiple essential trace metal concentrations and risk of hyperuricemia: insights from a central Chinese population.Biometals : an international journal on the role of metal ions in biology, biochemistry, and medicine · 2026
    Article
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Irene Martinez-MorataDepartment of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA. Electronic address: im2557@cumc.columbia.edu.
Arce Domingo-RellosoDepartment of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA.
Melanie MayerDepartment of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA.
Kathrin SchillingDepartment of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
Ronald A GlabonjatDepartment of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
Katlyn McGrawDepartment of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
Tiffany R SanchezDepartment of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
Joel D KaufmanDepartments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA.
Dhananjay VaidyaDepartment of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Wendy PostDepartment of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Miranda JonesDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Daichi ShimboDepartment of Medicine and Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, USA.
Ying ZhangCenter for American Indian Health Research, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Amanda M FrettsCardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Gernot PichlerDepartment of Cardiology and Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Clinic Floridsdorf, Vienna, Austria.
Jason G UmansMedStar Health Research Institute and Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA.
Jose Manuel Garcia PinillaCardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA-Plataforma BIONAND, Malaga, Spain; Ciber-Cardiovascular. Instituto de Salud Carlos III, Madrid, Spain; Medicine and Dematology Department, University of Malaga, Malaga, Spain.
Shelley A ColePopulation Health Program, Texas Biomedical Research Institute, San Antonio, Texas, USA.
Juan C Martin-EscuderoMedicina, Toxicology and Dermatology Departament, University of Valladolid, Hospital Universitario Rio Hortega, Valladolid, Spain.
Josep RedonBig Data and Artificial Intelligence Unit, Biomedical Research Institute INCLIVA, Valencia, Spain.
Maria Grau-PerezDepartment of Statistics and Operational Research, University of Valencia, Valencia, Spain.
R Graham BarrDepartment of Medicine and Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, USA.
Linda ValeriDepartment of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Steven SheaDepartment of Medicine and Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, USA.
Maria Tellez-PlazaDepartment of Chronic Diseases Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: m.tellez@isciii.es.
Richard B DevereuxDepartment of Medicine, Weill Cornell Medicine, New York, New York, USA.
Ana Navas-AcienDepartment of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.

Funding

The Southwest National Primate Research Center Supplement- Infrastructure improvements of ABSL2 holding areasP51OD011133 · OD · TEXAS BIOMEDICAL RESEARCH INSTITUTE · PI Larry S. Schlesinger · 2012 to 2026
$129.7M
Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1M
True Metal fac coreP30ES009089 · NIEHS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI Steven N. Chillrud · 1998 to 2026
$44.7M
XENOBIOTIC BIOTRANSFORMATION AND DISPOSITIONP30ES007033 · NIEHS · UNIVERSITY OF WASHINGTON · PI Nicole Ann Errett · 1995 to 2026
$42.5M
Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
Clinical and Translational Science AwardUL1TR000040 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2012 to 2015
$26.2M
The Strong Heart Study, Phase VU01HL041654 · NHLBI · UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR · PI LEE, ELISA TAN · 1988 to 2013
$19.2M
Pulmonary microvascular perfusion in the Multi-Ethnic Study of AtherosclerosisR01HL077612 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI R Graham BARR · 2004 to 2026
$18.8M
Task Area A Core Study Operations.Task Area A shall encompass annual follow-up of cohort members, clinical endpoints ascertainment, study coordination activities, maintenance of the database and biosp75N92020D00001 · NHLBI · UNIVERSITY OF WASHINGTON · PI MCCLELLAND, ROBYN LEAGH · 2020 to 2025
$17.2M
STRONG HEART STUDY (SHS): OUHSC COORDINATING CENTER - TASK AREA B (B.1 AND B.3)75N92019D00027 · NHLBI · UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR · PI ZHANG, YING · 2019 to 2025
$15.5M
CARDIOVASCULAR DISEASE IN THE PIMA INDIANSU01HL041642 · NHLBI · MEDSTAR RESEARCH INSTITUTE · PI HOWARD, BARBARA V · 1988 to 2013
$12.6M
Supplemental Training in Making Data FAIR and AI/ML ReadyT32ES007322 · NIEHS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI Pam R Factor-Litvak, Allison Kupsco · 2000 to 2026
$12.1M
NCATS NIH HHS UL1 TR000040NCATS NIH HHS UL1 TR001079NCATS NIH HHS UL1 TR001420NHLBI NIH HHS 75N92019D00027NHLBI NIH HHS 75N92019D00028NHLBI NIH HHS 75N92019D00029NHLBI NIH HHS 75N92019D00030NHLBI NIH HHS 75N92020D00001NHLBI NIH HHS 75N92020D00002NHLBI NIH HHS 75N92020D00003NHLBI NIH HHS 75N92020D00004NHLBI NIH HHS 75N92020D00005NHLBI NIH HHS 75N92020D00006NHLBI NIH HHS 75N92020D00007NHLBI NIH HHS HHSN268201500003CNHLBI NIH HHS HHSN268201500003INHLBI NIH HHS N01 HC095159NHLBI NIH HHS N01 HC095160NHLBI NIH HHS N01 HC095161NHLBI NIH HHS N01 HC095162NHLBI NIH HHS N01 HC095163NHLBI NIH HHS N01 HC095164NHLBI NIH HHS N01 HC095165NHLBI NIH HHS N01 HC095166NHLBI NIH HHS N01 HC095167NHLBI NIH HHS N01 HC095168NHLBI NIH HHS N01 HC095169NHLBI NIH HHS R01 HL077612NHLBI NIH HHS R01 HL109282NHLBI NIH HHS R01 HL109284NHLBI NIH HHS R01 HL109301NHLBI NIH HHS R01 HL109315NHLBI NIH HHS R01 HL109319NHLBI NIH HHS U01 HL041642NHLBI NIH HHS U01 HL041652NHLBI NIH HHS U01 HL041654NHLBI NIH HHS U01 HL065520NHLBI NIH HHS U01 HL065521NIA NIH HHS R01 AG077518NIEHS NIH HHS P30 ES007033NIEHS NIH HHS P30 ES009089NIEHS NIH HHS P42 ES033719NIEHS NIH HHS R01 ES028758NIEHS NIH HHS T32 ES007322NIH HHS P51 OD011133
6 · The paper itself

Abstract

backgroundEnvironmental metals are recognized cardiovascular disease risk factors, yet the role of metal exposure in heart failure (HF) risk remains understudied.

objectivesThis study aims to evaluate the prospective association of urinary metals with incident HF across 3 geographically and ethnically/racially diverse cohorts: MESA (Multi-Ethnic Study of Atherosclerosis) and SHS (Strong Heart Study) in the United States, and the Hortega Study in Spain.

methodsAdults 18-85 years of age in MESA (n = 6,601), SHS (n = 2,917), and Hortega (n = 1,300) were followed up to 20 years. Urinary levels of a multi-metal panel were measured at baseline and corrected for urine dilution. Cox proportional hazards and Cox elastic-net models were used to estimate the multi-adjusted (sociodemographic/clinical/lifestyle covariates) HR of incident HF by individual metals and the mixture of 5 metals available in all cohorts, respectively. The pooled HR (95% CI) of HF by 1-unit increase in log2-transformed levels of individual metals (ie, doubling of the dose) across cohorts was estimated using a fixed effects meta-analysis. Analyses by left ventricular ejection fraction were conducted in a subset.

resultsA total of 1,001 participants developed HF. In adjusted models, significant associations (pooled HRs [95% CI] per doubling of urinary metal) were identified for cadmium (HR: 1.15 [95% CI: 1.07-1.24]) molybdenum (HR: 1.13 [95% CI: 1.05-1.22]), and zinc (HR: 1.22 [95% CI: 1.14-1.32]). The HRs (95% CIs) for the association of 1 IQR increase in the multi-metal mixture levels and incident HF were 1.38 (95% CI: 1.00-1.86) in MESA, HR: 1.55 (95% CI: 1.28-1.97) in SHS, and HR: 1.08 (95% CI: 0.85-1.63) in Hortega in fully adjusted models. Stratified models by left ventricular ejection fraction were consistent with the pooled results.

conclusionsUrinary metals are risk factors of HF across 3 diverse populations, supporting the role of reducing metal exposures to lower HF risk.

Indexed as

Heart FailureMetalsAdolescentAdultAgedAged, 80 and overCadmiumFemaleHumansIncidenceMaleMiddle AgedProspective StudiesRisk FactorsSpainStroke VolumeCadmiumMetalsbiomarkersheart failuremeta-analysismetalspreventionurinary metals

Identifiers

PMID40532446
PMCPMC12284413

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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.