Abstract 18395: Urinary Metals as Novel Risk Factors for Incident Heart Failure and Subtypes in Indigenous Communities in the US: Evidence From the Strong Heart Study

Abstract

Introduction: Chronic exposure to metals is an independent risk factor for CVD, yet the role of metal exposure on heart failure (HF) and HF subtypes remains understudied. Indigenous communities in the US suffer a high burden of CVD and have been historically exposed to moderate and high levels of environmental metals. In this study we evaluate the prospective association between urinary metal levels and incident HF and HF subtypes in the Strong Heart Study, the largest US cohort of American Indian adults. Hypothesis: We hypothesize that urinary metals are prospectively associated with increased HF risk, and the associations will be different for ejection fraction (EF) <50% and EF >50%. Methods: A total of 2,706 participants (mean (SD) age 56.4(8.1) years, 58% female) with urinary metals available at baseline (1989-1991) were included. Incident HF events were ascertained through 2019 by a physician panel, including classification of HF subtypes (EF50% and EF<50%). Progressively adjusted Cox proportional hazards models were used to identify the risk of incident HF and HF subtypes by an interquartile range (IQR) change in urine metals (Table 1). Results: A total of 444 participants developed HF (90 EF >50%, 127 EF<50%, 227 unclassified). Baseline levels of all metals were higher among participants who developed HF. In fully adjusted models (Model 2), higher levels of urinary cadmium, molybdenum and zinc were significantly associated with HF risk. The associations varied by HF subtype. While no significant associations were identified for those EF≥50%, higher levels of urinary tungsten, molybdenum, and zinc were significantly associated with HF EF<50% risk. Conclusions: We identified an association between baseline urine levels of several essential and non-essential metals and incident HF risk in the Strong Heart Study, with strongest associations for those with EF<50%. These findings can help identify novel modifiable risk factors of HF and inform prevention strategies.