Role of toxic metal exposure in the association of functional limitation and cardiovascular diseases among US adults
Bibliographic record
Abstract
Functional limitations are common among US adults and are established predictors of cardiovascular disease (CVD). However, it is unclear whether exposure to toxic metals modifies the association between functional limitations and CVD risk. This study evaluates whether blood concentrations of toxic metals modify the association between functional limitations and CVD in US adults. This cross-sectional study included 3097 adults aged 18 years or older who participated in the National Health and Nutrition Examination Survey (NHANES) 2021–2023. Exposure Functional Limitation status was assessed across three domains including cognition, mobility, and vision. Blood concentrations of lead, cadmium, mercury, manganese, and selenium were categorized as high (≥ 90th percentile) vs. low. The primary outcome was self-reported CVD, defined as any history of heart failure, coronary heart disease, angina, myocardial infarction, or stroke. Survey-weighted descriptive statistics, cross-tabulations, survey-weighted logistic regression models (adjusted for age, sex, race/ethnicity, marital status, and hypertension) were used to estimate the main and interaction effects. Among 3097 participants (mean age 47.9 [95% CI: 46.7–49.2] years, 49.9% male), the prevalence of any cognitive, mobility, and visual difficulty was 43.2% (40.1–46.3), 21.5%, (19.6–23.4) and 34.4% (32.4–36.5), respectively. In survey-weighted analyses, high blood cadmium was consistently associated with greater prevalence of functional impairment across all domains (for cognition: 8.2% [6.2–10.2] vs. 5.0% [3.6–6.4], p = 0.013; for mobility: 10.7% [7.8–13.7] vs. 5.2% [4.1–6.3], p < 0.001; for vision: 9.3% [7.0–11.5] vs. 4.9% [4.0–5.8], p < 0.001). In multivariable-adjusted logistic regression, high blood cadmium was associated with higher odds of cognitive (OR = 1.71, 95% CI: 1.07–2.73, p = 0.036) and mobility difficulty (OR = 1.99, 1.12–3.55, p = 0.032); similar associations were observed for high blood lead (cognitive: OR = 1.73, 1.07–2.79, p = 0.036; mobility: OR = 2.04, 1.14–3.65, p = 0.030). High blood mercury (OR = 1.70, 95% CI: 1.04–2.77, p = 0.041), manganese (OR = 1.75, 1.06–2.87, p = 0.037), and selenium (OR = 1.72, 1.06–2.79, p = 0.038) were each associated with increased odds of cognitive difficulty in adjusted models; similar patterns were observed for mobility, but no significant associations were found for visual difficulty. No significant interaction effects were detected in any model. Functional limitation in cognition and mobility was independently associated with higher CVD prevalence among US adults. Concurrent high exposure to toxic metals and functional limitation was associated with the highest observed CVD burden; however, toxic metal exposure did not statistically modify the association between functional limitation and CVD risk.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".