Current Environmental Health Reports

, Volume 3, Issue 4, pp 416–433 | Cite as

Environmental Metals and Cardiovascular Disease in Adults: A Systematic Review Beyond Lead and Cadmium

  • Anne E. Nigra
  • Adrian Ruiz-Hernandez
  • Josep Redon
  • Ana Navas-Acien
  • Maria Tellez-PlazaEmail author
Metals and Health (A Barchowsky, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Metals and Health


Published systematic reviews concluded that there is moderate to strong evidence to infer a potential role of lead and cadmium, widespread environmental metals, as cardiovascular risk factors. For other non-essential metals, the evidence has not been appraised systematically. Our objective was to systematically review epidemiologic studies on the association between cardiovascular disease in adults and the environmental metals antimony, barium, chromium, nickel, tungsten, uranium, and vanadium. We identified a total of 4 articles on antimony, 1 on barium, 5 on chromium, 1 on nickel, 4 on tungsten, 1 on uranium, and 0 on vanadium. We concluded that the current evidence is not sufficient to inform on the cardiovascular role of these metals because of the small number of studies. Few experimental studies have also evaluated the role of these metals in cardiovascular outcomes. Additional epidemiologic and experimental studies, including prospective cohort studies, are needed to understand the role of metals, including exposure to metal mixtures, in cardiovascular disease development.


Cardiovascular Atherosclerosis Metals Systematic review Epidemiologic studies 



Atomic absorption spectrometry




Confidence interval






Cardiovascular disease


Interquartile range


National Health and Nutrition Examination Survey



Maria Tellez-Plaza was supported by the Strategic Action for Research in Health sciences (CP12/03080 and PI15/00071), which is an initiative from Carlos III Health Institute Madrid and the Spanish Ministry of Economy and Competitiveness and co-funded with European Funds for Regional Development (FEDER). Ana Navas-Acien and Anne E. Nigra were supported by grants R01ES021367 and R01ES025216 from the National Institute of Environmental Health Sciences.

Authors’ Contributions

All authors conceptualized the review. A.E.N., A.R.H., M.T.P., and A.N.A. developed the search strategy. A.E.N. and A.R.H. reviewed all the retrieved abstracts. A.N.A. and M.T.P. acted as third reviewers in case of inconsistent article selection by A.E.N. and A.R.H. A.E.N., A.R.H., A.N.A., and M.T.P. drafted the data extraction tables. A.E.N. and A.R.H. assisted in editing data extraction tables. All the authors interpreted the data extraction tables. A.E.N., A.R.H., A.N.A., and M.T.P. wrote the initial draft of the manuscript. J.R. assisted in writing the manuscript. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

Anne E. Nigra, Adrian Ruiz-Hernandez, Josep Redon, Ana Navas-Acien, and Maria Tellez-Plaza declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

40572_2016_117_MOESM1_ESM.doc (30 kb)
ESM 1 (DOC 30 kb)
40572_2016_117_MOESM2_ESM.docx (57 kb)
ESM 2 (DOCX 56 kb)
40572_2016_117_Fig3_ESM.gif (31 kb)
Supplementary File 3

Squares represent effect estimates and are proportional to the inverse of the variance of the log odds ratios, and lines represent 95 % CIs. aComposite prevalence of prevalent cardiovascular and cerebrovascular disease. bPooled estimate of ORs for prevalent congestive heart failure, coronary heart disease, MI, and stroke. cComposite prevalence of prevalent cardiovascular and cerebrovascular disease. dPooled estimate of ORs for prevalent congestive heart failure, coronary heart disease, MI, and stroke. ePooled estimate of ORs for prevalent cardiovascular disease and stroke. fPooled estimate of ORs for prevalent congestive heart failure, coronary heart disease, MI, and stroke. Abbreviations: NR not reported, MI myocardial infarction, PAD peripheral arterial disease. Total N was reported where number of cases/non-cases was not available. Pooled estimates within studies were pooled via inverse-variance weighted random effects. (GIF 31 kb)

40572_2016_117_MOESM3_ESM.tiff (78.5 mb)
High resolution image (TIFF 80367 kb)


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  • Anne E. Nigra
    • 1
    • 2
    • 3
  • Adrian Ruiz-Hernandez
    • 4
    • 5
  • Josep Redon
    • 4
    • 5
    • 6
  • Ana Navas-Acien
    • 1
    • 2
    • 3
    • 7
  • Maria Tellez-Plaza
    • 1
    • 5
    Email author
  1. 1.Department of Environmental Health SciencesJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Environmental Health SciencesColumbia University Mailman School of Public HealthNew YorkUSA
  4. 4.Department of Internal MedicineHospital Clínico de ValenciaValenciaSpain
  5. 5.Area of Cardiometabolic and Renal RiskInstitute for Biomedical Research Hospital Clinical of Valencia (INCLIVA)ValenciaSpain
  6. 6.CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Minister of HealthMadridSpain
  7. 7.Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreUSA

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