{ "abstract": "Background\n\nCardiovascular disease (CVD) remains the leading cause of mortality worldwide, with its burden continuing to rise. Environmental cadmium (Cd) exposure has emerged as a potential risk factor for CVD. This study aimed to investigate the associations between Cd exposure and CVD risk, and to explore cross-sectional associations and a potential inflammatory pathway using exploratory mediation analysis.Methods\n\nThis study utilized data from the National Health and Nutrition Examination Survey. Logistic regression models were used to identify factors influencing CVD risk. Dose-response relationships were evaluated using restricted cubic splines (RCS). Exploratory mediation analysis was conducted to assess the potential mediating role of NLR in the association between Cd exposure and CVD risk.Results\n\nIndividuals with CVD had significantly higher levels of blood Cd, urinary Cd, and NLR than controls (p < 0.05) in both sexes. In males, the highest quartile (Q4) of blood Cd (OR = 3.06, 95% CI: 1.45-6.46, p = 0.004) and urinary Cd (OR = 3.02, 95% CI: 1.52-6.02, p = 0.002) were significantly associated with higher CVD prevalence. Conversely, no significant association was observed in females for blood Cd (p = 0.505), and the association for urinary Cd (p = 0.046) was notably weaker and less robust than that in males. Interaction analyses confirmed sex-specific differences (p-interaction < 0.05). NLR showed significant exploratory mediating effects (indirect effects), accounting for 9.4% (95% CI: 3.5%-15.2%) of the blood Cd-CVD link and 5.0% (95% CI: 1.9%-8.1%) of the urinary Cd-CVD link in males. Similar significant mediation was observed in the general population for blood Cd: 7.2% (95% CI: 2.2%-12.2%), and for urinary Cd: 6.4% (95% CI: 2.8%-10.0%).Conclusions\n\nThis cross-sectional study identified significant sex-specific and dose-dependent associations between Cd exposure and CVD risk. Inflammatory responses, particularly those reflected by elevated NLR, were cross-sectionally associated with the observed Cd-CVD link, suggesting a potential pathway that warrants prospective validation, especially in males.", "abstract_shown": true, "affiliations": [ "The First School of Clinical Medicine Lanzhou University Lanzhou 730000 Gansu China lzu.edu.cn.", "Evidence-Based Social Science Research Center Health Technology Assessment Center School of Public Health Lanzhou University Lanzhou Gansu China lzu.edu.cn.", "Gansu Key Laboratory of Evidence-Based Medicine Lanzhou University Lanzhou Gansu Province 730000 China lzu.edu.cn.", "Chinese Center for Disease Control and Prevention National Institute for Occupational Health and Poison Control Beijing China chinacdc.cn.", "Clinical Research Center Sichuan Provincial People's Hospital University of Electronic Science and Technology of China Chengdu Sichuan China uestc.edu.cn.", "School of Public Health Lanzhou University Lanzhou Gansu China lzu.edu.cn.", "Department of Cardiology The First Hospital of Lanzhou University Lanzhou Gansu China lzu.edu.cn.", "Gansu Key Laboratory of Cardiovascular Diseases The First Hospital of Lanzhou University Lanzhou Gansu China lzu.edu.cn.", "Gansu Clinical Medical Research Center for Cardiovascular Diseases The First Hospital of Lanzhou University Lanzhou Gansu 730000 China lzu.edu.cn." ], "article_type": "research article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0, 1 ], "name": "Xinyi Li", "orcid": "0009-0000-2302-2614" }, { "affs": [ 0, 1 ], "name": "Kaiwen Wang" }, { "affs": [ 1, 2 ], "name": "Xu Hui" }, { "affs": [ 1, 2 ], "name": "Ruiqi Yang", "orcid": "0009-0009-3001-516X" }, { "affs": [ 1, 2 ], "name": "Weize Kong", "orcid": "0009-0002-5241-2966" }, { "affs": [ 1, 2 ], "name": "Liangying Hou", "orcid": "0000-0002-9163-0475" }, { "affs": [ 3 ], "name": "Siyu Zhang", "orcid": "0000-0003-2357-5045" }, { "affs": [ 4 ], "name": "Peijing Yan" }, { "affs": [ 5 ], "name": "Yongbin Lu", "orcid": "0000-0001-5215-3816" }, { "affs": [ 0, 6, 7, 8 ], "name": "Xiaowei Niu", "orcid": "0000-0002-4806-0411" } ], "bibtex": "https://research.draconitic.com/paper/6w6pwnp3x8xf7.bib", "cited_by": 0, "doi": "10.1155/crp/3957573", "fulltext_url": "https://europepmc.org/articles/PMC13687931", "id": "6w6pwnp3x8xf7", "issns": [ "2090-8016", "2090-0597" ], "landing_url": "https://europepmc.org/article/MED/42923634", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2307|Heavy Metal Exposure and Toxicity" ] ], "openalex": "W7223173953", "pdf_url": "https://europepmc.org/articles/PMC13687931?pdf=render", "pmcid": "PMC13687931", "pmid": "42923634", "published": "2026-10-21", "publisher": null, "ris": "https://research.draconitic.com/paper/6w6pwnp3x8xf7.ris", "sources": [ { "first_seen": "2026-10-30T12:20:33Z", "native_id": "MED:42923634", "source": "europepmc", "url": "https://europepmc.org/article/MED/42923634" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2307|Heavy Metal Exposure and Toxicity", "subfield": "pharmacology-toxicology" } ], "title": "Sex-Specific Cross-Sectional Associations and Exploratory Mediation Analysis of Cardiovascular Disease Risk by Neutrophil-to-Lymphocyte Ratio in Cadmium-Exposed Populations.", "title_text": "Sex-Specific Cross-Sectional Associations and Exploratory Mediation Analysis of Cardiovascular Disease Risk by Neutrophil-to-Lymphocyte Ratio in Cadmium-Exposed Populations.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:33Z", "url": "https://research.draconitic.com/paper/6w6pwnp3x8xf7", "venue": "Cardiology research and practice", "versions": [] }