Sex-Specific Cross-Sectional Associations and Exploratory Mediation Analysis of Cardiovascular Disease Risk by Neutrophil-to-Lymphocyte Ratio in Cadmium-Exposed Populations.
9 affiliations
- 1The First School of Clinical Medicine Lanzhou University Lanzhou 730000 Gansu China lzu.edu.cn.
- 2Evidence-Based Social Science Research Center Health Technology Assessment Center School of Public Health Lanzhou University Lanzhou Gansu China lzu.edu.cn.
- 3Gansu Key Laboratory of Evidence-Based Medicine Lanzhou University Lanzhou Gansu Province 730000 China lzu.edu.cn.
- 4Chinese Center for Disease Control and Prevention National Institute for Occupational Health and Poison Control Beijing China chinacdc.cn.
- 5Clinical Research Center Sichuan Provincial People's Hospital University of Electronic Science and Technology of China Chengdu Sichuan China uestc.edu.cn.
- 6School of Public Health Lanzhou University Lanzhou Gansu China lzu.edu.cn.
- 7Department of Cardiology The First Hospital of Lanzhou University Lanzhou Gansu China lzu.edu.cn.
- 8Gansu Key Laboratory of Cardiovascular Diseases The First Hospital of Lanzhou University Lanzhou Gansu China lzu.edu.cn.
- 9Gansu Clinical Medical Research Center for Cardiovascular Diseases The First Hospital of Lanzhou University Lanzhou Gansu 730000 China lzu.edu.cn.
Abstract
Background
Cardiovascular 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
This 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
Individuals 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
This 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.
Related
- Predictive value of combined estimated plasma volume status and neutrophil-to-lymphocyte ratio for cardiovascular mortality in patients with acute myocardial infarction with heart failure
- Beyond Prognosis: A Systematic Review of the Neutrophil-to-Lymphocyte Ratio as a Modifiable Cardiovascular Biomarker
- Nonlinear associations of the neutrophil-to-lymphocyte ratio and derived neutrophil-to-lymphocyte ratio with asthma–COPD overlap prevalence: a cross-sectional study
- Associations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with amputation risk in patients with diabetic foot disease: a systematic review and meta-analysis
- CO063 | NEUTROPHIL-TO-LYMPHOCYTE RATIO AS A POTENTIAL PREDICTOR OF THROMBOSIS IN CLASSICAL HODGKIN LYMPHOMA: AN EXPLORATORY ANALYSIS
BibTeX
@article{li2026sexspecific,
title = {{Sex-Specific Cross-Sectional Associations and Exploratory Mediation Analysis of Cardiovascular Disease Risk by Neutrophil-to-Lymphocyte Ratio in Cadmium-Exposed Populations.}},
author = {Xinyi Li and Kaiwen Wang and Xu Hui and Ruiqi Yang and Weize Kong and Liangying Hou and Siyu Zhang and Peijing Yan and Yongbin Lu and Xiaowei Niu},
journal = {Cardiology research and practice},
year = {2026},
month = oct,
doi = {10.1155/crp/3957573},
url = {https://europepmc.org/article/MED/42923634},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sex-Specific Cross-Sectional Associations and Exploratory Mediation Analysis of Cardiovascular Disease Risk by Neutrophil-to-Lymphocyte Ratio in Cadmium-Exposed Populations.
AU - Xinyi Li
AU - Kaiwen Wang
AU - Xu Hui
AU - Ruiqi Yang
AU - Weize Kong
AU - Liangying Hou
AU - Siyu Zhang
AU - Peijing Yan
AU - Yongbin Lu
AU - Xiaowei Niu
PY - 2026
DA - 2026/10/21
JO - Cardiology research and practice
DO - 10.1155/crp/3957573
UR - https://europepmc.org/article/MED/42923634
AB - Background Cardiovascular 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 This 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 Individuals 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 This 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.
SN - 2090-8016
SN - 2090-0597
ER -