Associations of urinary trace elements and serum uric acid with 10-year atherosclerotic cardiovascular disease risk: a study based on a community-dwelling older adult cohort in Shenzhen

Objective To investigate the associations between urinary trace elements and 10-year atherosclerotic cardiovascular disease (ASCVD) risk, and to assess the potential mediating role of serum uric acid (SUA).

Methods This study selected 1 068 community-dwelling older adults (≥60 years) from the 2021 Shenzhen Elderly-Related Diseases Cohort, using a random cluster sampling method. Demographic characteristics, lifestyle factors, and health examination data were collected. Urinary trace element concentrations were measured through inductively coupled plasma mass spectrometry (ICP-MS). The 10-year ASCVD risk was estimated via the China-PAR model. Restricted cubic spline (RCS) models were adopted to examine dose-response relationships of urinary trace elements with the atherogenic index of plasma (AIP), SUA, and ASCVD risk. Multivariable regression analysis was performed to identify key trace elements, and mediation analysis to assess the role of SUA.

Results Among the 1 068 participants, 184 (17.23%) were rated with high ASCVD risk. The RCS analysis indicated that urinary zinc was positively associated with both AIP (χ²=10.460, P<0.001) and 10-year ASCVD risk (χ²=14.255, P<0.001) in a dose-dependent manner. Generalized linear models (GLMs) showed that urinary zinc was significantly associated with AIP (β=0.04, 95%CI: 0.02–0.06) and ASCVD risk (OR=1.64, 95%CI: 1.27–2.13). Urinary zinc was also positively associated with the SUA level (β=9.28, 95%CI: 1.98–16.57). The mediation analysis revealed that SUA partially mediated the associations of urinary zinc with AIP and ASCVD risk, accounting for 25.59% and 4.42% of the total effects, respectively.

Conclusions Among the trace elements measured in urine, only zinc was found to be associated with an increased risk of ASCVD. The study demonstrated that elevated urinary zinc levels were significantly correlated with increases in both AIP and 10-year ASCVD risk. SUA played a partial mediating role in these associations. However, no such relationship was observed for the other trace elements examined. These findings provide novel epidemiological evidence for the potential role of trace elements, particularly zinc, in ASCVD risk assessment.