Toxic Grounds: A Narrative Review of the Role of Heavy Metal Soil and Water Contamination in Cardiovascular Disease Development

Cardiovascular disease (CVD) remains a leading cause of global mortality, with environmental exposures increasingly recognized as significant contributors alongside traditional risk factors. Among these, heavy metal contamination of soil and water represents an overlooked yet potentially modifiable risk factor for the development of cardiovascular disease. This review synthesizes current evidence linking specific heavy metal exposures through contaminated soil and water to cardiovascular outcomes, particularly focusing on lead, cadmium, arsenic, and copper. Strong associations between heavy metal exposure and cardiovascular pathology are consistently demonstrated through multiple mechanistic pathways. For instance, lead exposure correlates with elevated blood pressure (a 3.25 mmHg increase in systolic BP per twofold rise in blood lead levels), an increased heart failure risk (34%), higher serum levels in patients with peripheral artery disease (13.8%), and is linked to conduction abnormalities like intraventricular and atrioventricular block. Chronic arsenic exposure shows dose-dependent relationships with atherosclerosis (evidenced by increased carotid artery intimal thickness). Cadmium exposure is significantly associated with atherosclerosis across multiple vascular territories, increased stroke risk with carotid plaques, a higher risk of heart failure, and independently correlates with peripheral artery disease incidence. Moreover, serum copper levels are significantly elevated in heart failure patients. Mortality data further reveal up to a 46% greater risk of circulatory mortality in populations with elevated blood lead levels, with similar associations for cadmium and arsenic. This review emphasizes the need for a paradigm shift in CVD prevention that integrates the assessment and remediation of environmental heavy metal exposure alongside traditional risk factor modification. Future research and public health initiatives should prioritize establishing precise exposure thresholds, developing standardized screening protocols, and implementing targeted interventions for exposed populations.