Concurrent Heavy Metal Exposures and Idiopathic Dilated Cardiomyopathy: A Case-Control Study from the Katanga Mining Area of the Democratic Republic of Congo

Int J Environ Res Public Health. 2021 May 6;18(9):4956. doi: 10.3390/ijerph18094956.


Blood and/or urine levels of 27 heavy metals were determined by ICPMS in 41 patients with dilated cardiomyopathy (DCM) and 29 presumably healthy subjects from the Katanga Copperbelt (KC), in the Democratic Republic of Congo (DRC). After adjusting for age, gender, education level, and renal function, DCM probability was almost maximal for blood concentrations above 0.75 and 150 µg/dL for arsenic and copper, respectively. Urinary concentrations above 1 for chromium, 20 for copper, 600 for zinc, 30 for selenium, 2 for cadmium, 0.2 for antimony, 0.5 for thallium, and 0.05 for uranium, all in μg/g of creatinine, were also associated with increased DCM probability. Concurrent and multiple exposures to heavy metals, well beyond permissible levels, are associated with increased probability for DCM. Study findings warrant screening for metal toxicity in case of DCM and prompt public health measures to reduce exposures in the KC, DRC.

Keywords: Katanga Copperbelt; environmental exposures; heavy metals; idiopathic dilated cardiomyopathy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arsenic*
  • Cardiomyopathy, Dilated* / chemically induced
  • Cardiomyopathy, Dilated* / epidemiology
  • Case-Control Studies
  • Democratic Republic of the Congo / epidemiology
  • Environmental Exposure / analysis
  • Humans
  • Metals, Heavy*
  • Zambia


  • Metals, Heavy
  • Arsenic