Background To evaluate whether blood markers of lead, cadmium, and mercury can improve prediction for cardiovascular disease (CVD) mortality when added individually, jointly, or as an integrative index/Environmental Risk Score (ERS), in a model with established risk factors. Methods and Results Our study sample comprised 16 028 adults aged ≥40 years who were enrolled in the National Health and Nutrition Examination Survey 1999-2012 and followed up through December 31, 2015. The study sample was…