Tellez-Plaza Maria, Guallar Eliseo, Fabsitz Richard R, Howard Barbara V, Umans Jason G, Francesconi Kevin A, Goessler Walter, Devereux Richard B, Navas-Acien Ana
Department of Environmental Health Sciences.
Circ Cardiovasc Qual Outcomes. 2013 Nov;6(6):626-33. doi: 10.1161/CIRCOUTCOMES.112.000134.
Cadmium has been associated with peripheral arterial disease (PAD) in cross-sectional studies, but prospective evidence is lacking. Our goal was to evaluate the association of urine cadmium concentrations with incident PAD in a large population-based cohort.
A prospective cohort study was performed with 2864 adult American Indians 45 to 74 years of age from Arizona, Oklahoma, and North and South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2 follow-up examination visits in 1993 to 1995 and 1997 to 1999. Participants were free of PAD, defined as an ankle brachial index <0.9 or >1.4 at baseline, and had complete baseline information on urine cadmium, potential confounders, and ankle brachial index determinations in the follow-up examinations. Urine cadmium was measured using inductively coupled plasma mass spectrometry and corrected for urinary dilution by normalization to urine creatinine. Multivariable-adjusted hazard ratios were computed using Cox-proportional hazards models for interval-censored data. A total of 470 cases of incident PAD, defined as an ankle brachial index <0.9 or >1.4, were identified. After adjustment for cardiovascular disease risk factors including smoking status and pack-years, the hazard ratio comparing the 80th to the 20th percentile of urine cadmium concentrations was 1.41 (1.05-1.81). The hazard ratio comparing the highest to the lowest tertile was 1.96 (1.32-2.81). The association persisted after excluding participants with ankle brachial index >1.4 only as well as in subgroups defined by sex and smoking status.
Urine cadmium, a biomarker of long-term cadmium exposure, was independently associated with incident PAD, providing further support for cadmium as a cardiovascular disease risk factor.
在横断面研究中,镉已被证实与外周动脉疾病(PAD)有关,但前瞻性证据尚缺。我们的目标是在一个大型人群队列中评估尿镉浓度与新发PAD之间的关联。
对来自亚利桑那州、俄克拉何马州以及北达科他州和南达科他州的2864名45至74岁成年美国印第安人进行了一项前瞻性队列研究,这些人于1989年至1991年参与了强心研究,并在1993年至1995年以及1997年至1999年进行了两次随访检查。参与者在基线时无PAD(定义为踝臂指数<0.9或>1.4),且在随访检查中有关于尿镉、潜在混杂因素以及踝臂指数测定的完整基线信息。使用电感耦合等离子体质谱法测量尿镉,并通过将其标准化为尿肌酐来校正尿液稀释。使用Cox比例风险模型对区间删失数据计算多变量调整后的风险比。共识别出470例新发PAD病例(定义为踝臂指数<0.9或>1.4)。在调整包括吸烟状况和吸烟包年数在内的心血管疾病风险因素后,尿镉浓度第80百分位数与第20百分位数相比的风险比为1.41(1.05 - 1.81)。最高三分位数与最低三分位数相比的风险比为1.96(1.32 - 2.81)。在仅排除踝臂指数>1.4的参与者以及按性别和吸烟状况定义的亚组中,该关联仍然存在。
尿镉作为长期镉暴露的生物标志物,与新发PAD独立相关,这为镉作为心血管疾病风险因素提供了进一步支持。