Department of Toxicology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi 030001, China; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA; Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
Toxicol Appl Pharmacol. 2018 Aug 15;353:15-22. doi: 10.1016/j.taap.2018.05.032. Epub 2018 May 26.
We hypothesized that the associations of urinary Cd with blood pressure and cardiovascular disease (CVD) mortality may be modified by renal function.
We tested these hypotheses using data from the National Health and Nutrition Examination Survey (NHANES, 1999-2010).
Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with blood Cd. DBP was positively related to urinary Cd whereas SBP was inversely associated with urinary Cd. In the stratified analyses by level of eGFR, the associations between SBP and urinary Cd were not statistically significant among those with normal renal function and those with mildly reduced renal function whereas SBP significantly positively associated with urinary Cd among those with moderately or severely decreased renal function (p for trend, 0.0004). Renal function appeared to be a modifying factor of the association between urinary Cd and mortality. CVD mortality risks (p for trend, 0.04) were significantly increased with increasing urinary Cd with hazard ratios (HRs) (95% CIs) of 2.18 (0.68-7.01) for the highest quartile of urinary Cd compared to the lowest. The association between urinary Cd and CVD mortality became stronger in the stratified analyses by renal function and these associations became more consistent in those who never smoked.
The inverse association between urinary Cd and blood pressure observed in previous studies may be due to lack of consideration of renal function as an effect modifier. The strength of the association between urinary Cd and CVD mortality may be underestimated without considering renal function.
我们假设尿镉与血压和心血管疾病（CVD）死亡率之间的关联可能会受到肾功能的影响。
我们使用来自国家健康和营养检查调查（NHANES，1999-2010 年）的数据来检验这些假设。
收缩压（SBP）和舒张压（DBP）均与血镉呈正相关。DBP 与尿镉呈正相关，而 SBP 与尿镉呈负相关。在按 eGFR 水平分层的分析中，在肾功能正常和轻度肾功能减退的人群中，SBP 与尿镉之间的关联没有统计学意义，而在中度或重度肾功能减退的人群中，SBP 与尿镉呈显著正相关（趋势检验 P 值，0.0004）。肾功能似乎是尿镉与死亡率之间关联的一个修饰因素。随着尿镉的增加，CVD 死亡率风险呈上升趋势（趋势检验 P 值，0.04），与最低 quartile 相比，尿镉最高 quartile 的风险比（HR）（95%CI）为 2.18（0.68-7.01）。在按肾功能分层的分析中，尿镉与 CVD 死亡率之间的关联变得更强，在从未吸烟的人群中，这些关联变得更加一致。
在之前的研究中观察到的尿镉与血压之间的负相关可能是由于缺乏对肾功能作为效应修饰剂的考虑。如果不考虑肾功能，尿镉与 CVD 死亡率之间的关联的强度可能被低估。
