Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Danish Cancer Society Research Center, Copenhagen, Denmark.
Environ Int. 2021 May;150:106428. doi: 10.1016/j.envint.2021.106428. Epub 2021 Feb 8.
Cadmium exposure has been associated with cardiovascular disease. Cigarette smoking is a key source of cadmium exposure and thus a potential confounder in observational studies of environmental cadmium and cardiovascular disease that include tobacco smokers. We leveraged up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to test the hypothesis that cadmium exposure is associated with acute myocardial infarction (AMI) among people who never smoked. Between 1993 and 1997, 19,394 never-smoking participants (ages 50-64 years) were enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 males and 600 females. We identified 809 AMI cases occurring between baseline and the end of 2015 using the Danish National Patient Registry. We quantified cadmium, creatinine, and osmolality in baseline urine samples. Using an unweighted case-cohort approach, we estimated adjusted hazard ratios (aHR) for AMI in Cox proportional hazards models with age as the time axis. Participants had relatively low concentrations of urinary cadmium, as expected for never smokers (median = 0.20; 25th, 75th = 0.13, 0.32 μg cadmium/g creatinine). We did not find strong evidence to support an association between higher urinary cadmium and AMI when comparing the highest versus lowest quartile (aHR = 1.16; 95% CI: 0.86 - 1.56) and per IQR increment in cadmium concentration (aHR = 1.02; 95% CI: 0.93 - 1.12). Results were not materially different across strata defined by sex. Results were generally similar using creatinine or osmolality to account for differences in urine dilution. While cadmium exposure has been identified as a risk factor for cardiovascular disease, we did not find strong evidence that urinary cadmium at relatively low-levels is associated with AMI among people who have never smoked.
镉暴露与心血管疾病有关。吸烟是镉暴露的一个主要来源,因此在包括吸烟者在内的环境镉与心血管疾病的观察性研究中,吸烟可能是一个潜在的混杂因素。我们利用丹麦饮食、癌症和健康队列中长达 20 年的随访数据,检验了镉暴露与从不吸烟人群中急性心肌梗死(AMI)之间关联的假设。1993 年至 1997 年间,招募了 19394 名从不吸烟的参与者(年龄在 50-64 岁之间),并提供了一份尿液样本。从这个样本中,我们随机选择了 600 名男性和 600 名女性的亚组。我们使用丹麦国家患者登记处确定了基线至 2015 年底期间发生的 809 例 AMI 病例。我们在 Cox 比例风险模型中使用年龄作为时间轴,对基线尿液样本中的镉、肌酐和渗透压进行了量化。使用未加权的病例-队列方法,我们估计了 Cox 比例风险模型中 AMI 的调整后风险比(aHR),年龄作为时间轴。正如预期的那样,参与者尿液中的镉浓度相对较低(中位数=0.20;25 分位数,75 分位数=0.13,0.32μg 镉/g 肌酐),从不吸烟者的情况就是如此。我们没有发现强有力的证据支持尿液中镉含量较高与 AMI 之间存在关联,比较最高与最低四分位数时(aHR=1.16;95%CI:0.86-1.56),以及每增加一个四分位距的镉浓度时(aHR=1.02;95%CI:0.93-1.12)。按性别定义的分层结果没有明显差异。用肌酐或渗透压来解释尿液稀释的差异,结果基本相似。虽然镉暴露已被确定为心血管疾病的一个危险因素,但我们没有发现强有力的证据表明,从不吸烟者尿液中相对较低水平的镉与 AMI 有关。