尿液镉与心力衰竭事件：丹麦从不吸烟者的病例队列分析。
Urinary Cadmium and Incident Heart Failure: A Case-Cohort Analysis Among Never-Smokers in Denmark.
机构信息
From the Department of Epidemiology, Brown University School of Public Health, Providence, RI.
Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY.
出版信息
Epidemiology. 2022 Mar 1;33(2):185-192. doi: 10.1097/EDE.0000000000001446.
BACKGROUND
Epidemiologic studies suggest cadmium exposure is associated with cardiovascular disease risk, including heart failure. However, prior findings may be influenced by tobacco smoking, a dominant source of cadmium exposure and risk factor for heart failure. The present study leverages up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to examine the relationship between urinary cadmium and incident heart failure among people who never smoked.
METHODS
Between 1993 and 1997, 19,394 never-smoking participants (ages 50-64 years) enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 men and 600 women and identified 958 incident heart failure cases occurring between baseline and 2015. Using a case-cohort approach, we estimated adjusted hazard ratios (aHR) for heart failure in Cox proportional hazards models with age as the time scale.
RESULTS
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). In adjusted models, we found that higher urinary cadmium was associated with a higher rate of incident heart failure overall (aHR = 1.1 per interquartile range difference [95% CI = 1.0, 1.2). In sex-stratified analyses, the association seemed restricted to men (aHR = 1.5 [95% CI = 1.2, 1.9]).
CONCLUSIONS
In this cohort of people who never smoked tobacco, environmental cadmium was positively associated with incident heart failure, especially among men.
背景
流行病学研究表明，镉暴露与心血管疾病风险相关，包括心力衰竭。然而，先前的研究结果可能受到吸烟的影响，吸烟是镉暴露和心力衰竭的主要来源和危险因素。本研究利用丹麦饮食、癌症和健康队列中长达 20 年的随访数据，研究了从不吸烟人群的尿液镉与心力衰竭事件之间的关系。
方法
1993 年至 1997 年间，19394 名从不吸烟的参与者（年龄 50-64 岁）入组并提供了尿液样本。从这个样本中，我们随机选择了 600 名男性和 600 名女性的子队列，并确定了 958 例基线至 2015 年间发生的心力衰竭事件。使用病例-队列方法，我们在 Cox 比例风险模型中以年龄为时间尺度，估计了心力衰竭的调整后风险比（aHR）。
结果
参与者尿液中的镉浓度相对较低，这与从不吸烟者的预期相符（中位数=0.20；25 分位、75 分位=0.13、0.32μg 镉/g 肌酐）。在调整模型中，我们发现尿液中镉浓度较高与心力衰竭事件的发生率整体升高相关（aHR=1.1，每四分位距差异[95%CI=1.0,1.2]）。在性别分层分析中，这种关联似乎仅限于男性（aHR=1.5[95%CI=1.2,1.9]）。
结论
在本项从不吸烟人群的队列研究中，环境镉与心力衰竭的发生呈正相关，尤其是在男性中。
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