CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Environ Res. 2024 Dec 15;263(Pt 1):120014. doi: 10.1016/j.envres.2024.120014. Epub 2024 Sep 18.
Exposure to environmental toxic metals represents a significant global public health concern. Many studies have reported that cadmium (Cd) exposure increases the risk of hypertension. Since the shape of such relation has not been well characterized, we assessed it by performing a systematic review and dose-response meta-analysis of human studies.
We searched the literature through September 5, 2024 to identify papers related to Cd, hypertension, and blood pressure. Inclusion criteria were: observational design, adult population, assessment of exposure using Cd biomarkers, and availability of exposure category-specific risk estimates for hypertension. We performed a dose-response meta-analysis of the results from included studies.
Of the 18 studies published between 2006 and 2024, most had a cross-sectional design. Cd was measured in whole blood and/or urine in almost all studies, whereas only two studies measured Cd in serum. The dose-response meta-analysis indicated an almost linear relation between urinary Cd concentrations and hypertension risk with RR = 1.18, 95% CI 1.02-1.37 at 2.0 μg/g creatinine compared with no exposure. In contrast, the association between blood Cd concentrations and hypertension risk was non-linear: there was a steep monotonic increase in risk for Cd concentrations below 2 μg/L, reaching a RR of 1.48 (95% CI 1.17-1.86) at 2.0 μg/L, after which a plateau seemed reached. We found similar trends when restricting to studies of Asian population, while when considering North American studies, hypertension risk increased above 1.0 μg/g creatinine.
In this dose-response meta-analysis, risk of hypertension showed a non-linear positive association with blood Cd concentrations and a linear positive association with urinary Cd concentrations. Inconsistency in the shape of associations could relate to the different timing of exposure assessed by the biomarkers or the alteration Cd excretion at increasing exposure levels. Mitigation of Cd exposure is confirmed as a public health priority for chronic disease prevention.
暴露于环境有毒金属是一个重大的全球公共卫生问题。许多研究报告称，镉（Cd）暴露会增加患高血压的风险。由于这种关系的形状尚未得到很好的描述，我们通过对人类研究进行系统评价和剂量反应荟萃分析来评估它。
我们通过检索文献，于 2024 年 9 月 5 日之前确定了与 Cd、高血压和血压相关的论文。纳入标准为：观察性设计、成年人群、使用 Cd 生物标志物评估暴露情况以及可获得高血压特定暴露类别风险估计值的研究。我们对纳入研究的结果进行了剂量反应荟萃分析。
在 2006 年至 2024 年期间发表的 18 项研究中，大多数为横断面设计。几乎所有研究都测量了全血和/或尿液中的 Cd，而只有两项研究测量了血清中的 Cd。剂量反应荟萃分析表明，尿 Cd 浓度与高血压风险之间呈近乎线性关系，与无暴露相比，2.0μg/g 肌酐时 RR 为 1.18，95%CI 为 1.02-1.37。相比之下，血 Cd 浓度与高血压风险之间的关系是非线性的：在 Cd 浓度低于 2μg/L 时，风险呈陡峭单调递增，在 2.0μg/L 时达到 RR 为 1.48（95%CI 1.17-1.86），之后似乎达到了一个平台。当限制在亚洲人群的研究中时，我们发现了类似的趋势，而当考虑北美研究时，高血压风险在 1.0μg/g 肌酐以上时增加。
在这项剂量反应荟萃分析中，高血压风险与血 Cd 浓度呈正相关，与尿 Cd 浓度呈线性正相关。关联形状的不一致可能与生物标志物评估的暴露时间不同或随着暴露水平的增加 Cd 排泄的改变有关。减轻 Cd 暴露被证实是预防慢性病的公共卫生重点。
