title: Cadmium exposure and all-cause and cardiovascular mortality in the U.S. general population.
abstract: BACKGROUND
  Urine cadmium concentrations were associated with all-cause and cardiovascular mortality in men in the 1988-1994 U.S. National Health and Nutrition Examination Survey (NHANES) population. Since 1988, cadmium exposure has decreased substantially in the United States. The associations between blood and urine cadmium and cardiovascular disease (CVD) mortality at more recent levels of exposure are unknown.
  
  
  OBJECTIVE
  We evaluated the prospective association of blood and urine cadmium concentrations with all-cause and CVD mortality in the 1999-2004 U.S. population.
  
  
  METHODS
  We followed 8,989 participants who were ≥ 20 years of age for an average of 4.8 years. Hazard ratios for mortality end points comparing the 80th to the 20th percentiles of cadmium distributions were estimated using Cox regression.
  
  
  RESULTS
  The multivariable adjusted hazard ratios [95% confidence intervals (CIs)] for blood and urine cadmium were 1.50 (95% CI: 1.07, 2.10) and 1.52 (95% CI: 1.00, 2.29), respectively, for all-cause mortality, 1.69 (95% CI: 1.03, 2.77) and 1.74 (95% CI: 1.07, 2.83) for CVD mortality, 1.98 (95% CI: 1.11, 3.54) and 2.53 (95% CI: 1.54, 4.16) for heart disease mortality, and 1.73 (95% CI: 0.88, 3.40) and 2.09 (95% CI: 1.06, 4.13) for coronary heart disease mortality. The population attributable risks associated with the 80th percentile of the blood (0.80 μg/L) and urine (0.57 μg/g) cadmium distributions were 7.0 and 8.8%, respectively, for all-cause mortality and 7.5 and 9.2%, respectively, for CVD mortality.
  
  
  CONCLUSIONS
  We found strongly suggestive evidence that cadmium, at substantially low levels of exposure, remains an important determinant of all-cause and CVD mortality in a representative sample of U.S. adults. Efforts to further reduce cadmium exposure in the population could contribute to a substantial decrease in CVD disease burden.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. mtellezp@jhsph.edu
authors.forename: Maria
authors.initials: M
authors.lastname: Tellez-Plaza
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
authors.forename: Andy
authors.initials: A
authors.lastname: Menke
authors.forename: Ciprian M
authors.initials: CM
authors.lastname: Crainiceanu
authors.forename: Roberto
authors.initials: R
authors.lastname: Pastor-Barriuso
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
mesh_terms: D000328:Adult; D002104:Cadmium / Q000633:toxicity*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014481:United States
chemical_list: D002104:Cadmium