title: Cadmium exposure and incident cardiovascular disease.
abstract: BACKGROUND
  Cadmium is a widespread toxic metal with potential cardiovascular effects, but no studies have evaluated cadmium and incident cardiovascular disease. We evaluated the association of urine cadmium concentration with cardiovascular disease incidence and mortality in a large population-based cohort.
  
  
  METHODS
  We conducted a prospective cohort study of 3348 American Indian adults 45-74 years of age from Arizona, Oklahoma, and North and South Dakota, who participated in the Strong Heart Study in 1989-1991. Urine cadmium was measured using inductively coupled plasma mass spectrometry. Follow-up extended through 31 December 2008.
  
  
  RESULTS
  The geometric mean cadmium level in the study population was 0.94 μg/g (95% confidence interval [CI] = 0.92-0.96). We identified 1084 cardiovascular events, including 400 deaths. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratios (HRs) (comparing the 80th to the 20th percentile of urine cadmium concentrations) was 1.43 for cardiovascular mortality (95% CI = 1.21-1.70) and 1.34 for coronary heart disease mortality (1.10-1.63). The corresponding HRs for incident cardiovascular disease, coronary heart disease, stroke, and heart failure were 1.24 (1.11-1.38), 1.22 (1.08-1.38), 1.75 (1.17-2.59), and 1.39 (1.01-1.94), respectively. The associations were similar in most study subgroups, including never-smokers.
  
  
  CONCLUSIONS
  Urine cadmium, a biomarker of long-term exposure, was associated with increased cardiovascular mortality and increased incidence of cardiovascular disease. These findings support that cadmium exposure is a cardiovascular risk factor.
authors.affiliation: Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Tellez-Plaza
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Jason G
authors.initials: JG
authors.lastname: Umans
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Francesconi
authors.forename: Walter
authors.initials: W
authors.lastname: Goessler
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Silbergeld
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
mesh_terms: D000368:Aged; D001130:Arizona / Q000453:epidemiology; D002104:Cadmium / Q000009:adverse effects* / Q000652:urine; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000208:ethnology / Q000401:mortality; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D004785:Environmental Pollutants / Q000009:adverse effects* / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D015233:Models, Statistical; D009658:North Dakota / Q000453:epidemiology; D009825:Oklahoma / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013023:South Dakota / Q000453:epidemiology
chemical_list: D004785:Environmental Pollutants; D002104:Cadmium