title: Cadmium exposure and incident peripheral arterial disease.
abstract: BACKGROUND
  Cadmium has been associated with peripheral arterial disease (PAD) in cross-sectional studies, but prospective evidence is lacking. Our goal was to evaluate the association of urine cadmium concentrations with incident PAD in a large population-based cohort.
  
  
  RESULTS
  A prospective cohort study was performed with 2864 adult American Indians 45 to 74 years of age from Arizona, Oklahoma, and North and South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2 follow-up examination visits in 1993 to 1995 and 1997 to 1999. Participants were free of PAD, defined as an ankle brachial index <0.9 or >1.4 at baseline, and had complete baseline information on urine cadmium, potential confounders, and ankle brachial index determinations in the follow-up examinations. Urine cadmium was measured using inductively coupled plasma mass spectrometry and corrected for urinary dilution by normalization to urine creatinine. Multivariable-adjusted hazard ratios were computed using Cox-proportional hazards models for interval-censored data. A total of 470 cases of incident PAD, defined as an ankle brachial index <0.9 or >1.4, were identified. After adjustment for cardiovascular disease risk factors including smoking status and pack-years, the hazard ratio comparing the 80th to the 20th percentile of urine cadmium concentrations was 1.41 (1.05-1.81). The hazard ratio comparing the highest to the lowest tertile was 1.96 (1.32-2.81). The association persisted after excluding participants with ankle brachial index >1.4 only as well as in subgroups defined by sex and smoking status.
  
  
  CONCLUSIONS
  Urine cadmium, a biomarker of long-term cadmium exposure, was independently associated with incident PAD, providing further support for cadmium as a cardiovascular disease risk factor.
authors.affiliation: Department of Environmental Health Sciences.
authors.forename: Maria
authors.initials: M
authors.lastname: Tellez-Plaza
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Richard R
authors.initials: RR
authors.lastname: Fabsitz
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: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001130:Arizona; D015415:Biomarkers / Q000652:urine; D002104:Cadmium / Q000009:adverse effects* / Q000652:urine; D004781:Environmental Exposure / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D013058:Mass Spectrometry; D008875:Middle Aged; D009658:North Dakota; D009825:Oklahoma; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D013023:South Dakota
chemical_list: D015415:Biomarkers; D002104:Cadmium
keywords: cadmium; peripheral arterial disease