Cadmium exposure has been associated with cardiovascular disease. Cigarette smoking is a key source of cadmium exposure and thus a potential confounder in observational studies of environmental cadmium and cardiovascular disease that include tobacco smokers. We leveraged up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to test the hypothesis that cadmium exposure is associated with acute myocardial infarction (AMI) among people who never smoked. Between 1993 and 1997, 19,394 never-smoking participants (ages 50–64 years) were enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 males and 600 females. We identified 809 AMI cases occurring between baseline and the end of 2015 using the Danish National Patient Registry. We quantified cadmium, creatinine, and osmolality in baseline urine samples. Using an unweighted case-cohort approach, we estimated adjusted hazard ratios (aHR) for AMI in Cox proportional hazards models with age as the time axis. 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). We did not find strong evidence to support an association between higher urinary cadmium and AMI when comparing the highest versus lowest quartile (aHR = 1.16; 95% CI: 0.86 – 1.56) and per IQR increment in cadmium concentration (aHR = 1.02; 95% CI: 0.93 – 1.12). Results were not materially different across strata defined by sex. Results were generally similar using creatinine or osmolality to account for differences in urine dilution. While cadmium exposure has been identified as a risk factor for cardiovascular disease, we did not find strong evidence that urinary cadmium at relatively low-levels is associated with AMI among people who have never smoked.

镉暴露与心血管疾病有关。吸烟是镉暴露的一个主要来源，因此在包括吸烟者在内的环境镉和心血管疾病的观察性研究中是一个潜在的混杂因素。我们利用丹麦饮食、癌症和健康队列长达 20 年的随访来检验以下假设：镉暴露与从不吸烟的人中急性心肌梗死 (AMI) 相关。1993 年至 1997 年间，19,394 名从不吸烟的参与者（年龄 50-64 岁）被招募并提供了尿液样本。从这个样本中，我们随机选择了一个由 600 名男性和 600 名女性组成的子队列。我们利用丹麦国家患者登记处确定了从基线到 2015 年底之间发生的 809 例 AMI 病例。我们量化了基线尿液样本中的镉、肌酐和渗透压。使用未加权的病例队列方法，我们在以年龄为时间轴的 Cox 比例风险模型中估计了 AMI 的调整后风险比 (aHR)。参与者的尿镉浓度相对较低，正如对从不吸烟者的预期一样（中位数 = 0.20；第 25、75 个= 0.13、0.32 μg 镉/g 肌酐）。在比较最高与最低四分位数（aHR = 1.16；95% CI：0.86 – 1.56）和每 IQR 镉浓度增量（aHR = 1.02；95%）时，我们没有发现强有力的证据支持较高尿镉与 AMI 之间的关联。置信区间：0.93 – 1.12）。按性别定义的不同阶层的结果没有显着差异。使用肌酐或渗透压来解释尿液稀释的差异，结果通常相似。虽然镉暴露已被确定为心血管疾病的危险因素，但我们没有发现强有力的证据表明，相对较低水平的尿镉与从未吸烟者的 AMI 相关。