Abstract

Background:

The general population is ubiquitously exposed to the toxic metal cadmium through the diet and smoking. Cadmium exposure is associated with increased morbidity and mortality in myocardial infarction and stroke. Atherosclerosis is the main underlying mechanism of myocardial infarction. However, associations between cadmium and coronary artery atherosclerosis have not been examined.

Objectives:

Our study sought to examine the hypothesis that blood cadmium (B-Cd) is positively associated with coronary artery calcification, as a measure of coronary artery atherosclerosis in the population-based Swedish SCAPIS study.

Methods:

Our analysis included 5,627 individuals (51% women), age 50–64 y, enrolled from 2013 to 2018. The coronary artery calcium score (CACS) was obtained from computed tomography. Blood cadmium was determined by inductively coupled plasma mass spectrometry (ICP-MS). Associations between B-Cd and coronary artery calcium score (CACS Agatston score) were evaluated using prevalence ratios (PRs) in models adjusted for sex, age, smoking, hypertension, diabetes, low-density cholesterol/high-density cholesterol ratio, and family history.

Results:

The median B-Cd concentration was $0.24\mathrm{\mu }\mathrm{g}/\mathrm{L}$. The prevalence of positive coronary artery calcium ($\text{CACS}>0$) was 41% and the prevalence of $\text{CACS}\ge 100$ was 13%. Relative to the lowest quartile (Q) of B-Cd ($<0.16\mathrm{\mu }\mathrm{g}/\mathrm{L}$), the highest quartile (median $0.63\mathrm{\mu }\mathrm{g}/\mathrm{L}$) was associated with a small but significant increase in $\text{CACS}>0$ (PR 1.1; 95% CI: 1.0, 1.3), and a greater relative increase in $\text{CACS}\ge 100$ (PR 1.6; 95% CI: 1.3, 2.0). When restricted to 2,446 never-smokers, corresponding PRs were 1.1 (95% CI 0.9, 1.3) for $\text{CACS}>0$ (63 cases in Q4) and 1.7 (95% CI 1.1, 2.7) for $\text{CACS}\ge 100$ (17 cases in Q4).

Discussion:

Blood cadmium in the highest quartile was associated with CACS in a general population sample with low to moderate cadmium exposure. This supports the hypothesis that atherosclerosis is an important mechanism underlying the associations between cadmium and incident cardiovascular disease. The findings suggest that public health measures to reduce cadmium exposure are warranted. https://doi.org/10.1289/EHP8523

中文翻译：

---

镉暴露和冠状动脉粥样硬化：瑞典中年成人的基于人群的横断面研究

摘要

背景：

普通人群通过饮食和吸烟普遍接触有毒金属镉。镉暴露与心肌梗塞和中风的发病率和死亡率增加有关。动脉粥样硬化是心肌梗死的主要潜在机制。然而，尚未研究镉与冠状动脉粥样硬化之间的关联。

目标：

我们的研究试图检验血镉 (B-Cd) 与冠状动脉钙化呈正相关的假设，作为基于人群的瑞典 SAPIS 研究中冠状动脉粥样硬化的衡量标准。

方法：

我们的分析包括 2013 年至 2018 年登记的 5,627 名个体（51% 女性），年龄 50-64 岁。冠状动脉钙化评分（CACS）来自计算机断层扫描。通过电感耦合等离子体质谱（ICP-MS）测定血镉。B-Cd 与冠状动脉钙化评分（CACS Agatston 评分）之间的关联使用患病率（PRs）在根据性别、年龄、吸烟、高血压、糖尿病、低密度胆固醇/高密度胆固醇比率和家庭调整的模型中进行评估历史。

结果：

B-Cd 浓度中位数为$0.24\mathrm{\mu }\mathrm{G}/\mathrm{大号}$. 冠状动脉钙化阳性的患病率（$\text{CACS}>0$) 为 41%，$\text{CACS}\ge 100$为 13%。相对于 B-Cd 的最低四分位数 (Q) ($<0.16\mathrm{\mu }\mathrm{G}/\mathrm{大号}$)，最高四分位数（中位数$0.63\mathrm{\mu }\mathrm{G}/\mathrm{大号}$) 与小但显着的增加有关$\text{CACS}>0$(PR 1.1; 95% CI: 1.0, 1.3)，以及更大的相对增加$\text{CACS}\ge 100$（PR 1.6；95% CI：1.3、2.0）。当仅限于 2,446 名从不吸烟者时，相应的 PR 为 1.1 (95% CI 0.9, 1.3)$\text{CACS}>0$（第 4 季度 63 例）和 1.7 例（95% CI 1.1, 2.7）$\text{CACS}\ge 100$（第 4 季度 17 例）。

讨论：

在低至中度镉暴露的一般人群样本中，最高四分位数的血镉与 CACS 相关。这支持了动脉粥样硬化是镉与心血管疾病之间关联的重要机制的假设。研究结果表明，有必要采取公共卫生措施减少镉暴露。https://doi.org/10.1289/EHP8523