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. 2021 May:150:106428.
doi: 10.1016/j.envint.2021.106428. Epub 2021 Feb 8.

Urine cadmium and acute myocardial infarction among never smokers in the Danish Diet, Cancer and Health cohort

Clara G Sears  1 , Aslak Harbo Poulsen  2 , Melissa Eliot  3 , Chanelle J Howe  3 , Katherine A James  4 , James M Harrington  5 , Nina Roswall  2 , Kim Overvad  6 , Anne Tjønneland  7 , Ole Raaschou-Nielsen  8 , Gregory A Wellenius  9 , Jaymie Meliker  10
Affiliations

Urine cadmium and acute myocardial infarction among never smokers in the Danish Diet, Cancer and Health cohort

Clara G Sears et al. Environ Int. 2021 May.

Abstract

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.

Keywords: Acute myocardial infarction; Cadmium; Cardiovascular disease; Case-cohort study.

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Conflict of interest statement

COMPETING INTERESTS: None.

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Flow diagram of case-cohort study design with participants from the Diet, Cancer and Health cohort (Copenhagen and Aarhus, Denmark; 1993–1997)
See this image and copyright information in PMC

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