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. 2023 Jul 4:11:1106732.
doi: 10.3389/fpubh.2023.1106732. eCollection 2023.

Association of blood cadmium with all-cause and cause-specific mortality in patients with hypertension

Shuaijie Chen  1   2 , Ruming Shen  1   2 , Jiayi Shen  1 , Lingchun Lyu  1 , Tiemin Wei  1
Affiliations

Association of blood cadmium with all-cause and cause-specific mortality in patients with hypertension

Shuaijie Chen et al. Front Public Health. .

Abstract

Background: Cadmium is a commonly found heavy metal with a prolonged biological half-life, which results in long-term health burden for the population. Prior studies have demonstrated an association between blood cadmium and hypertension. However, few studies examined the relationship between blood cadmium and long-term health outcomes in patients with hypertension. This study aimed to investigate the association of blood cadmium with mortality in patients with hypertension.

Methods: This study analyzed data from the National Health and Nutrition Examination Survey 1999-2012. Complex sampling-weighted multivariate Cox proportional hazards models were used to evaluate the hazard ratios (HRs) of all-cause, cardiovascular, and Alzheimer's disease mortality in patients with hypertension classified by blood cadmium concentrations' quantiles.

Results: The study included 12,208 patients with hypertension with a median follow-up duration of 10.8 years. During this period, there were 4,485 all-cause deaths, including 1,520 cardiovascular deaths and 180 Alzheimer's disease deaths. Compared with the lowest quintile of blood cadmium (≤0.25 μg/L) group, the highest quintile of blood cadmium (≥0.80 μg/L) group's adjusted HRs were 1.85 (95% CI, 1.59-2.14) for all-cause mortality, 1.76 (95% CI, 1.33-2.34) for cardiovascular mortality, and 3.41 (95% CI, 1.54-7.51) for Alzheimer's disease mortality. Additionally, the adjusted HR for cardiovascular mortality was 2.12 (95% CI, 1.36-3.30) in never-smoking patients with hypertension.

Conclusion: Higher blood cadmium is associated with increased risks of all-cause, cardiovascular, and Alzheimer's disease mortality in patients with hypertension. The effect of blood cadmium on cardiovascular mortality may be more pronounced in never-smoking hypertensive patients.

Keywords: NHANES; blood cadmium; cardiovascular risk; hypertension; mortality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of participants selection.
Figure 2
Figure 2
Dose–response curves for concentrations of blood cadmium and mortality. (A) All-cause mortality. (B) Cardiovascular mortality. (C) Alzheimer’s disease mortality.
Figure 3
Figure 3
The adjusted HRs of the highest quintile of blood cadmium compared with the lowest quintile of blood cadmium in subgroups (gender, age, BMI, blood pressure control, eGFR, and smoking status). (A) All-cause mortality. (B) Cardiovascular mortality. (C) Alzheimer’s disease mortality.
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