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Published on: January 18, 2018
Urinary cadmium concentration and the risk of ischemic stroke
Cheng Chen1, Pengcheng Xun1, Cari Tsinovoi1
1From the Departments of Epidemiology and Biostatistics (C.C., P.X., C.T., K.H.) and Environmental Health (L.K.), School of Public Health, and Department of Neurology (J.M.), School of Medicine, Indiana University, Bloomington; Department of Epidemiology and Biostatistics (L.A.M.), Dornsife School of Public Health, Drexel University, Philadelphia, PA; Columbia Research Reactor (J.B.), University of Missouri; National Institute for Occupational Safety and Health (L.M.), Centers for Disease Control and Prevention, Washington, DC; Department of Medicine (M.C.), Larner College of Medicine, University of Vermont, Burlington; and Department of Biostatistics (J.C.), University of North Carolina at Chapel Hill.
Objectives:
To examine the association between urinary cadmium levels and the incidence of ischemic stroke and to explore possible effect modifications.
Methods:
A case-cohort study was designed nested in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, including 680 adjudicated incident cases of ischemic stroke and 2,540 participants in a randomly selected subcohort. Urinary creatinine-corrected cadmium concentration was measured at baseline. Multivariable-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated with the Barlow weighting method for the Cox proportional hazards regression model.
Results:
The median urinary cadmium concentration was 0.42 (interquartile range 0.27-0.68) μg/g creatinine. After adjustment for potential confounders, urinary cadmium was associated with increased incidence of ischemic stroke (quintile 5 vs quintile 1: HR 1.50, 95% CI 1.01-2.22, p for trend = 0.02). The observed association was more pronounced among participants in the lowest serum zinc tertile (tertile 3 vs tertile 1: HR 1.82, 95% CI 1.06-3.11, p for trend = 0.004, p for interaction = 0.05) but was attenuated and became nonsignificant among never smokers (tertile 3 vs tertile 1: never smokers: HR 1.27, 95% CI 0.80-2.03, p for trend = 0.29; ever smokers: HR 1.60, 95% CI 1.06-2.43, p for trend = 0.07, p for interaction = 0.51).
Conclusions:
Findings from this study suggest that cadmium exposure may be an independent risk factor for ischemic stroke in the US general population. Never smoking and maintaining a high serum zinc level may ameliorate the potential adverse effects of cadmium exposure.
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