Associations between urinary cadmium levels, blood pressure, and hypertension: the ESTEBAN survey

Mechanism of cadmium-induced nephrotoxicity

Heavy metals are found naturally in our environment and have many uses and applications in daily life. However, high concentrations of metals may be a result of pollution due to industrialization. In particular, cadmium (Cd), a white metal abundantly distributed in the terrestrial crust, is found in mines together with zinc, which accumulates after volcanic eruption or is found naturally in the sea and earth. High levels of Cd have been associated with disease. In the human body, Cd accumulates in two ways: via inhalation or consumption, mainly of plants or fish contaminated with high concentrations. Several international organizations have been working to establish the limit values of heavy metals in food, water, and the environment to avoid their toxic effects. Increased Cd levels may induce kidney, liver, or neurological diseases. Cd mainly accumulates in the kidney, causing renal disease in people exposed to moderate to high levels, which leads to the development of end-stage chronic kidney disease or death. The aim of this review is to provide an overview of Cd-induced nephrotoxicity, the mechanisms of Cd damage, and the current treatments used to reduce the toxic effects of Cd exposure.

Heavy Metal Exposure: Molecular Pathways, Clinical Implications, and Protective Strategies

Heavy metals are often found in soil and can contaminate drinking water, posing a serious threat to human health. Molecular pathways and curation therapies for mitigating heavy metal toxicity have been studied for a long time. Recent studies on oxidative stress and aging have shown that the molecular foundation of cellular damage caused by heavy metals, namely, apoptosis, endoplasmic reticulum stress, and mitochondrial stress, share the same pathways as those involved in cellular senescence and aging. In recent aging studies, many types of heavy metal exposures have been used in both cellular and animal aging models. Chelation therapy is a traditional treatment for heavy metal toxicity. However, recently, various antioxidants have been found to be effective in treating heavy metal-induced damage, shifting the research focus to investigating the interplay between antioxidants and heavy metals. In this review, we introduce the molecular basis of heavy metal-induced cellular damage and its relationship with aging, summarize its clinical implications, and discuss antioxidants and other agents with protective effects against heavy metal damage.

The association between blood heavy metals and gallstones: A cross-sectional study

BACKGROUND AND AIMS

Exposure to heavy metals has been widely recognized as a risk factor for human health. However, there is limited information on the effects of blood heavy metals on gallstones. This study aims to investigate the relationship between blood heavy metals and gallstones using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

7192 participants aged 20 years or older with complete information were included in the study. Serum concentrations of heavy metals were determined by inductively coupled plasma kinetic reaction cell mass spectrometry. Gallstones were presented by standard questionnaires. Logistic regression, nonlinear, subgroup, and sensitivity analyses were used to estimate the association between blood heavy metals and gallstones.

RESULTS

Multivariate logistic regression showed that the highest quintile of blood selenium (Se) was associated with a higher risk of gallstones compared with the lowest quintile (OR = 1.66, 95% CI: 1.16-2.36), particularly in individuals who were under 65 years of age, females, non-Hispanic Whites, non-drinkers, obese, and had a college education or higher. There was no correlation between blood cadmium (Cd), mercury (Hg), lead (Pb), manganese (Mn), and gallstones in the total population. Restricted cubic spline curves showed that a negative correlation was observed between blood Cd (OR = 0.84, 95% CI: 0.710-1.00), Hg (OR = 0.87, 95% CI: 0.78-0.97) and gallstones when Cd < 0.302 μg/L and Hg < 3.160 μg/L.

CONCLUSIONS

Blood Se was an independent risk factor for gallstones, particularly in individuals under 65 years old, females, non-Hispanic Whites, non-drinkers, obese, and had a college education or higher. Furthermore, blood Cd and Hg were associated with a reduced risk of gallstones within a certain range.

Blood Cadmium and Abdominal Aortic Calcification in Population with Different Weight Statuses: a Population-Based Study

The aim of our study was to assess the effect of blood cadmium levels (B-Cd) on abdominal aortic calcification (AAC). We used the data from the 2013-2014 NHANES database. A total of 1530 participants were included in our study, with a mean AAC score of 1.40 ± 0.10, and a prevalence of severe AAC of 7.98%. Participants with higher B-Cd quartiles showed a higher prevalence of severe AAC. B-Cd was positively associated with higher AAC scores and increased risk of severe AAC. In the obese population, blood cadmium levels showed a positive association with the risk of severe AAC. There may be a positive correlation between B-Cd levels and AAC scores and risk of severe AAC, and this correlation is more pronounced in the obese population. Therefore, the cadmium load in AAC patients in the obese population should be considered in clinical work.

Association between Heavy Metals, Metalloids and Metabolic Syndrome: New Insights and Approaches

Metabolic syndrome (MetS) is an important public health issue that affects millions of people around the world and is growing to pandemic-like proportions. This syndrome is defined by the World Health Organization (WHO) as a pathologic condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia. Moreover, the etiology of MetS is multifactorial, involving many environmental factors, including toxicant exposures. Several studies have associated MetS with heavy metals exposure, which is the focus of this review. Environmental and/or occupational exposure to heavy metals are a major risk, contributing to the development of chronic diseases. Of particular note, toxic metals such as mercury, lead, and cadmium may contribute to the development of MetS by altering oxidative stress, IL-6 signaling, apoptosis, altered lipoprotein metabolism, fluid shear stress and atherosclerosis, and other mechanisms. In this review, we discuss the known and potential roles of heavy metals in MetS etiology as well as potential targeted pathways that are associated with MetS. Furthermore, we describe how new approaches involving proteomic and transcriptome analysis, as well as bioinformatic tools, may help bring about an understanding of the involvement of heavy metals and metalloids in MetS.

Association between urinary cadmium level and subclinical myocardial injury in the general population without cardiovascular disease aged ≥ 50 years

Cadmium (Cd) is a toxic heavy metal linked to an increased risk of cardiovascular disease (CVD). But the relationship between urinary Cd (U-Cd) and electrocardiographic subclinical myocardial injury (SC-MI) in older people is unclear. This study evaluated the connection between U-Cd and SC-MI in people who did not have CVD. The study involved 4269 participants from the National Health and Nutrition Examination Survey III(NHANES III) aged ≥ 50 years and had no history of CVD. The relationship between U-Cd and cardiac infarction/injury score (CIIS) was assessed by multivariable linear regression. Whether U-Cd and SC-MI were correlated was determined by multivariate logistic regression, restricted cubic spline, and subgroup analysis. There was a significant association between U-Cd and CIIS (β, 1.04, 95% confidence interval (CI): 0.39-1.69; P = 0.003) in the highest quartile and fully adjusted model. After adjusting for relevant confounders, multivariable logistic regression showed that participants in the highest quartile of U-Cd had a greater chance of having SC-MI than those in the first ( OR (95% CI), 1.37(1.13,1.66), P for trend = 0.003), and this relationship was especially strong among hypertensive participants. And a positive linear correlation between U-Cd and the prevalence of SC-MI was shown by restricted cubic spline analysis. U-Cd may be a novel risk element for SC-MI because it is independently and linearly linked to CIIS and SC-MI.

Association of multi-metals with the risk of hypertension and the interaction with obesity: A cross-sectional study in China

Background

Environmental exposure to multiple metals have been inconsistently associated with hypertension. Obesity is an important independent risk factor for hypertension, and few studies have assessed the interaction between obesity and metals in this context. We aimed to clarify their association and interaction.

Methods

This cross-sectional study included 3,063 adults from 11 districts or counties, Guangdong. We measured the whole blood levels of 13 metals and used multipollutant-based statistical methods to analyze the association of metals with hypertension. The interaction between metals and obesity on hypertension was assessed on additive and multiplicative scales.

Results

Four metals (manganese, arsenic, cadmium, and lead) were significantly associated with hypertension risk, five metals (manganese, zinc, arsenic, cadmium, and lead) were related to elevated SBP levels, five metals (manganese, zinc, selenium, cadmium, and lead) were associated with elevated DBP levels in single-metal model. Manganese remained significantly related to hypertension risk [odds ratio, 1.35 (1.02–1.78)] after adjusting for these four metals. Significant positive dose-response relationships between manganese, arsenic, cadmium, lead and hypertension risk were observed (P for overall &lt; 0.001, P for non-linearity &gt; 0.05). Compared with those in the lowest quartile, participants in the highest manganese quartile had a 2.83 mmHg (95% Cl: 0.71–4.96) (PFDR = 0.040) higher level of SBP. Individuals in the highest quartiles of zinc and lead had a 1.45 mmHg (0.10–2.81) (PFDR = 0.033) and 2.06 mmHg (0.59–3.53) (PFDR = 0.020) higher level of DBP, respectively. The negative interactions between cadmium, lead and obesity influences hypertension risk. BKMR analysis showed a significant joint effect of manganese, arsenic, cadmium and lead on hypertension when the concentrations of four metals were at or above their 55th percentile compared to their median values.

Conclusions

The combined effect of four metals (manganese, arsenic, cadmium and lead) were associated with the prevalence of hypertension. Potential interaction effects of cadmium, lead and obesity on hypertension risk may exist. Further cohort studies in larger population are needed to clarify these findings.

Hypertension risk is associated with elevated concentrations of rare earth elements in serum

BACKGROUND

Hypertension is a major contributor to cardiovascular morbidity and mortality, affecting over 17.1 million individuals worldwide. Environmental exposure such as toxic trace elements could be risk factors for hypertension, but the associations of toxic metal exposure with hypertension are not well understood.

METHODS

We recruited 400 volunteers consisting of 200 patients with hypertension (cases) and 200 healthy individuals without hypertension (controls). In the case or control group, half of the subjects came from the rare earth mining (REM) areas and the other half from non-REM areas. Serum levels of 8 rare earth elements (REEs) and 13 non-REEs were determined.

RESULTS

The concentrations of Ce and La were significant higher in the cases than in the controls in all comparisons. Serum concentrations of Mg, Mn, Dy, Ce and La were positively correlated with blood pressure, while those of concentrations K and Se were negatively correlated with blood pressure (p < 0.05). Compared with the lowest quartiles, participants in the highest quartiles of Sm, Gd, Dy, Yb, La and Ce had a 6.01-fold (95 % CI: 2.28, 15.8), 3.29-fold (95 % CI: 1.18, 9.16), 4.07-fold (95 % CI: 1.51,10.9), 7.83-fold (95 % CI: 2.78, 22.4), 20.00-fold (95 % CI: 5.48-72.9) and 6.13-fold (95 % CI: 2.13-17.6) increase in the probability of having hypertension respectively. Among all the detected metals, the univariate odds ratios (UORs) and adjusted odds ratios (AORs) of hypertension for highest vs. lowest quartile serum concentrations of Sm, Gd, Dy, Yb, La and Ce were significantly > 1 (p < 0.05), with the positive dose-response relationships observed between their serum levels and ORs associated with hypertension risk.

CONCLUSIONS

Collectively, there appears to be a positive correlation between hypertension and environmental exposure to REEs, especially La and Ce. Further studies are warranted to investigate the underlying mechanisms responsible for the risk.

The effect of blood cadmium levels on hypertension in male firefighters in a metropolitan city

Background

This study investigated the effect of dispatch frequency on blood cadmium levels and the effect of blood cadmium levels on hypertension in male firefighters in a metropolitan city.

Methods

We conducted a retrospective longitudinal study of male firefighters who completed the regular health checkups, including a health examination survey and blood cadmium measurements. We followed them for 3 years. To investigate the effect of dispatch frequency on blood cadmium levels and the effect of blood cadmium levels on hypertension, we estimated the short-term (model 1) and long-term (model 2) effects of exposure and hypothesized a reversed causal pathway model (model 3) for sensitivity analysis. Sequential conditional mean models were fitted using generalized estimating equations, and the odds ratios (ORs) and the respective 95% confidence intervals (CIs) were calculated for hypertension for log-transformed (base 2) blood cadmium levels and quartiles.

Results

Using the lowest category of dispatch frequency as a reference, we observed that the highest category showed an increase in blood cadmium levels of 1.879 (95% CI: 0.673, 3.086) μg/dL and 0.708 (95% CI: 0.023, 1.394) μg/dL in models 2 and 3, respectively. In addition, we observed that doubling the blood cadmium level significantly increased the odds of hypertension in model 1 (OR: 1.772; 95% CI: 1.046, 3.003) and model 3 (OR: 4.288; 95% CI: 1.110, 16.554). Using the lowest quartile of blood cadmium levels as a reference, the highest quartile showed increased odds of hypertension in model 1 (OR: 2.968; 95% CI: 1.121, 7.861) and model 3 (OR: 33.468; 95% CI: 1.881, 595.500).

Conclusions

We found that dispatch frequency may affect blood cadmium levels in male firefighters, and high blood cadmium levels may influence hypertension in a dose-response manner.

Occupational risk factors for hypertension

The identification and characterization of the modifiable risk factors of hypertension is of great value for public health and clinical medicine to achieve primary prevention. A large amount of literature on the effects of occupational factors on blood pressure and hypertension has been published. In this review, I summarize current evidence regarding the role of occupational factors in hypertension. The results of this review suggest that there is sufficient evidence to support the association between increased risk of hypertension and job stress, shift work, occupational lead exposure, and noise exposure. The association of hypertension with physical inactivity, sedentary behavior, and occupational exposure to mercury, arsenic, cadmium, or carbon disulfide remains inconclusive, although several studies have reported this finding. This review will serve as a step toward future research and provide baseline information for developing strategic interventions to prevent hypertension in the working population.

Total arsenic, dimethylarsinic acid, lead, cadmium, total mercury, methylmercury and hypertension among Asian populations in the United States: NHANES 2011-2018

BACKGROUND

Non-Hispanic Asians (NHA) in USA have been reported with higher arsenic (As), lead (Pb), cadmium (Cd), mercury (Hg) and their specific species levels, comparing with non-NHA. This study aimed to investigate the associations of these metal/metalloid levels with blood pressure levels and prevalence of hypertension among general NHA using the 2011-2018 National Health and Nutrition and Examination Survey (NHANES) data.

METHODS

The study included participants aged 20 years and older with determinations of As, Dimethylarsinic acid (DMA), Pb, Cd, Hg and methyl-Hg (MeHg) in blood (n = 10, 177) and urine (n = 5, 175). These metals/metalloid levels were measured by inductively coupled plasma mass spectrometry. Systolic (SBP) and diastolic blood pressure (DBP) levels were examined through a standardized protocol. Censored normal regression model and logistic regression model were employed to explore the associations of As, DMA, Pb, Cd, Hg and MeHg levels with blood pressure levels and prevalence of hypertension respectively, and potential confounders were adjusted in these regression models. Quantile-based g-computation approach was used to analysis joint effect of metals mixture on blood pressure level and hypertension.

RESULTS

For NHA, urinary As and Hg levels were associated with increased DBP level; Higher blood Hg and MeHg levels were related to increased blood pressure levels and hypertension; However, negative association was observed between urinary Cd and SBP level; Blood metals mixture (including blood Pb, Cd and Hg) was associated with increased DBP level, but not for hypertension. For non-NHA, urinary As and DMA levels were associated with increased SBP level, but not DBP level and prevalence of hypertension; Urinary Pb level was associated with decreased DBP level; Nevertheless, positive associations were observed between blood Pb levels and SBP and prevalence of hypertension; Blood Hg level was associated with decreased DBP level and prevalence of hypertension; Furthermore, blood MeHg level was associated with decreased DBP level; Positive association was observed between blood metals mixture and increased SBP level among non-NHA.

CONCLUSIONS

Highly exposed to Hg level among NHA was associated with increased blood pressure levels and prevalence of hypertension. Urinary As level was associated with increased DBP level among NHA. Furthermore, blood metals mixture was related to increased DBP level among NHA. Further prospective studies with larger sample size should be performed to warrant the results.

The impact of essential and toxic elements on cardiometabolic risk factors in adults and older people

BACKGROUND AND AIM

Evidence suggests an association between essential and toxic elements and the worsening of cardiometabolic risk factors. This study aimed to investigate the concentrations of zinc, copper, selenium, arsenic, cadmium, and mercury and their relationship with cardiometabolic risk factors in adults and older people.

METHODS

This cross-sectional study was carried out with 112 adults with a mean age of 59 (sd 14) years old and a BMI of 29.30 (sd 5.11) Kg/m². The subject's weight and height were measured for body mass index (BMI) calculation, classified according to the cut-off points recommended by the World Health Organization (WHO). We evaluated sociodemographic, clinical, lifestyle, waist circumference - WC, visceral adiposity index - VAI, glycemic lipid profile, blood pressure, and high-sensitive C-reactive protein (hs-CRP). Cardiovascular risk was defined by The Global Risk Score (GRS) score. Plasma zinc, selenium, copper levels, urinary arsenic, cadmium, and mercury levels were measured using the inductively coupled plasma mass spectrometry technique (ICP-MS).

RESULTS

There was a negative association between urinary arsenic and VAI (β - 0.03, p < 0.01), triglycerides (β - 1.10, p < 0.01), and VLDL cholesterol (β - 0.14, p = 0.02). Plasma copper and copper/zinc ratio were positively associated with fasting glucose and hs-CRP (β 0.38, p < 0.01; β 36.02, p = 0.01, β 0.004, p < 0.01, β 0.68, p < 0.001, respectively). Urinary arsenic (β - 0.14, p = 0.04) and cadmium (β - 36.42, p = 0.04) were negatively associated with systolic blood pressure. Also, urinary cadmium was negatively associated with diastolic blood pressure (β - 21.55, p = 0.03), and urinary mercury showed an opposite behavior (β 1.45, p = 0.03).

CONCLUSION

Essential and toxic elements in urine and plasma could be potential biomarkers for cardiovascular risk factors. A healthy lifestyle should be adopted; in addition, government policies should be developed to guarantee sustainable production and a safe environment.

Blood pressure mediated the effects of cognitive function impairment related to aluminum exposure in Chinese aluminum smelting workers

OBJECTIVES

The aim of this study is to investigate the effects that the Al on blood pressure and the effect of hypertension in aluminum-induced cognitive impairment in electrolytic aluminum worker.

METHODS

The study was conducted 392 male aluminum electrolytic workers in an aluminum plant of China. The concentration of alumina dust in the air of the electrolytic aluminum workshop is 1.07mg/m3-2.13mg/m3. According to the Permissible concentration-Time Weighted Average of alumina dust is 4mg/ m3, which does not exceed the standard. The blood pressure of the workers was measured. The plasma aluminum concentration of workers was determined by ICP-MS (Inductively Coupled Plasma Mass Spectrometry). Cognitive functions were measured using MMSE (Mini-Mental State Examination), VFT (Verbal Fluency Test), ATIME (Average Reaction Time), FOM (Fuld Object Memory Evaluation), DST (Digit Span Test), CDT (Clock Drawing Test) scales. Modified Poisson regression was used to analyze the risk of hypertension and cognitive impairment with different plasma aluminum concentrations. Generalized linear regression model was used to analyze the relationship between aluminum and cognitive function, blood pressure and cognitive function. Causal Mediation Analysis was used to analyze the mediation effect of blood press in aluminum-induced cognitive impairment.

RESULTS

Plasma aluminum appeared to be a risk factor for hypertension (PR (prevalence ratio) = 1.630, 95%-CI (confidence interval): 1.103 to 2.407), systolic blood pressure (PR = 1.578, 95%-CI: 1.038 to 2.399) and diastolic blood pressure (PR = 1.842, 95%-CI: 1.153 to 2.944). And plasma aluminum increased by e-fold, the scores of MMSE and VFT decreased by 0.630 and 2.231 units respectively and the time of ATIME increased by 0.029 units. In addition, generalized linear regression model showed that blood press was negatively correlated with the scores of MMSE and VFT. Finally, causal Mediation Analysis showed that hypertension was a part of the mediating factors of aluminum-induced decline in MMSE score, and the mediating effects was 16.300% (7.100%, 33.200%). In addition, hypertension was a part of the mediating factors of aluminum-induced decline in VFT score, and the mediating effects was 9.400% (2.600%, 29.000%) CONCLUSION: Occupational aluminum exposure increases the risk of hypertension and cognitive impairment. And hypertension may be a mediating factor of cognitive impairment caused by aluminum exposure.

The association between environmental cadmium exposure, blood pressure, and hypertension: a systematic review and meta-analysis

We performed a systematic and meta-analysis study to find the association between cadmium (Cd) exposure and blood pressure (BP)/hypertension (HTN) in exposed general populations. We searched main databases for literature published between year 2000 and April 15, 2021. Quality assessment was performed with the Joanna Briggs Institute (JBI) critical appraisal tools. Heterogeneity between studies was determined by I-squared (I²) statistic. The random effects model was used to determine the association between blood and urine Cd levels with hypertension. The overall standard differences in mean for Cd level in hypertensive and control groups were 3.34, 1.79, and 8.09 based on samples from blood, urine, and hair, respectively. The overall standard differences in mean for Cd level in the low and high exposure groups were - 0.795 and - 1.036 based on blood and urinary samples, respectively. Our findings indicate a positive relationship between blood and hair Cd levels and hypertension. We also found that hair is the optimal biological sample to find the relationship between Cd exposure and hypertension for both genders. However, more studies are needed to confirm these findings.

Higher Blood Cadmium Concentration Is Associated With Increased Likelihood of Abdominal Aortic Calcification

Aims

This study aimed to evaluate the association between blood cadmium concentration (BCC) and abdominal aortic calcification (AAC) in adults aged ≥40 years in the United States.

Methods

Data were obtained from the 2013–2014 National Health and Nutrition Examination Survey (NHANES). Participants without data about BCC and AAC scores were excluded. BCC was directly measured using inductively coupled plasma mass spectrometry (ICP–MS). AAC scores were quantified by the Kauppila scoring system, and severe AAC was defined as an AAC score &gt;6. Weighted multivariable regression analysis and subgroup analysis were conducted to explore the independent relationship between cadmium exposure with AAC scores and severe AAC.

Results

A total of 1,530 participants were included with an average BCC of 0.47 ± 0.02 μg/L and AAC score of 1.40 ± 0.10 [mean ± standard error (SE)]. The prevalence of severe AAC was 7.96% in the whole subjects and increased with the higher BCC tertiles (Tertile 1: 4.74%, Tertile 2: 9.83%, and Tertile 3: 10.17%; p = 0.0395). We observed a significant positive association between BCC and the AAC score (β = 0.16, 95% CI: 0.01~0.30) and an increased risk of severe AAC [odds ratio (OR) = 1.45; 95% CI: 1.03~2.04]. Subgroup analysis and interaction tests revealed that there was no dependence for the association between BCC and AAC.

Conclusion

Blood cadmium concentration was associated with a higher AAC score and an increased likelihood of severe AAC in adults in the United States. Cadmium exposure is a risk factor for AAC, and attention should be given to the management of blood cadmium.

Family History of Hypertension and Cobalt Exposure Synergistically Promote the Prevalence of Hypertension

It has been previously reported that family history of hypertension (FHH) and exposure to metals are each independent risk factor for hypertension, but the interaction between the two in relation to hypertension risk has been poorly studied. The object of this study is Dong ethnic group in Guizhou, China. The impacts of exposure to metals and FHH on hypertension incidence were examined by using the restrictive cubic spline (RCS) model as well as the multivariate logistic regression model. As a result, FHH, together with cobalt and lead exposure, was identified to show independent significant correlation with hypertension incidence (P < 0.05). The risk of hypertension increased with the increase in lead and cobalt exposure quartiles. Typically, the RCS model revealed such dose-response relation. To further confirm the association of cobalt, lead, and FHH with the risk of hypertension, multiplication and addition models were used to analyze the influence of the interactions between these variables on the risk of hypertension. The results showed that there was a multiplying interaction between the influence of the FHH and cobalt on the risk of hypertension. As for the additive interaction between cobalt and FHH, the relative excess risk due to interaction (RERI) was determined to be 0.596 (95% Cl: 0.001-1.191), the attributable proportion due to interaction (AP) was calculated as 0.256 (95% Cl: 0.075-0.437), whereas the synergy index (S) was identified to be 1.814 (95% Cl: 1.080-3.047). Our study provides some limited evidence that a FHH and cobalt exposure synergistically promote the prevalence of hypertension.

Sex differences in the effects of whole-life, low-dose cadmium exposure on postweaning high-fat diet-induced cardiac pathogeneses

We previously showed the development of cardiac remodeling (hypertrophy or fibrosis) in mice with either post-weaning high-fat diet (HFD, 60% kcal fat) feeding or exposure to chronic low-dose cadmium. Here, we determined whether whole-life exposure to environmentally relevant, low-dose cadmium affects the susceptibility of offspring to post-weaning HFD-induced cardiac pathologies and function. Besides, we also determined whether these effects are sex-dependent. Male and female mice were exposed to cadmium-containing (0, 0.5, or 5 parts per million [ppm]) drinking water before breeding; the pregnant mice and dams with offspring continually drank the same cadmium-containing water. After weaning, the offspring were continued on the same regime as their parents and fed either a HFD or normal fat diet for 24 weeks. Cardiac function was examined with echocardiography. Cardiac tissues were used for the histopathological and biochemical (gene and protein expression by real-time PCR and Western blotting) assays. Results showed a dose-dependent cadmium accumulation in the hearts of male and female mice along with decreased cardiac zinc and copper levels only in female offspring. Exposure to 5 ppm, but not 0.5 ppm, cadmium significantly enhanced HFD cardiac effects only in female mice, shown by worsened cardiac systolic and diastolic dysfunction (ejection fraction, mitral E-to-annular e' ratio), increased fibrosis (collagen, fibronectin, collagen1A1), hypertrophy (cardiomyocyte size, atrial natriuretic peptide, β-myosin heavy chain), and inflammation (intercellular adhesion molecule-1, tumor necrosis factor-α, plasminogen activator inhibitor type 1), compared to the HFD group. These synergistic effects were associated with activation of the p38 mitogen-activated protein kinases (MAPK) signaling pathway and increased oxidative stress, shown by 3-nitrotyrosine and malondialdehyde, along with decreased metallothionein expression. These results suggest that whole-life 5 ppm cadmium exposure significantly increases the susceptibility of female offspring to HFD-induced cardiac remodeling and dysfunction. The underlying mechanism and potential intervention will be further explored in the future.

Cadmium and lipid balance in outdoor workers exposed to urban stressor

The aim of our study was to evaluate the association between levels of blood and urinary cadmium and lipid balance in a group of outdoor workers. The study was conducted on a group of 146 individuals (average age 45,1 ± 8,5). Blood and urinary samples were collected for the detection of total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, blood cadmium and urinary cadmium. We divided the group of workers into two subgroups according to the task:75 traffic policemen and 71 police drivers. Gender differences were found. The Pearson correlation coefficient showed a positive association between blood and urinary cadmium levels and total cholesterol, LDL and triglycerides levels. Total cholesterol, LDL cholesterol and triglycerides were significantly higher in the group of traffic policemen than in police drivers. In conclusion, the results suggest a statistically significant association between blood and urinary cadmium levels and lipid balance contributing to an increase of the cardiovascular risk.

Negatively interactive effect of chromium and cadmium on obesity: Evidence from adults living near ferrochromium factory

BACKGROUND

Researchers have reported that chromium (Cr) exposure may be associated with metabolism of glucose and lipids in residents living in a long-term Cr polluted area. Previous statistical analysis is mainly focused on individual chromium exposure. Furtherly, we aim to investigated the independent, combined, and interaction effects of the co-exposure of urine Cr (UCr) with cadmium (UCd), lead (UPb) and manganese (UMn) on body mass index (BMI), waist circumference, and the risk of overweight and abdominal obesity.

METHOD

We enrolled 1187 participants from annual surveys between 2017 and 2019. Heavy metal concentrations in urine were standardized using covariate-adjusted urine creatinine levels. Multiple linear/logistic regression models were applied to measure the single effect of urine heavy metal concentration on the outcomes. The quantile-based g-computation (g-comp) model was used to evaluate the combined effect of metal mixture on the outcomes and to compare the contribution of each metal. Both additive and multiplicative interactions were measured for UCr with UCd, UPb, UMn on the outcomes. Analysis was performed on the overall population and stratified by smoking habit.

RESULTS

For the overall study population, UCr was positively associated with BMI (p trend = 0.023) and waist circumference (p trend = 0.018). For smoking participants, the g-comp model demonstrated that the metal mixture was negatively associated with BMI, with UCr and UCd contributing the most in the positive and negative direction. A negative additive interaction was observed between UCr and UCd on BMI and abdominal obesity. We did not observe a significant interaction effect of UCr with UPb or UMn.

CONCLUSION

Our study indicated that Cr and Cd exposure may be associated with BMI and waist circumference, with combined and interaction effects of the heavy metals noted. Further epidemiological and experimental researches could simultaneously consider single and complex mixed exposure to verify the findings and biological mechanisms.

Influence of serum ferritin combined with blood cadmium concentrations on blood pressure and hypertension: From the Korean National Health and Nutrition Examination Survey

BACKGROUND

Previous studies have suggested that cadmium (Cd) exposure and serum ferritin levels may influence the development of hypertension.

OBJECTIVE

We evaluated whether the association between blood Cd levels and the development of hypertension could be modified by serum ferritin levels in a representative sample of the adult population of South Korea.

METHODS

We used data from the Korean National Health and Nutrition Examination Survey (2008-2012), a nationally representative, cross-sectional, population-based study. We included 5752 adults aged 19 years and older who had records of blood Cd and ferritin levels and blood pressure measurements. Multiple logistic regression was used to examine the association between Cd exposure and the development of hypertension, as well as the modifying effects of serum ferritin.

RESULTS

Men had higher levels of serum ferritin, and women had higher levels of Cd. Smoking in men was significantly associated with high blood pressure and risk of hypertension. Significantly fewer women were smokers, and the combination of abnormal serum ferritin levels and high Cd levels was significantly associated with high systolic blood pressure [odds ratio (OR) = 2.11; 95% confidence interval (CI) = 1.04-4.28], high diastolic blood pressure (OR = 2.07; 95% CI = 1.04-4.12), and increased hypertension risk (OR = 1.83; 95% CI = 1.03-3.25) in women who never smoked.

CONCLUSIONS

Our results provide further evidence that individuals with abnormal serum ferritin levels should limit their exposure to Cd to prevent hypertension.

Association between Enzyme-Linked Immunosorbent Assay-Measured Kidney Injury Markers and Urinary Cadmium Levels in Chronic Kidney Disease

Cadmium exposure is associated with chronic kidney disease (CKD), but the optimal biomarker for early cadmium-associated nephrotoxicity in low-level exposure has not yet been established. We conducted a cross-sectional investigation involving 167 CKD patients stratified according to tertiles of urinary cadmium levels (UCd), in which enzyme-linked immunosorbent assay (ELISA)-measured novel renal biomarkers were utilized to assess the extent of renal injury associated with cadmium burden. In the analyses, urinary kidney injury molecule-1 (KIM-1) levels and age were the independent factors positively correlated with UCd after adjusting for covariates in non-dialysis-dependent CKD patients (high vs. low UCd, odds ratio (95% confidence interval), 1.0016 (1.0001–1.0032), p = 0.043, and 1.0534 (1.0091–1.0997), p = 0.018). Other conventional and novel renal biomarkers, such as serum creatinine, estimated glomerular filtration rate, CKD staging, urinary protein/creatinine ratio, urinary 8-hydroxy-2-deoxyguanosine (8-OHdG), and urinary epidermal growth factor (EGF) were not independently correlated with UCd in the analyses. In conclusion, our study found that the ELISA-measured urinary KIM-1 level could serve as an early renal injury marker in low-level cadmium exposure for non-dialysis-dependent CKD patients. In addition, age was an independent factor positively associated with UCd in this population.

The Risk Factors of Blood Cadmium Elevation in Chronic Kidney Disease

Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk factors for elevated blood cadmium levels (BCLs) have not been studied in CKD. We conducted a cross-sectional investigation in 200 CKD patients and stratified them by the tertiles of BCL to compare their demographic, environmental, and biochemical data. The factors associated with BCL were identified, and their effects were examined in subgroups. In the analyses, female sex, smoking, and CKD stage 5D were associated with high BCL, and statin was inversely correlated with BCL (odds ratio [95% confidence interval, CI], 6.858 [2.381–19.746], p < 0.001, 11.719 [2.843–48.296], p = 0.001, 30.333 [2.252–408.520], p = 0.010, and 0.326 [0.122–0.873], p = 0.026; deviations of BCL [nmol/L, 95% CI], 2.66 [1.33–4.00], p < 0.001, 3.68 [1.81–5.56], p < 0.001, 3.38 [0.95–5.82], p = 0.007, and −2.07 [−3.35–−0.78], p = 0.002). These factors were also independently correlated with BCL in subgroups, including non-dialysis CKD, hypertensive patients, non-smokers, and male patients. In conclusion, female sex, smoking, and CKD stage 5D were the major risk factors for elevated BCL; additionally, statins were negatively associated with BCL in CKD.

Biomarkers of cadmium exposure and renal function in estuarine adult villagers

OBJECTIVE

Assess cadmium (Cd) exposure of adults living in two estuarine communities in Aratu bay, Bahia, Brazil and its association with effects on renal function.

METHODS

This cross-sectional study included 88 volunteers aged 17-55 years, living in the following two communities: Santa Luzia (SL) located more intimately in the bay and Cotegipe (CT), a bit further and closer to a ferro-manganese alloy plant. Cd in blood (CdB) and urine (CdU), along with blood lead (PbB) levels were determined by graphite furnace atomic absorption spectrometry. Renal function was evaluated by the estimated glomerular filtration rate (eGFR) and tubular cell biomarkers: retinol binding protein (RBP), β2-microglobulin (β2M), and N-acetyl-β-D-glucosaminidase (NAG).

RESULTS

The median CdU levels in villagers of the two communities were 0.20 and 0.44 µg/g creat. and SL vs CT, respectively. Age range (> 35 years), cigarette smoking and lower family income were significantly associated with more elevated CdU levels. Multiple linear regression analysis demonstrated a significant association between LnCdU and LnRBP levels (β = 0.200, 95%CI 0.074-0.365) after adjusted for sex, urinary creatinine and blood lead levels.

CONCLUSION

These data show consistent evidences of association between Cd exposure and elevated tubular cell biomarker excretion in estuarine villagers living close to an industrial site.

Effect of combined exposure to silica nanoparticles and cadmium chloride on female zebrafish ovaries

Silica nanoparticles (SiNPs) and cadmium chloride (CdCl2) are two important environmental pollutants. In previous research, found that SiNPs in zebrafish larvae can amplify the cardiovascular damage caused by cadmium. Whether SiNPs in the ovaries can amplify the adverse effects of cadmium on the zebrafish ovaries is worth studying problem. In this study, sexually mature female zebrafish were used as model organisms and exposed to 1 μmol/L CdCl2 and/or 25 μg/mL SiNPs for 30 days. The results showed that the structure and function of ovaries in the sole and combined exposure groups changed significantly, resulting in reduced ovarian quality, decreased number of mature oocytes, and the development of malformed offspring. A deep-sequencing analysis showed that organisms' lipid metabolism and transportation, estrogen metabolism, and response to the maturation, meiosis, and vitellogenin synthesis of oocytes were significantly affected by single exposure or combined exposure. These findings provide further insights into the harm of cooperation of CdCl2 and/or SiNPs to the aquatic ecosystems.

Cadmium and cardiovascular disease: An overview of pathophysiology, epidemiology, therapy, and predictive value

Cadmium is a widely distributed toxic heavy metal that has been associated with many diseases including chronic renal dysfunction, osteomalacia, acute heart failure, secondary hypertension, and atherosclerosis. Although several studies have suggested that cadmium may affect multiple systems by inducing lipid per oxidation in cells and disturbing the antioxidant system, the mechanism by which cadmium affects the cardiovascular system remains unclear. Recent studies on heart failure and acute myocardial infarction have shown that cadmium has good predictive ability for mortality in patients with cardiovascular disease. In this study, we briefly review the role of cadmium in cardiovascular disease, which may prompt further studies to investigate the potential association between cadmium and mortality in patients with cardiovascular disease.

Cadmium and cardiovascular disease: An overview of pathophysiology, epidemiology, therapy, and predictive value

Cadmium is a widely distributed toxic heavy metal that has been associated with many diseases including chronic renal dysfunction, osteomalacia, acute heart failure, secondary hypertension, and atherosclerosis. Although several studies have suggested that cadmium may affect multiple systems by inducing lipid per oxidation in cells and disturbing the antioxidant system, the mechanism by which cadmium affects the cardiovascular system remains unclear. Recent studies on heart failure and acute myocardial infarction have shown that cadmium has good predictive ability for mortality in patients with cardiovascular disease. In this study, we briefly review the role of cadmium in cardiovascular disease, which may prompt further studies to investigate the potential association between cadmium and mortality in patients with cardiovascular disease.

An updated systematic review on the association between Cd exposure, blood pressure and hypertension

BACKGROUND

Since the first report by Perry et al. (1955), most studies affirmed the hypertensive effects of cadmium (Cd) in humans. Nonetheless, conclusions between studies remain inconsistent.

OBJECTIVE

The aim of this study was to reevaluate the evidence for a potential relationship between Cd exposure and altered blood pressure and/or hypertension, focusing on studies published between January 2010 and March 2020.

METHODS

We reviewed all observational studies from database searches (PubMed and SCOPUS) on Cd exposure and blood pressure or hypertension. We extracted information from studies that provided sufficient data on population characteristics, smoking status, exposure, outcomes, and design.

RESULTS

Thirty-eight studies met our inclusion criteria; of those, twenty-nine were cross sectional, three case control, five cohort and one interventional study. Blood or urinary Cd levels were the most commonly used biomarkers.

CONCLUSIONS

A positive association between blood Cd levels and blood pressure and/or hypertension was identified in numerous studies at different settings. Limited number of representative population-based studies of never-smokers was observed, which may have confounded our conclusions. The association between urinary Cd and blood pressure and/or hypertension remains uncertain due to conflicting results, including inverse relationships with lack of strong mechanistic support. We point to the urgent need for additional longitudinal studies to confirm our findings.

Does underweight amplify the relationship between short-term particulate matter exposure and blood pressure in children and adolescents: a large cross-sectional study in a metropolis of China

Overweight/obesity modified the effects of ambient particulate matter (PM) exposure on blood pressure (BP). This study aims to assess whether interaction of underweight and short-term PM exposure on BP exists in Chinese children. A cross-sectional analysis including 144,513 children aged 6 to 17 years in 2016 Health Promotion Program for Children and Adolescents of Suzhou, China, was performed. Daily concentrations of inhalable PM (PM₁₀) and fine PM (PM_2.5) were extracted from air monitoring stations close to students' schools. We applied generalized linear mixed-effects models to estimate the interactions. Estimated changes (95% confidence intervals (CIs)) of systolic BP (SBP), diastolic BP (DBP), and odds ratios (ORs) (95% CIs) for prevalence of HBP were calculated. Significant interactions between PM and underweight on BP and prevalence of high BP (HBP) were observed. For example, at lag 6, the ORs (95% CIs) for HBP by each 10 μg/m³ changes of PM_2.5 were 1.066 (1.039, 1.093) and 1.036 (1.028, 1.043) among underweight and normal weight subjects, respectively; these values for PM₁₀ were 1.048 (1.031, 1.065) and 1.025 (1.021, 1.030). At lag 5, the increases of SBP for PM_2.5 were 0.32 (95% CI 0.22, 0.43) mmHg and 0.23 (95% CI 0.29, 0.26) mmHg, while changes of DBP were 0.27 (95% CI 0.18, 0.35) mmHg and 0.19 (95% CI 0.16, 0.21) mmHg among underweight and normal weight subjects, respectively. Stratified analyses demonstrated that these interactions were only obtained in males. Effects of short-term PM exposure on BP and prevalence of HBP are enhanced in underweight children and adolescents.

Blood cadmium levels and sources of exposure in an adult urban population in southern Brazil

BACKGROUND

Cadmium (Cd) is a toxic metal that is widely present in the environment due to geologic and anthropogenic sources. Exposures to high Cd levels may cause nephrotoxicity, carcinogenicity, pulmonary and cardiovascular disease, among others. The goal of this study was to investigate in an adult urban population whether an association exists between sources and levels of Cd exposure and blood Cd concentrations.

METHODS

Using a census-based design, a total of 959 adults, aged 40 years or older, were randomly selected. Information on socio-demographics, dietary, and lifestyle background was obtained by household interviews. Blood Cd levels were measured by inductively coupled-plasma mass spectrometry. Geometric means (GM) (95% CI) and the 50th percentile were determined, stratified by sex, age, race, education, income class, smoking status, consumption of vegetables, red meat and milk, occupation and blood pressure. To assess the association between Cd exposure and the aforementioned variables, we estimated the geometric mean ratio (GMR) (95%CI) of blood Cd concentrations.

RESULTS AND CONCLUSION

The geometric mean (95%CI) of blood Cd levels in the total population was 0.25 (0.22, 0.27) ug/dL. In a univariate analysis, significantly higher blood Cd levels were found in men (p < 0.001), current and former smokers (p < 0.001), alcohol drinkers (p < 0.001), those who never or almost never consumed milk (p < 0.001), and in subjects with higher diastolic blood pressure (p = 0.03). Significant correlations were found between the number of cigarettes consumed daily and blood Cd levels. Multivariate analysis confirmed higher blood Cd concentrations were associated with alcohol consumption (GMR 95%CI = 1.28, 1.04-1.59) and in former and current smokers (GMR 95% IC = 1.33, 1.06-1.67 and 4.23, 3.24-5.52, respectively). Our results shed novel information on variables associated with blood Cd levels in an urban Brazilian population, and should encourage additional research to prevent environmental Cd exposure, both in Brazil and globally.