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Guldbrand C, Barregard L, Sallsten G, Forsgard N, Lundh T, Borné Y, Fagerberg B, Engström G, Bergström G, Harari F. Low-level exposure to lead and atherosclerosis in the carotid arteries: Results from the Swedish population-based cohort SCAPIS. Environ Res 2024; 244:117900. [PMID: 38092241 DOI: 10.1016/j.envres.2023.117900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Lead exposure is associated with cardiovascular disease. Atherosclerosis has been hypothesized to be one of the underlying mechanisms behind this association. AIM To investigate whether lead exposure is associated with an increased risk of atherosclerosis in the carotid arteries in a large Swedish population-based cohort. METHODS We performed a cross-sectional study using data from the population-based Swedish CardioPulmonary bioImage Study (SCAPIS), including 5622 middle-aged men and women, enrolled 2013-2018. Blood lead (B-Pb), measured by inductively coupled plasma mass spectrometry, was used as exposure biomarker. The presence of atherosclerotic plaque in the carotid arteries (yes/no), total plaque area (mm2) and the presence of large plaques (>25 mm2) were determined by ultrasonography. Associations between B-Pb and the different outcomes were analysed using Poisson and linear regression models, adjusted for potential confounders. RESULTS Atherosclerotic plaque was present in 57% of the individuals, for whom the median total plaque area was 16 mm2 (range: 0.2-222). The median B-Pb concentration was 14 μg/L (range: 0.75-203). After adjusting for potential confounders, individuals in the fourth quartile of B-Pb (Q4) had a prevalence ratio (PR) for plaque of 1.08 (95% CI: 1.01, 1.16) when compared with the first quartile (Q1). A 10 μg/L increase in B-Pb concentrations was associated with an increase of 0.92 mm2 (95% CI: 0.14, 1.71) in total plaque area. The PR for large plaque was 1.09 (95% CI: 0.84, 1.42 for Q4 vs Q1). CONCLUSIONS This study shows an association between B-Pb and atherosclerosis in the carotid arteries providing some support for the hypothesis that atherosclerosis is one of the mechanisms underlying the association between lead exposure and cardiovascular disease.
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Affiliation(s)
- Carl Guldbrand
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden
| | - Yan Borné
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florencia Harari
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden.
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Eriksson J, Barregard L, Sallsten G, Berlinger B, Weinbruch S, Manousou S, Ellingsen DG, Nyström HF. Urinary iodine excretion and optimal time point for sampling when estimating 24-h urinary iodine. Br J Nutr 2023; 130:1289-1297. [PMID: 36744548 PMCID: PMC10511680 DOI: 10.1017/s0007114523000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
Iodine deficiency may cause thyroid dysfunction. The iodine intake in a population is measured by urinary iodine concentration (UIC) in spot samples or 24-h urinary iodine excretion (24UIE). 24UIE is considered the gold standard and may be estimated using an equation including UIC, urinary creatinine concentration, sex and age (e24UIE). The aims of this study were to evaluate the preferable timing of UIC when using this equation and assess the variability of UIE. Sixty healthy non-smoking women (n 31) and men (n 29) were included in Gothenburg, Sweden. Twelve urine samples were collected at six fixed times on two separate days. Variability was calculated for UIC, 24UIE, e24UIE, iodine excretion per hour (iHr) and UIC adjusted for creatinine and specific gravity. Median 24UIE was 156 µg/24 h and the median UIC (all spot samples) was 104 µg/l. UIC (P < 0·001), 24UIE (P = 0·001) and e24UIE (P < 0·001) were significantly higher in men. e24UIE was relatively similar to 24UIE. However, when e24UIE was calculated from UIC in the first void, it was about 15 % lower than 24UIE (P < 0·001). iHr was lowest in the morning and highest in the afternoon. Median iHr was higher in men (7·4 v. 5·3 µg/h, P < 0·001). The variability of UIE was higher within individuals than between individuals. This study suggests that most time points for estimation of individual 24UIE are appropriate, but they should preferably not be collected in the first void.
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Affiliation(s)
- Janna Eriksson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Praktikertjänst AB, Skövde, 54130, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Balazs Berlinger
- National Institute of Occupational Health, Oslo, Norway
- Department of Animal Hygiene, Herd Health and Mobile Clinic, University of Veterinary Medicine, Budapest, Hungary
| | - Stephan Weinbruch
- National Institute of Occupational Health, Oslo, Norway
- Institute of Applied Geosciences, Darmstadt Technical University, Darmstadt, Germany
| | - Sofia Manousou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Frölunda Specialist Hospital, Västra Frölunda, Sweden
| | | | - Helena Filipsson Nyström
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg’s Centre for Molecular and Translational Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ellingsen DG, Weinbruch S, Sallsten G, Berlinger B, Barregard L. The variability of arsenic in blood and urine of humans. J Trace Elem Med Biol 2023; 78:127179. [PMID: 37148695 DOI: 10.1016/j.jtemb.2023.127179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Humans are exposed to inorganic and organic arsenic. The total arsenic (As) concentration in urine is a commonly used biomarker of exposure. However, little is known about variability of As in biological fluids and the diurnal variation of As excretion. OBJECTIVES Main objectives were to assess the variability of As in urine, plasma (P-As), whole blood (B-As), and the blood cell fraction (C-As), and to assess diurnal variation of As excretion. METHODS Six urine samples were collected at fixed times during 24 h on two different days around one week apart among 29 men and 31 women. Blood samples were collected when the morning urine samples were delivered. The intra-class correlation coefficient (ICC) was calculated as the ratio of the between-individuals variance to the total observed variance. RESULTS Geometric mean (GM) 24 h urinary excretions of As (U-As24 h) were 41 and 39 µg/24 h on the two days of sampling. Concentrations of B-As, P-As and C-As were highly correlated with U-As24 h and As in first void morning urine. No statistically significant differences were observed for the urinary As excretion rate between the different sampling times. A high ICC was observed for As in the cellular blood fraction (0.803), while ICC for first morning urine corrected for creatine was low (0.316). CONCLUSIONS The study suggests that C-As is the most reliable biomarker for use in exposure assessment of individual exposure. Morning urine samples have low reliability for such use. No apparent diurnal variation was observed in the urinary As excretion rate.
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Affiliation(s)
- Dag G Ellingsen
- National Institute of Occupational Health, 0363 Oslo, Norway.
| | - Stephan Weinbruch
- National Institute of Occupational Health, 0363 Oslo, Norway; Technical University of Darmstadt, Institute of Applied Geosciences, 64287 Darmstadt, Germany
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Sweden
| | | | - Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Sweden
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Kilbo Edlund K, Sallsten G, Molnár P, Andersson EM, Ögren M, Segersson D, Fagman E, Fagerberg B, Barregard L, Bergström G, Stockfelt L. Long-term exposure to air pollution, coronary artery calcification, and carotid artery plaques in the population-based Swedish SCAPIS Gothenburg cohort. Environ Res 2022; 214:113926. [PMID: 35868579 DOI: 10.1016/j.envres.2022.113926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/20/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
Long-term exposure to air pollution is associated with cardiovascular events. A main suggested mechanism is that air pollution accelerates the progression of atherosclerosis, yet current evidence is inconsistent regarding the association between air pollution and coronary artery and carotid artery atherosclerosis, which are well-established causes of myocardial infarction and stroke. We studied associations between low levels of long-term air pollution, coronary artery calcium (CAC) score, and the prevalence and area of carotid artery plaques, in a middle-aged population-based cohort. The Swedish CArdioPulmonary bioImage Study (SCAPIS) Gothenburg cohort was recruited during 2013-2017 and thoroughly examined for cardiovascular risk factors, including computed tomography of the heart and ultrasonography of the carotid arteries. In 5070 participants (age 50-64 years), yearly residential exposures to air pollution (PM2.5, PM10, PMcoarse, NOx, and exhaust-specific PM2.5 1990-2015) were estimated using high-resolution dispersion models. We used Poisson regression to examine associations between long-term (26 years' mean) exposure to air pollutants and CAC score, and prevalence of carotid artery plaques, adjusted for potential confounders. Among participants with carotid artery plaques, we also examined the association with plaque area using linear regression. Mean exposure to PM2.5 was low by international standards (8.5 μg/m3). There were no consistent associations between long-term total PM2.5 exposure and CAC score or presence of carotid artery plaques, but an association between total PM2.5 and larger plaque area in participants with carotid plaques. Associations with traffic-related air pollutants were consistently positive for both a high CAC score and bilateral carotid artery plaques. These associations were independent of road traffic noise. We found stronger associations among men and participants with cardiovascular risk factors. The results lend some support to atherosclerosis as a main modifiable pathway between low levels of traffic-related ambient air pollution and cardiovascular disease, especially in vulnerable individuals.
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Affiliation(s)
- Karl Kilbo Edlund
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Gerd Sallsten
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Peter Molnár
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Eva M Andersson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Mikael Ögren
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Erika Fagman
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
| | - Leo Stockfelt
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden
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Sallsten G, Ellingsen DG, Berlinger B, Weinbruch S, Barregard L. Variability of lead in urine and blood in healthy individuals. Environ Res 2022; 212:113412. [PMID: 35523277 DOI: 10.1016/j.envres.2022.113412] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/12/2022] [Accepted: 04/29/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lead is a non-essential toxic trace element. Lead in blood (BPb) is the most common biomarker of lead exposure but lead in urine (UPb) has also been used. There is, however, limited data on the variability of UPb in the general population and the association with BPb. OBJECTIVES Our aims were to assess variability of lead in repeated blood and urine samples. The diurnal variation of UPb was also examined as well as associations with BPb. METHODS We established an openly available biobank including 60 healthy non-smoking individuals, 29 men and 31 women, 21-64 years of age (median 31 years), with repeated sampling of blood and urine. Timed urine samples were collected at six fixed time points in two 24 h periods, about one week apart, and adjusted for creatinine and specific gravity (SG). BPb and UPb were analyzed by inductively coupled plasma mass spectrometry. The within- and between-individual variabilities and intra-class correlation coefficients (ICCs; ratios of the between-individual to total observed variances) were calculated using mixed-effects models. RESULTS The ICCs for UPb samples were mostly above 0.5, when adjusted for creatinine or SG, and higher for overnight samples compared with daytime samples. The highest ICCs were obtained for BPb (ICC = 0.97) and for urine samples corrected for dilution by SG or creatinine. The ICC was 0.66 for overnight samples adjusted for creatinine. High correlations with BPb were found for 24 h UPb (rs = 0.77) and overnight samples, e.g. rs = 0.74 when adjusted for SG. There was diurnal variation of UPb with lowest excretion rate in overnight samples. There was also a significant association between the Pb excretion rate and urinary flow rate. CONCLUSIONS In addition to BPb, UPb adjusted for creatinine or SG seems to be a useful biomarker for exposure assessment in epidemiological studies.
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Affiliation(s)
- Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Sweden.
| | | | - Balazs Berlinger
- National Institute of Occupational Health, Oslo, Norway; Department of Animal Hygiene, Herd Health and Mobile Clinic, University of Veterinary Medicine, István U. 2., H-1078, Budapest, Hungary
| | - Stephan Weinbruch
- National Institute of Occupational Health, Oslo, Norway; Institute of Applied Geosciences, Technical University Darmstadt, Schnittspahnstr. 9, D-64287, Darmstadt, Germany
| | - Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Sweden
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Barregard L, Sallsten G, Lundh T, Mölne J. Low-level exposure to lead, cadmium and mercury, and histopathological findings in kidney biopsies. Environ Res 2022; 211:113119. [PMID: 35288159 DOI: 10.1016/j.envres.2022.113119] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND Lead (Pb), cadmium (Cd) and mercury (Hg) are all nephrotoxic metals, and a large part of the body burden of Cd and Hg is found in the kidneys. There are, however, few studies on associations between exposure to these toxic metals and renal biopsy findings, and none at low-level exposure. AIM To examine the hypothesis that low-level concentration of Pb, Cd or Hg in the kidneys is associated with histopathological changes in the kidneys. METHODS We determined concentrations of Pb, Cd and Hg in kidney, blood and urine in 109 healthy kidney donors, aged 24-70 years. The renal biopsies were scored according to the Banff classification regarding tubular atrophy, interstitial fibrosis, glomerulosclerosis, arteriosclerosis, and arteriolohyalinosis. Kidney function was assessed based on glomerular filtration rate (GFR) as well as urinary excretion of albumin, low molecular weight proteins, kidney injury molecule 1 and N-acetylglucose aminidase. Associations between metal concentrations and histopathological changes, were assessed in models also including age, sex and smoking. RESULTS The median kidney concentrations of Pb, Cd and Hg were 0.08, 13 and 0.21 μg/g, respectively. There were signs of tubular atrophy in 63%, interstitial fibrosis in 21%, glomerulosclerosis in 71%, arteriosclerosis in 47%, and arteriolohyalinosis in 36% of the donors, but, as could be expected, the histopathological findings were limited, mostly Banff grade 1. In models adjusted for age, sex and smoking, kidney Cd was positively associated with tubular atrophy (p = 0.03) and possibly with arteriolohyalinosis (p = 0.06). Kidney Hg was associated with arteriosclerosis (p = 0.004). DISCUSSION AND CONCLUSIONS The results suggest that even low levels of Cd in the kidney can induce a mild degree of tubular atrophy. This is in line with previous findings at high-level Cd exposure. The association between kidney Hg and renal arteriosclerosis was unexpected, and may be a chance finding.
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Affiliation(s)
- Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University and Skane University Hospital, Lund, Sweden
| | - Johan Mölne
- Department of Clinical Pathology, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
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Thacher JD, Roswall N, Lissåker C, Aasvang GM, Albin M, Andersson EM, Engström G, Eriksson C, Hvidtfeldt UA, Ketzel M, Khan J, Lanki T, Ljungman PLS, Mattisson K, Molnar P, Raaschou-Nielsen O, Oudin A, Overvad K, Petersen SB, Pershagen G, Poulsen AH, Pyko A, Rizzuto D, Rosengren A, Schioler L, Sjöström M, Stockfelt L, Tiittanen P, Sallsten G, Ögren M, Selander J, Sorensen M. Occupational noise exposure and risk of incident stroke: a pooled study of five Scandinavian cohorts. Occup Environ Med 2022; 79:oemed-2021-108053. [PMID: 35450950 PMCID: PMC9453564 DOI: 10.1136/oemed-2021-108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/11/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the association between occupational noise exposure and stroke incidence in a pooled study of five Scandinavian cohorts (NordSOUND). METHODS We pooled and harmonised data from five Scandinavian cohorts resulting in 78 389 participants. We obtained job data from national registries or questionnaires and recoded these to match a job-exposure matrix developed in Sweden, which specified the annual average daily noise exposure in five exposure classes (LAeq8h): <70, 70-74, 75-79, 80-84, ≥85 dB(A). We identified residential address history and estimated 1-year average road traffic noise at baseline. Using national patient and mortality registers, we identified 7777 stroke cases with a median follow-up of 20.2 years. Analyses were conducted using Cox proportional hazards models adjusting for individual and area-level potential confounders. RESULTS Exposure to occupational noise at baseline was not associated with overall stroke in the fully adjusted models. For ischaemic stroke, occupational noise was associated with HRs (95% CI) of 1.08 (0.98 to 1.20), 1.09 (0.97 to 1.24) and 1.06 (0.92 to 1.21) in the 75-79, 80-84 and ≥85 dB(A) exposure groups, compared with <70 dB(A), respectively. In subanalyses using time-varying occupational noise exposure, we observed an indication of higher stroke risk among the most exposed (≥85 dB(A)), particularly when restricting analyses to people exposed to occupational noise within the last year (HR: 1.27; 95% CI: 0.99 to 1.63). CONCLUSIONS We found no association between occupational noise and risk of overall stroke after adjustment for confounders. However, the non-significantly increased risk of ischaemic stroke warrants further investigation.
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Affiliation(s)
- Jesse D Thacher
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Nina Roswall
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Claudia Lissåker
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Maria Albin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Eva M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Charlotta Eriksson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | | | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Jibran Khan
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Timo Lanki
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Kristoffer Mattisson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Peter Molnar
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Sustainable Health, Umeå University, Umeå, Sweden
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sesilje Bondo Petersen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Aslak Harbo Poulsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Andrei Pyko
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Centre, Stockholm, Sweden
| | - Annika Rosengren
- Molecular and Clinical Medicine, Sahlgrenska Cademy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linus Schioler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Sjöström
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Leo Stockfelt
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pekka Tiittanen
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Kuopio, Finland
| | - Gerd Sallsten
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Ögren
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Selander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mette Sorensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
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Nilsson Sommar J, Andersson EM, Andersson N, Sallsten G, Stockfelt L, Ljungman PL, Segersson D, Eneroth K, Gidhagen L, Molnar P, Wennberg P, Rosengren A, Rizzuto D, Leander K, Lager A, Magnusson PK, Johansson C, Barregard L, Bellander T, Pershagen G, Forsberg B. Long-term exposure to particulate air pollution and black carbon in relation to natural and cause-specific mortality: a multicohort study in Sweden. BMJ Open 2021; 11:e046040. [PMID: 34497075 PMCID: PMC8438896 DOI: 10.1136/bmjopen-2020-046040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To estimate concentration-response relationships for particulate matter (PM) and black carbon (BC) in relation to mortality in cohorts from three Swedish cities with comparatively low pollutant levels. SETTING Cohorts from Gothenburg, Stockholm and Umeå, Sweden. DESIGN High-resolution dispersion models were used to estimate annual mean concentrations of PM with aerodynamic diameter ≤10 µm (PM10) and ≤2.5 µm (PM2.5), and BC, at individual addresses during each year of follow-up, 1990-2011. Moving averages were calculated for the time windows 1-5 years (lag1-5) and 6-10 years (lag6-10) preceding the outcome. Cause-specific mortality data were obtained from the national cause of death registry. Cohort-specific HRs were estimated using Cox regression models and then meta-analysed including a random effect of cohort. PARTICIPANTS During the study period, 7 340 cases of natural mortality, 2 755 cases of cardiovascular disease (CVD) mortality and 817 cases of respiratory and lung cancer mortality were observed among in total 68 679 individuals and 689 813 person-years of follow-up. RESULTS Both PM10 (range: 6.3-41.9 µg/m3) and BC (range: 0.2-6.8 µg/m3) were associated with natural mortality showing 17% (95% CI 6% to 31%) and 9% (95% CI 0% to 18%) increased risks per 10 µg/m3 and 1 µg/m3 of lag1-5 exposure, respectively. For PM2.5 (range: 4.0-22.4 µg/m3), the estimated increase was 13% per 5 µg/m3, but less precise (95% CI -9% to 40%). Estimates for CVD mortality appeared higher for both PM10 and PM2.5. No association was observed with respiratory mortality. CONCLUSION The results support an effect of long-term air pollution on natural mortality and mortality in CVD with high relative risks also at low exposure levels. These findings are relevant for future decisions concerning air quality policies.
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Affiliation(s)
- Johan Nilsson Sommar
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umea University, Umeå, Sweden
| | - Eva M Andersson
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Leonard Stockfelt
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petter Ls Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrkoping, Sweden
| | - Kristina Eneroth
- SLB-analys, Environment and Health Administration, Stockholm, Sweden
| | - Lars Gidhagen
- Swedish Meteorological and Hydrological Institute, Norrkoping, Sweden
| | - Peter Molnar
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Patrik Wennberg
- Family Medicine, Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Debora Rizzuto
- Ageing Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anton Lager
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
- Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Ke Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christer Johansson
- SLB-analys, Environment and Health Administration, Stockholm, Sweden
- Department of Environmental Science, Stockholm University, Stockholm, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umea University, Umeå, Sweden
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9
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Andersson EM, Sandsveden M, Forsgard N, Sallsten G, Manjer J, Engström G, Barregard L. Is Cadmium a Risk Factor for Breast Cancer - Results from a Nested Case-Control Study Using Data from the Malmö Diet and Cancer Study. Cancer Epidemiol Biomarkers Prev 2021; 30:1744-1752. [PMID: 34244159 DOI: 10.1158/1055-9965.epi-21-0181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/06/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Some studies have shown that cadmium (Cd) is associated with breast cancer risk. One hypothesis is that Cd has estrogen-like properties. This case-control study investigated the association between breast cancer risk and blood Cd (BCd) levels. METHODS All breast cancers in the Malmö Diet and Cancer cohort were identified through linkage to the Swedish Cancer Registry, baseline (1991-1996) through 2014. Two controls per case were selected from the same cohort. BCd was analyzed at baseline. Associations were analyzed using logistic regression. RESULTS Mean BCd was 0.51 μg/L among 1,274 cases and 0.46 among 2,572 controls. There was an overall increased risk of breast cancer [OR, 1.18; 95% confidence interval (CI), 1.05-1.36] per μg/L of BCd. An increased risk was, however, only found at high BCd [OR, 1.34 (95% CI, 1.05-1.73)] for BCd more than 1.20 μg/L. The group with the highest BCd was mainly smokers. A spline indicated that at BCd less than 1.0 μg/L, the OR was not increased. The association with BCd was stronger in current smokers and at body mass index (BMI) above 25, while no modification due to receptor status was found. CONCLUSIONS The results indicated increased risk of breast cancer only for high Cd exposure, which occurred mainly among smokers. This made it difficult to disentangle the effects of smoking and Cd, despite inclusion of smoking habits in the models. IMPACT This study provides support for reducing Cd exposure through smoking cessation and dietary choice. On the population level, preventive measures against Cd pollution are warranted.
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Affiliation(s)
- Eva M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Malte Sandsveden
- Department of Surgery, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Manjer
- Department of Clinical Science in Malmö, Lund University, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Science in Malmö, Lund University, Malmö, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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10
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Barregard L, Sallsten G, Harari F, Andersson EM, Forsgard N, Hjelmgren O, Angerås O, Fagman E, Persson M, Lundh T, Borné Y, Fagerberg B, Engström G, Bergström G. Cadmium Exposure and Coronary Artery Atherosclerosis: A Cross-Sectional Population-Based Study of Swedish Middle-Aged Adults. Environ Health Perspect 2021; 129:67007. [PMID: 34160297 PMCID: PMC8221368 DOI: 10.1289/ehp8523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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 0.24μg/L. The prevalence of positive coronary artery calcium (CACS>0) was 41% and the prevalence of CACS≥100 was 13%. Relative to the lowest quartile (Q) of B-Cd (<0.16μg/L), the highest quartile (median 0.63μg/L) was associated with a small but significant increase in CACS>0 (PR 1.1; 95% CI: 1.0, 1.3), and a greater relative increase in CACS≥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 CACS>0 (63 cases in Q4) and 1.7 (95% CI 1.1, 2.7) for CACS≥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.
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Affiliation(s)
- Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florencia Harari
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva M. Andersson
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ola Hjelmgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erika Fagman
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University and Skåne University Hospital, Lund, Sweden
| | - Yan Borné
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Sallsten G, Barregard L. Variability of Urinary Creatinine in Healthy Individuals. Int J Environ Res Public Health 2021; 18:ijerph18063166. [PMID: 33808539 PMCID: PMC8003281 DOI: 10.3390/ijerph18063166] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Abstract
Many urinary biomarkers are adjusted for dilution using creatinine or specific gravity. The aim was to evaluate the variability of creatinine excretion, in 24 h and spot samples, and to describe an openly available variability biobank. Urine and blood samples were collected from 60 healthy non-smoking adults, 29 men and 31 women. All urine was collected at six time points during two 24 h periods. Blood samples were also collected twice and stored frozen. Analyses of creatinine in urine was performed in fresh urine using an enzymatic method. For creatinine in urine, the intra-class correlation (ICC) was calculated for 24 h urine and spot samples. Diurnal variability was examined, as well as association with urinary flow rate. The creatinine excretion rate was lowest in overnight samples and relatively constant in the other five samples. The creatinine excretion rate in each individual was positively correlated with urinary flow rate. The creatinine concentration was highest in the overnight sample and at 09:30. For 24 h samples the ICC was 0.64, for overnight samples it was 0.5, and for all spot samples, it was much lower. The ICC for urinary creatinine depends on the time of day of sampling. Frozen samples from this variability biobank are open for researchers examining normal variability of their favorite biomarker(s).
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12
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Barregard L, Ellingsen DG, Berlinger B, Weinbruch S, Harari F, Sallsten G. Normal variability of 22 elements in 24-hour urine samples - Results from a biobank from healthy non-smoking adults. Int J Hyg Environ Health 2021; 233:113693. [PMID: 33581414 DOI: 10.1016/j.ijheh.2021.113693] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/29/2020] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Urine is often used for biomonitoring the exposure to elements. However, most studies report concentrations in spot urine samples, which may not accurately mirror the "gold standard" of complete 24-h (24 h) urine samples. There are relatively few data published for 24 h samples, and little information on the within- and between person variability. OBJECTIVES The present study aimed at assessing variability within and between individuals in 24 h excretion for a number of elements in adults from the general population and the typical 24 h excretion of these elements. In addition, we assessed concentrations adjusted for creatinine and specific gravity (SG), and associations between elements. METHODS 60 healthy non-smokers (31 women and 29 men) from Sweden, aged 21-64 years, collected all urine during 24 h (split into six separate samples) on two occasions, about one week apart. Concentrations of As, Br, Cd, Co, Cr, Cu, Fe, Hg, Li, Mn, Mo, Ni, P, Pb, S, Sb, Se, Sn, U, V, W, and Zn in urine were analyzed by inductively coupled plasma sector-field mass spectrometry (ICP-SF-MS) and 24 h excretion rates were calculated for each day. The ratio of between-individual variance and the total variance, the intra-class correlation (ICC) was calculated based on natural log-transformed 24 h excretion. Correlation coefficients were calculated between excretion rates (mass/24 h), and concentrations adjusted for creatinine and SG. RESULTS Geometric means (GM), and 90-percentiles are presented for each element. The 24 h excretion was higher in men than in women for most elements, and the difference was statistically significant for Cr, Cu, Fe, Li, P, Pb, S, Se, U, V, and Zn. However, for Cd and Co, the excretion was higher in women. Variability between days was low for Cd, Co, Hg, Pb, Sn, Se, V, and Zn (ICC 0.75-0.90), highest for Cr (ICC = 0.3) and Sb (ICC = 0.18), and moderate for the other elements. Spearman's rank correlation coefficients were about 0.8-0.9 for 17 elements, and 0.3-0.7 for Br, Cu, P, S, Se. Excretion of P and S were highly correlated, and also associated with excretion of most of the other elements, especially Cu, Se, V, and Zn. A high correlation was also found between As and Hg, between Mo and W, as well as between Cr, Fe and Mn. CONCLUSIONS These data present normal variability of 24 h excretion of a number of elements, and can also be used as updated reference levels for elements with no or limited previous literature available. Information on variability within- and between individuals is important to know when designing studies with urine levels of elements used as exposure biomarker in studies of associations with health outcomes.
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Affiliation(s)
- Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Sweden.
| | | | - Balazs Berlinger
- National Institute of Occupational Health, Oslo, Norway; Soos Research and Development Center, University of Pannonia, Zrinyi Miklos str. 18, H-8800, Nagykanizsa, Hungary
| | - Stephan Weinbruch
- National Institute of Occupational Health, Oslo, Norway; Institute of Applied Geosciences, Technical University Darmstadt, Schnittspahnstr. 9, D-64287, Darmstadt, Germany
| | - Florencia Harari
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg & Sahlgrenska University Hospital, Sweden
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13
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Wallin M, Barregard L, Sallsten G, Lundh T, Sundh D, Lorentzon M, Ohlsson C, Mellström D. Low-level cadmium exposure is associated with decreased cortical thickness, cortical area and trabecular bone volume fraction in elderly men: The MrOS Sweden study. Bone 2021; 143:115768. [PMID: 33232837 DOI: 10.1016/j.bone.2020.115768] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
It is well known that high-level exposure to cadmium can cause bone disease such as osteoporosis, osteomalacia and fractures. However, the effect of low-level exposure, as found in the general population (mainly derived from diet and smoking), has only been assessed recently. The aim of this study was to examine if cadmium exposure in the general Swedish population causes other bone changes than decreased areal bone mineral density as measured by traditional DXA technology, e.g. changes in microstructure and geometry, such as cortical thickness or area, cortical porosity and trabecular bone volume. The study population consisted of 444 men, aged 70-81 years at inclusion year 2002-2004, from the Swedish cohort of the Osteoporotic Fractures in Men Study (MrOS). Cadmium was analyzed in baseline urine samples (U-Cd). Different parameters of bone geometry and microstructure were measured at the distal tibia at follow-up in 2009, including examination with high-resolution peripheral quantitative computed tomography (HR-pQCT). Associations between bone parameters and U-Cd in tertiles were estimated in multivariable analyses, including potential confounding factors (age, smoking, BMI, and physical activity). We found significant associations between U-Cd and several bone geometry or microstructure parameters, with 9% lower cortical thickness (p = 0.03), 7% lower cortical area (p = 0.04), and 5% lower trabecular bone volume fraction (p = 0.02) in the third tertile of U-Cd, using the first tertile as the reference. Furthermore, significant negative associations were found between log-transformed U-Cd and cortical thickness, cortical area, trabecular number and trabecular bone volume fraction, and a significant positive association with trabecular separation. The results indicate that low-level Cd exposure in the general population has negative effects on both cortical and trabecular bone.
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Affiliation(s)
- Maria Wallin
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Skåne University Hospital, Lund, Sweden
| | - Daniel Sundh
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lorentzon
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Geriatric Medicine Clinic, Sahlgrenska University Hospital Mölndal, Sweden
| | - Claes Ohlsson
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Li H, Wallin M, Barregard L, Sallsten G, Lundh T, Ohlsson C, Mellström D, Andersson EM. Smoking-Induced Risk of Osteoporosis Is Partly Mediated by Cadmium From Tobacco Smoke: The MrOS Sweden Study. J Bone Miner Res 2020; 35:1424-1429. [PMID: 32191351 DOI: 10.1002/jbmr.4014] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/19/2020] [Accepted: 03/15/2020] [Indexed: 11/09/2022]
Abstract
Cigarette smoking is a risk factor for osteoporosis and bone fracture. Moreover, smoking causes exposure to cadmium, which is a known risk factor for osteoporosis. It is hypothesized that part of smoking-induced osteoporosis may be mediated via cadmium from tobacco smoke. We investigated this hypothesis using mediation analysis in a Swedish cohort of elderly men. This study was performed in 886 elderly men from the Swedish cohort of the Osteoporotic Fractures in Men (MrOS) study. Urinary samples, bone mineral density (BMD), smoking data, and other background information were obtained at baseline in 2002-2004. Urinary cadmium was analyzed in baseline samples and adjusted for creatinine. The cohort was followed until August 2018 for fracture incidence, based on the X-ray register. Mediation analysis was conducted to evaluate the indirect effect (via cadmium) of smoking on both BMD and fractures. Time to first fracture was analyzed using the accelerated failure time (AFT) model and Aalen's additive hazard model. The mean level of urinary cadmium was 0.25 μg/g creatinine. There were significant inverse associations between smoking and total body, total hip, and trochanter BMD. The indirect effects via cadmium were estimated to be 43% of the total effects of smoking for whole-body BMD, and even more for total hip and trochanter BMD. Smoking was also associated with higher risk of all fractures and major osteoporosis fractures. The indirect effects via cadmium were largest in nonvertebral osteoporosis fractures and hip fractures, constituting at least one-half of the total effects, in both the AFT and Aalen's model. The findings in this study provide evidence that cadmium exposure from tobacco smoke plays an important role in smoking-induced osteoporosis © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Huiqi Li
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Maria Wallin
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Claes Ohlsson
- Center for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Center for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva M Andersson
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Torén K, Neitzel R, Sallsten G, Andersson E. Occupational exposure to soft paper dust and mortality. Occup Environ Med 2020; 77:549-554. [PMID: 32241835 PMCID: PMC7402447 DOI: 10.1136/oemed-2019-106394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/24/2020] [Accepted: 03/19/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Occupational exposure to soft paper dust is associated with impaired lung function. Whether there is an increased risk for asthma or chronic obstructive pulmonary disease (COPD) is unclear. METHODS We studied 7870 workers from three Swedish soft paper mills, and defined high-exposed workers, as having been exposed to soft paper dust exceeding 5 mg/m3 for at least 5 years. The remaining workers were classified as 'low exposed'. Person-years at risk were calculated and stratified according to gender, age and calendar-year. The follow-up time was from 1960 to 2013. The expected numbers of deaths were calculated using the Swedish population as reference and standardised mortality ratios (SMRs) with 95% CIs were assessed. RESULTS There was an increased mortality due to obstructive lung disease (asthma and COPD), among high-exposed workers, SMR 1.89, 95% CI 1.20 to 2.83, based on 23 observed cases. High-exposed workers had an increased mortality from asthma, SMR 4.13, 95% CI 1.78 to 8.14, based on eight observed cases. The increased asthma mortality was also observed among high-exposed men, SMR 4.38, 95% CI 1.42 to 10.2, based on five observed cases. The asthma mortality among low-exposed workers, both men and women, was not increased. The COPD mortality was not clearly increased among high-exposed workers (SMR 1.52, 95% CI 0.85 to 2.50). CONCLUSION High occupational exposure to soft paper dust increases the mortality due to asthma, and the results suggest that soft paper dust levels in workplaces should be below 5 mg/m3.
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Affiliation(s)
- Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .,Dept of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Richard Neitzel
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Gerd Sallsten
- Dept of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Andersson
- Dept of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Harari F, Barregard L, Östling G, Sallsten G, Hedblad B, Forsgard N, Borné Y, Fagerberg B, Engström G. Blood Lead Levels and Risk of Atherosclerosis in the Carotid Artery: Results from a Swedish Cohort. Environ Health Perspect 2019; 127:127002. [PMID: 31808705 PMCID: PMC6957277 DOI: 10.1289/ehp5057] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Lead exposure has been associated with increased incidence of adverse clinical cardiovascular outcomes. Atherosclerosis has been suggested as one of the underlying mechanisms, and findings from experimental studies support this, but human data are scarce. OBJECTIVES Our objective was to determine the association between environmental lead exposure based on blood lead (B-Pb) concentrations and the prevalence of atherosclerotic plaque in the carotid artery. METHODS We used cross-sectional data from the Malmö Diet and Cancer Study cardiovascular cohort (MDCS-CC; recruitment in 1991-1994) covering 4,172 middle-aged men and women. B-Pb at baseline, measured by inductively coupled plasma mass spectrometry, was used as the exposure biomarker. The presence of atherosclerotic plaque in the carotid artery was determined by B-mode ultrasonography. We used logistic regression to estimate odds ratios (ORs) for prevalence of plaque in the carotid artery according to B-Pb quartiles. RESULTS The median B-Pb was 25μg/L (range: 1.5-258), and 36% of the cohort had any atherosclerotic plaque. After controlling for confounders and known cardiovascular risk factors, the OR for prevalence of plaque in the highest quartile (Q4) of B-Pb compared with the lowest quartile (Q1) was 1.35 (95% CI: 1.09, 1.66) in the total group, 1.58 (95% CI: 1.20, 2.08) among women, and 1.18 (95% CI: 0.83, 1.69) among men. Among women, associations were limited to those who were postmenopausal [OR for Q4 vs. Q1=1.72 (95% CI: 1.26, 2.34) vs. OR=0.96 (95% CI: 0.49, 1.89 in premenopausal women)]. Associations were weak and nonsignificant in never-smokers [OR for Q4 vs. Q1=1.14 (95% CI: 0.81, 1.61)]. DISCUSSION Our study shows an association between B-Pb concentrations and occurrence of atherosclerotic plaque in the carotid artery, adding evidence for an underlying pro-atherogenic role of lead in cardiovascular disease. Associations appeared to be limited to postmenopausal (vs. premenopausal) women. https://doi.org/10.1289/EHP5057.
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Affiliation(s)
- Florencia Harari
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Gerd Östling
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Bo Hedblad
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yan Borné
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
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Ljungman PLS, Andersson N, Stockfelt L, Andersson EM, Nilsson Sommar J, Eneroth K, Gidhagen L, Johansson C, Lager A, Leander K, Molnar P, Pedersen NL, Rizzuto D, Rosengren A, Segersson D, Wennberg P, Barregard L, Forsberg B, Sallsten G, Bellander T, Pershagen G. Long-Term Exposure to Particulate Air Pollution, Black Carbon, and Their Source Components in Relation to Ischemic Heart Disease and Stroke. Environ Health Perspect 2019; 127:107012. [PMID: 31663781 PMCID: PMC6867232 DOI: 10.1289/ehp4757] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Long-term exposure to particulate matter (PM) in ambient air has been associated with cardiovascular mortality, but few studies have considered incident disease in relation to PM from different sources. OBJECTIVES We aimed to study associations between long-term exposure to different types of PM and sources, and incident ischemic heart disease (IHD) and stroke in three Swedish cities. METHODS Based on detailed emission databases, monitoring data, and high-resolution dispersion models, we calculated source contributions to PM with aerodynamic diameter ≤10μm (PM10), PM with aerodynamic diameter ≤2.5μm (PM2.5), and black carbon (BC) from road wear, traffic exhaust, residential heating, and other sources in Gothenburg, Stockholm, and Umeå. Registry data for participants from four cohorts were used to obtain incidence of IHD and stroke for first hospitalization or death. We constructed time windows of exposure for same-year, 1- to 5-y, and 6- to 10-y averages preceding incidence from annual averages at residential addresses. Risk estimates were based on random effects meta-analyses of cohort-specific Cox proportional hazard models. RESULTS We observed 5,166 and 3,119 incident IHD and stroke cases, respectively, in 114,758 participants. Overall, few consistent associations were observed between the different air pollution measures and IHD or stroke incidence. However, same-year levels of ambient locally emitted BC (range: 0.01-4.6 μg/m3) were associated with a 4.0% higher risk of incident stroke per interquartile range (IQR), 0.30 μg/m3 [95% confidence interval (CI): 0.04, 7.8]. This association was primarily related to BC from traffic exhaust. PM10 (range: 4.4-52 μg/m3) and PM2.5 (range: 2.9-22 μg/m3) were not associated with stroke. Associations with incident IHD were observed only for PM2.5 exposure from residential heating. DISCUSSION Few consistent associations were observed between different particulate components and IHD or stroke. However, long-term residential exposure to locally emitted BC from traffic exhaust was associated with stroke incidence. The comparatively low exposure levels may have contributed to the paucity of associations. https://doi.org/10.1289/EHP4757.
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Affiliation(s)
- Petter L. S. Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leo Stockfelt
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva M. Andersson
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Nilsson Sommar
- Unit of Occupational and Environmental Medicine, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kristina Eneroth
- SLB-analys, Environment and Health Administration, Stockholm, Sweden
| | - Lars Gidhagen
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Christer Johansson
- SLB-analys, Environment and Health Administration, Stockholm, Sweden
- Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden
| | - Anton Lager
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
- Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Molnar
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Ageing Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Patrik Wennberg
- Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bertil Forsberg
- Unit of Occupational and Environmental Medicine, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Torén K, Olin AC, Johnsson Å, Vikgren J, Forsgard N, Bergström G, Sallsten G, Barregård L. The association between cadmium exposure and chronic airflow limitation and emphysema: the Swedish CArdioPulmonary BioImage Study (SCAPIS pilot). Eur Respir J 2019; 54:13993003.00960-2019. [DOI: 10.1183/13993003.00960-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/27/2019] [Indexed: 11/05/2022]
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Li H, Fagerberg B, Sallsten G, Borné Y, Hedblad B, Engström G, Barregard L, Andersson EM. Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study. Environ Health 2019; 18:56. [PMID: 31200698 PMCID: PMC6570857 DOI: 10.1186/s12940-019-0495-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/31/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Smoking is a strong risk factor for cardiovascular disease (CVD) and causes exposure to cadmium, which is a pro-atherosclerotic metal. Cadmium exposure has also been shown to increase the risk of CVD, even after adjustment for smoking. Our hypothesis was that part of the risk of CVD in smokers may be mediated by cadmium exposure from tobacco smoke. We examined this hypothesis in a mediation analysis, trying to assess how much of the smoking-induced CVD risk could be explained via cadmium. METHODS We used prospective data on CVD (incidence and mortality) in a Swedish population-based cohort of 4304 middle-aged men and women (the Malmö Diet and Cancer Study). Blood cadmium was analyzed in base-line samples from 1991, and clinical events were followed up for 16-19 years based on registry data. Mediation analysis was conducted to evaluate the indirect effect (via cadmium) of smoking on CVD. Survival was analyzed by the accelerated failure time (AFT) model and the Aalen additive hazard model. RESULTS The mean blood cadmium level in the study population was 0.43 μg/L (median 0.24 μg/L) and increased with recent and current smoking. As expected, shorter survival time (AFT model) and higher incidence rate (Aalen model) were found in current smokers for all CVD outcomes and this effect seemed to be partly mediated by cadmium. For the sum of acute myocardial infarction, bypass grafts and percutaneous coronary intervention, and death in ischemic heart disease, about half of the increased risk of such events in current smokers was mediated via cadmium, with similar results for the AFT and Aalen models. CONCLUSIONS Cadmium plays an important role in smoking-induced CVDs. This provides evidence for mechanisms and is of importance for both individuals and policy makers.
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Affiliation(s)
- Huiqi Li
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, P.O. Box 414, 405 30 Gothenburg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, P.O. Box 414, 405 30 Gothenburg, Sweden
| | - Yan Borné
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Bo Hedblad
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, P.O. Box 414, 405 30 Gothenburg, Sweden
| | - Eva M. Andersson
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, P.O. Box 414, 405 30 Gothenburg, Sweden
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20
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Borné Y, Fagerberg B, Sallsten G, Hedblad B, Persson M, Melander O, Nilsson J, Orho-Melander M, Barregard L, Engström G. Biomarkers of blood cadmium and incidence of cardiovascular events in non-smokers: results from a population-based proteomics study. Clin Proteomics 2019; 16:21. [PMID: 31114450 PMCID: PMC6518646 DOI: 10.1186/s12014-019-9231-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background Cadmium is a toxic metal with multiple adverse health effects, including risk of cardiovascular disease (CVD). The mechanistic link between cadmium and CVD is unclear. Our aim was to examine the associations between blood cadmium (B-Cd) and 88 potential protein biomarkers of CVD. Methods B-Cd and 88 plasma proteins were measured in a community-based prospective cohort, the Malmö Diet and Cancer study. The primary analysis was performed in never smokers (n = 1725). Multiple linear regression was used with adjustments for age and sex, and correction for multiple comparisons using the false discovery rate method. Proteins significantly associated with B-Cd were replicated in long-term former smokers (n = 782). Significant proteins were then studied in relation to incidence of CVD (i.e., coronary events or ischemic stroke) in never smokers. Results Fifteen proteins were associated with B-Cd in never smokers. Eight of them were replicated in long-term former smokers. Kidney injury molecule-1, fibroblast growth factor-23 (FGF23), tumor necrosis factor receptor-2, matrix metalloproteinase-12, cathepsin L1, urokinase plasminogen activator receptor, C-C motif chemokine-3 (CCL3), and chemokine (C-X3-C motif) ligand-1 were associated with B-Cd both in never smokers and long-term former smokers. Except for CCL3 and FGF23, these proteins were also significantly associated with incidence of CVD. Conclusions B-Cd in non-smokers was associated with eight potential plasma biomarkers of CVD and kidney injury. The results suggest pathways for the associations between B-Cd and CVD and kidney injury.
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Affiliation(s)
- Yan Borné
- 1Department of Clinical Sciences in Malmö, CRC, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
| | - Björn Fagerberg
- 2Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Gerd Sallsten
- 3Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Bo Hedblad
- 1Department of Clinical Sciences in Malmö, CRC, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
| | - Margaretha Persson
- 1Department of Clinical Sciences in Malmö, CRC, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
| | - Olle Melander
- 1Department of Clinical Sciences in Malmö, CRC, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
| | - Jan Nilsson
- 1Department of Clinical Sciences in Malmö, CRC, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
| | - Marju Orho-Melander
- 1Department of Clinical Sciences in Malmö, CRC, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
| | - Lars Barregard
- 3Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Gunnar Engström
- 1Department of Clinical Sciences in Malmö, CRC, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
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Nyberg E, Awad R, Bignert A, Ek C, Sallsten G, Benskin JP. Inter-individual, inter-city, and temporal trends of per- and polyfluoroalkyl substances in human milk from Swedish mothers between 1972 and 2016. Environ Sci Process Impacts 2018; 20:1136-1147. [PMID: 29987291 DOI: 10.1039/c8em00174j] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Inter-individual, inter-city, and temporal trends of 19 per- and polyfluoroalkyl substances (PFASs) were investigated in human milk collected in Stockholm (1972-2016) and Gothenburg (2007-2015), Sweden. The concentrations of perfluorohexane sulfonate (PFHxS), perfluorononanoate (PFNA), perfluorodecanoate (PFDA), perfluoroundecanoate (PFUnDA), and perfluorotridecanoate (PFTrDA) in human milk from Stockholm increased significantly over the entire monitoring periods, whereas branched (Br) and linear (L) isomers of perfluorooctane sulfonamide (FOSA) decreased. In human milk from Gothenburg, significant downward trends were detected for perfluorododecanoate (PFDoDA), PFHxS and Br-perfluorooctane sulfonate (Br-PFOS) over the last decade. This declining trend was also observed for perfluorohexanoate (PFHxA), PFHxS, perfluorooctanoate (PFOA) and Br-PFOS in Stockholm over the same time period. No significant differences were observed in concentrations or relative PFAS profiles between Stockholm and Gothenburg. However, a comparison of the PFAS profile in Stockholm milk revealed distinct profiles for the time periods 1972-1996, 2000-2012, and 2013-2016, reflecting a shift in exposure over time. The lower bound estimated daily intake (EDI) for ∑PFAS concentrations in infants ranged from 7.1-40 ng per kg body weight per day (ng/kg bw/d) in Stockholm and from 5.2-25 ng/kg bw/d in Gothenburg over the studied time period, consistent with other European countries. Overall these data indicate that exposure to some legacy PFASs via breastmilk is declining, presumably as a result of regulation and phase-out initiatives. However, increasing concentrations for other PFASs and a shift in the overall PFAS profile in recent years may pose an ongoing health risk to infants.
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Affiliation(s)
- Elisabeth Nyberg
- Department of Environmental Research and Monitoring, Swedish Museum of Natural History, Stockholm, SE-114 18, Sweden.
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Harari F, Sallsten G, Christensson A, Petkovic M, Hedblad B, Forsgard N, Melander O, Nilsson PM, Borné Y, Engström G, Barregard L. Blood Lead Levels and Decreased Kidney Function in a Population-Based Cohort. Am J Kidney Dis 2018. [PMID: 29699886 DOI: 10.1053/j.ajkd.2018.02.358.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Environmental lead exposure has been associated with decreased kidney function, but evidence from large prospective cohort studies examining low exposure levels is scarce. We assessed the association of low levels of lead exposure with kidney function and kidney disease. STUDY DESIGN Prospective population-based cohort. SETTING & PARTICIPANTS 4,341 individuals aged 46 to 67 years enrolled into the Malmö Diet and Cancer Study-Cardiovascular Cohort (1991-1994) and 2,567 individuals subsequently followed up (2007-2012). PREDICTOR Blood lead concentrations in quartiles (Q1-Q4) at baseline. OUTCOMES Change in estimated glomerular filtration rate (eGFR) between the baseline and follow-up visit based on serum creatinine level alone or in combination with cystatin C level. Chronic kidney disease (CKD) incidence (185 cases) through 2013 detected using a national registry. MEASUREMENTS Multivariable-adjusted linear regression models to assess associations between lead levels and eGFRs at baseline and follow-up and change in eGFRs over time. Cox regression was used to examine associations between lead levels and CKD incidence. Validation of 100 randomly selected CKD cases showed very good agreement between registry data and medical records and laboratory data. RESULTS At baseline, 60% of study participants were women, mean age was 57 years, and median lead level was 25 (range, 1.5-258) μg/L. After a mean of 16 years of follow-up, eGFR decreased on average by 6mL/min/1.73m2 (based on creatinine) and 24mL/min/1.73m2 (based on a combined creatinine and cystatin C equation). eGFR change was higher in Q3 and Q4 of blood lead levels compared with Q1 (P for trend = 0.001). The HR for incident CKD in Q4 was 1.49 (95% CI, 1.07-2.08) compared with Q1 to Q3 combined. LIMITATIONS Lead level measured only at baseline, moderate number of CKD cases, potential unmeasured confounding. CONCLUSIONS Low-level lead exposure was associated with decreased kidney function and incident CKD. Our findings suggest lead nephrotoxicity even at low levels of exposure.
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Affiliation(s)
- Florencia Harari
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden.
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Anders Christensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Marinka Petkovic
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Bo Hedblad
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olle Melander
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Yan Borné
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
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Harari F, Sallsten G, Christensson A, Petkovic M, Hedblad B, Forsgard N, Melander O, Nilsson PM, Borné Y, Engström G, Barregard L. Blood Lead Levels and Decreased Kidney Function in a Population-Based Cohort. Am J Kidney Dis 2018; 72:381-389. [PMID: 29699886 DOI: 10.1053/j.ajkd.2018.02.358] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/12/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Environmental lead exposure has been associated with decreased kidney function, but evidence from large prospective cohort studies examining low exposure levels is scarce. We assessed the association of low levels of lead exposure with kidney function and kidney disease. STUDY DESIGN Prospective population-based cohort. SETTING & PARTICIPANTS 4,341 individuals aged 46 to 67 years enrolled into the Malmö Diet and Cancer Study-Cardiovascular Cohort (1991-1994) and 2,567 individuals subsequently followed up (2007-2012). PREDICTOR Blood lead concentrations in quartiles (Q1-Q4) at baseline. OUTCOMES Change in estimated glomerular filtration rate (eGFR) between the baseline and follow-up visit based on serum creatinine level alone or in combination with cystatin C level. Chronic kidney disease (CKD) incidence (185 cases) through 2013 detected using a national registry. MEASUREMENTS Multivariable-adjusted linear regression models to assess associations between lead levels and eGFRs at baseline and follow-up and change in eGFRs over time. Cox regression was used to examine associations between lead levels and CKD incidence. Validation of 100 randomly selected CKD cases showed very good agreement between registry data and medical records and laboratory data. RESULTS At baseline, 60% of study participants were women, mean age was 57 years, and median lead level was 25 (range, 1.5-258) μg/L. After a mean of 16 years of follow-up, eGFR decreased on average by 6mL/min/1.73m2 (based on creatinine) and 24mL/min/1.73m2 (based on a combined creatinine and cystatin C equation). eGFR change was higher in Q3 and Q4 of blood lead levels compared with Q1 (P for trend = 0.001). The HR for incident CKD in Q4 was 1.49 (95% CI, 1.07-2.08) compared with Q1 to Q3 combined. LIMITATIONS Lead level measured only at baseline, moderate number of CKD cases, potential unmeasured confounding. CONCLUSIONS Low-level lead exposure was associated with decreased kidney function and incident CKD. Our findings suggest lead nephrotoxicity even at low levels of exposure.
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Affiliation(s)
- Florencia Harari
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden.
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Anders Christensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Marinka Petkovic
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Bo Hedblad
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olle Melander
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Yan Borné
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Lund University, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
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Andersson EM, Fagerberg B, Sallsten G, Borné Y, Hedblad B, Engström G, Barregard L. Partial Mediation by Cadmium Exposure of the Association Between Tobacco Smoking and Atherosclerotic Plaques in the Carotid Artery. Am J Epidemiol 2018; 187:806-816. [PMID: 29020130 DOI: 10.1093/aje/kwx306] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/23/2017] [Indexed: 12/20/2022] Open
Abstract
Exposure to cadmium confers increased cardiovascular risk. Tobacco smoke contains cadmium, which, hypothetically, may mediate parts of the tobacco-associated risk of developing atherosclerotic plaques. Baseline data from the Swedish Malmö Diet and Cancer cohort (1991-1996) were used to test this hypothesis. Mediation analysis was used to examine associations between smoking and blood cadmium levels and the prevalence of ultrasound-assessed carotid atherosclerotic plaques. The total association with smoking status (never smokers, 2 categories of former smokers, and current smokers) was split into direct and indirect association, and the proportion mediated was estimated. The adjusted estimated plaque prevalence was approximately 27% among never smokers. We identified both a direct and an indirect pathway between smoking and carotid plaques; the indirect association, through cadmium, was observed among current smokers and former smokers who had quit smoking less than 15 years before. For current smokers, the prevalence ratio for plaque was 1.5, with 60%-65% of the association with smoking being mediated through cadmium. Recent former smokers had a prevalence ratio of 1.3, and 40%-45% was mediated through cadmium. Long-time former smokers had a prevalence ratio of 1.2, but none of the association was mediated through cadmium. In conclusion, about two-thirds of the proatherosclerotic association with smoking was mediated by cadmium.
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Affiliation(s)
- Eva M Andersson
- Authors affiliations: Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Authors affiliations: Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yan Borné
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Bo Hedblad
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Lars Barregard
- Authors affiliations: Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Borné Y, Fagerberg B, Persson M, Östling G, Söderholm M, Hedblad B, Sallsten G, Barregard L, Engström G. Cadmium, Carotid Atherosclerosis, and Incidence of Ischemic Stroke. J Am Heart Assoc 2017; 6:JAHA.117.006415. [PMID: 29197829 PMCID: PMC5778998 DOI: 10.1161/jaha.117.006415] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Exposure to cadmium has been associated with carotid plaques, inflammation in carotid plaques, and increased risk of ischemic stroke. This study examined the separate and interacting effects of blood cadmium levels and carotid plaques on the risk of incident ischemic stroke. Methods and Results Cadmium levels were measured in 4156 subjects (39.2% men; mean±SD age 57.3±5.9 years) without history of stroke, from the Malmö Diet and Cancer cohort. The right carotid artery was examined using B‐mode ultrasound examination at baseline. Incidence of ischemic stroke was monitored over a mean follow‐up of 16.7 years. Carotid plaque was present in 34.5% of participants. Cadmium was significantly higher in subjects with plaque (mean±SD: 0.53±0.58 μg/L versus 0.42±0.49 μg/L; P<0.001). A total of 221 subjects had ischemic stroke during the follow‐up. Incidence of ischemic stroke was associated both with carotid plaque (hazard ratio 1.44, 95% confidence interval, 1.09–1.90, P=0.009) and cadmium (hazard ratio for quartile [Q] 4 versus Q1–3: 1.95, confidence interval, 1.33–2.85, P=0.001), after adjustment for risk factors. There was a significant interaction between cadmium and plaque with respect to risk of ischemic stroke (P=0.011). Adjusted for risk factors, subjects with plaque and cadmium in Q4 had a hazard ratio of 2.88 (confidence interval, 1.79–4.63) for ischemic stroke, compared with those without plaque and cadmium in Q1 to Q3. Conclusions Cadmium was associated with incidence of ischemic stroke, both independently and in synergistic interaction with carotid plaques. This supports the hypothesis that cadmium promotes vulnerability of carotid plaques, thereby increasing the risk of rupture and ischemic stroke.
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Affiliation(s)
- Yan Borné
- Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Björn Fagerberg
- Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital University of Gothenburg, Sweden
| | | | - Gerd Östling
- Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | | | - Bo Hedblad
- Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Sweden
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Stockfelt L, Andersson EM, Molnár P, Gidhagen L, Segersson D, Rosengren A, Barregard L, Sallsten G. Long-term effects of total and source-specific particulate air pollution on incident cardiovascular disease in Gothenburg, Sweden. Environ Res 2017; 158:61-71. [PMID: 28600978 DOI: 10.1016/j.envres.2017.05.036] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/25/2017] [Accepted: 05/28/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND AIMS Long-term exposure to air pollution increases cardiopulmonary morbidity and mortality, but it is not clear which components of air pollution are the most harmful, nor which time window of exposure is most relevant. Further studies at low exposure levels have also been called for. We analyzed two Swedish cohorts to investigate the effects of total and source-specific particulate matter (PM) on incident cardiovascular disease for different time windows of exposure. METHODS Two cohorts initially recruited to study predictors of cardiovascular disease (the PPS cohort and the GOT-MONICA cohort) were followed from 1990 to 2011. We collected data on residential addresses and assigned each individual yearly total and source-specific PM and Nitrogen Oxides (NOx) exposures based on dispersion models. Using multivariable Cox regression models with time-dependent exposure, we studied the association between three different time windows (lag 0, lag 1-5, and exposure at study start) of residential PM and NOx exposure, and incidence of ischemic heart disease, stroke, heart failure and atrial fibrillation. RESULTS AND DISCUSSION During the study period, there were 2266 new-onset cases of ischemic heart disease, 1391 of stroke, 925 of heart failure and 1712 of atrial fibrillation. The majority of cases were in the PPS cohort, where participants were older. Exposure levels during the study period were moderate (median: 13µg/m3 for PM10 and 9µg/m3 for PM2.5), and similar in both cohorts. Road traffic and residential heating were the largest local sources of PM air pollution, and long distance transportation the largest PM source in total. In the PPS cohort, there were positive associations between PM in the last five years and both ischemic heart disease (HR: 1.24 [95% CI: 0.98-1.59] per 10µg/m3 of PM10, and HR: 1.38 [95% CI: 1.08-1.77] per 5µg/m3 of PM2.5) and heart failure. In the GOT-MONICA cohort, there were positive but generally non-significant associations between PM and stroke (HR: 1.48 [95% CI: 0.88-2.49] per 10µg/m3 of PM10, and HR: 1.50 [95% CI: 0.90-2.51] per 5µg/m3 of PM2.5, in the last five years). Effect estimates were stronger for women, non-smokers, and higher socioeconomic classes. Exposure in the last five years seemed to be more strongly associated with outcomes than other exposure time windows. Associations between source-specific PM air pollution and outcomes were mixed and generally weak. High correlations between the main pollutants limited the use of multi-pollutant models. CONCLUSIONS The main PM air pollutants were associated with ischemic heart disease and stroke (in women) at the relatively low exposure levels in Gothenburg, Sweden. The associations tended to be stronger for women than for men, for non-smokers than for smokers, and for higher socioeconomic classes than for lower. The associations could not be attributed to a specific PM source or type, and differed somewhat between the two cohorts. The results of this study confirm that further efforts to reduce air pollution exposure should be undertaken in Sweden to reduce the negative health effects in the general population.
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Affiliation(s)
- Leo Stockfelt
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Eva M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Molnár
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Gidhagen
- Swedish Meteorological and Hydrological Institute, Sweden
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Almerud P, Akerstrom M, Andersson EM, Strandberg B, Sallsten G. Low personal exposure to benzene and 1,3-butadiene in the Swedish petroleum refinery industry. Int Arch Occup Environ Health 2017; 90:713-724. [PMID: 28578463 PMCID: PMC5583277 DOI: 10.1007/s00420-017-1234-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Petroleum refinery workers are exposed to the carcinogens benzene and 1,3-butadiene. Declining exposures have been reported internationally but information on current exposure in the Swedish refinery industry is limited. The aim was to examine refinery workers' personal exposure to benzene and 1,3-butadiene and increase awareness of exposure conditions by collaboration with involved refineries. METHODS Altogether 505 repeated personal exposure measurements were performed among workers at two refineries. Full-shift measurements were conducted in different exposure groups using Perkin Elmer diffusive samplers filled with Carbopack X. Mean levels were calculated using mixed-effects models. A large fraction of measurements below the limit of detection (LOD) required imputation of computer-generated data. RESULTS Mean benzene exposure among process technicians was 15.3 µg/m3 (95% CI 10.4-22.5 µg/m3) and 13.7 µg/m3 (95% CI 8.3-22.7 µg/m3) for Refinery 1 and 2, respectively. Process technicians working outdoors had higher exposure than maintenance workers (20.7 versus 5.9 µg/m3, p < 0.01). Working in the harbour and tank park (Refinery 1), compared with the process area, was associated with higher exposure. The 1,3-butadiene exposure was low, 5.4 and 1.8 µg/m3, respectively. The total variation was generally attributed to within-worker variability. CONCLUSIONS Low benzene and 1,3-butadiene levels were found among refinery workers. Mean benzene exposure was about 1% of the Swedish occupational limit (1500 µg/m3) and for 1,3-butadiene, exposure was even lower. A large fraction of values below the LOD can be managed by carefully modelled, computer-generated data.
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Affiliation(s)
- Pernilla Almerud
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden.
| | - M Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden
| | - E M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden
| | - B Strandberg
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden
| | - G Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden
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Moberg L, Nilsson PM, Samsioe G, Sallsten G, Barregard L, Engström G, Borgfeldt C. Increased blood cadmium levels were not associated with increased fracture risk but with increased total mortality in women: the Malmö Diet and Cancer Study. Osteoporos Int 2017; 28:2401-2408. [PMID: 28432383 PMCID: PMC5524859 DOI: 10.1007/s00198-017-4047-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 04/10/2017] [Indexed: 12/22/2022]
Abstract
UNLABELLED This study aimed to investigate if high levels of blood cadmium at baseline were associated with increased fracture risk during follow-up in middle-aged women. No increased fracture risk was observed during follow-up, but women with higher levels of cadmium had an increased overall mortality. INTRODUCTION Exposure to high levels of cadmium has been associated with an increased fracture risk. The aim was to investigate a perceived association between low levels of blood cadmium (B-Cd) at baseline and risk of first incident fracture. METHODS From the population-based Malmö Diet and Cancer Study Cardiovascular cohort, 2920 middle-aged women with available background questionnaire and B-Cd measurements were included. Women were divided into quartiles (Q) according to their cadmium levels (Cd-Q1 <0.18 μg/L, Cd-Q2 0.18-0.28 μg/L, Cd-Q3 0.28-0.51 μg/L, and Cd-Q4 >0.51 μg/L). National registries were analysed for prospective risk of fractures or death. Associations between B-Cd and fracture risk were assessed by survival analysis (Cox regression analysis). RESULTS In total, 998 first incident fractures occurred in women during a follow-up lasting 20.2 years (median) (12.5-21.2 years) (25th-75th percentile). Women in Cd-Q4 were more often current smokers than in Cd-Q1 78.4 vs. 3.3% (p < 0.001) and the number of cigarettes smoked per day correlated with B-Cd (r = 0.49; p < 0.001). The risk of fracture was not associated with baseline B-Cd in adjusted models. The hazard ratio (HR) Cd-Q4 vs. Cd-Q1 was 1.06 (95% confidence interval (CI) 0.89-1.27). In the multivariate Cox regression, independent variables for increased fracture risk were history of gastric ulcer and increasing age, whereas increasing body mass index (BMI) lowered fracture risk. Overall mortality was significantly higher for women with high B-Cd, HR 2.06 (95% CI 1.57-2.69). CONCLUSIONS Higher blood levels of cadmium did not increase fracture risk in middle-aged women but reduced overall survival.
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Affiliation(s)
- L Moberg
- Department of Obstetrics and Gynaecology, Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden.
| | - P M Nilsson
- Department of Internal Medicine, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - G Samsioe
- Department of Obstetrics and Gynaecology, Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - G Sallsten
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Barregard
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Engström
- Department of Internal Medicine, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - C Borgfeldt
- Department of Obstetrics and Gynaecology, Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
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Fagerberg B, Borne Y, Sallsten G, Smith J, Acosta S, Persson M. Circulating cadmium concentration and risk of aortic aneurysms: A nested case-control study within the Malmö Diet and Cancer cohort. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fagerberg B, Borné Y, Sallsten G, Smith JG, Acosta S, Persson M, Melander O, Forsgard N, Gottsäter A, Hedblad B, Barregard L, Engström G. Circulating cadmium concentration and risk of aortic aneurysms: A nested case-control study within the Malmö Diet and Cancer cohort. Atherosclerosis 2017; 261:37-43. [DOI: 10.1016/j.atherosclerosis.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/13/2017] [Accepted: 04/07/2017] [Indexed: 12/31/2022]
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Akerstrom M, Barregard L, Lundh T, Sallsten G. Relationship between mercury in kidney, blood, and urine in environmentally exposed individuals, and implications for biomonitoring. Toxicol Appl Pharmacol 2017; 320:17-25. [DOI: 10.1016/j.taap.2017.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/28/2017] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
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Wallin M, Barregard L, Sallsten G, Lundh T, Karlsson MK, Lorentzon M, Ohlsson C, Mellström D. Response to "Low-Level Cadmium Exposure and Bone Health". J Bone Miner Res 2017; 32:420-421. [PMID: 27925285 DOI: 10.1002/jbmr.3050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Maria Wallin
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Skåne University Hospital, Lund, Sweden
| | - Magnus K Karlsson
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Fagerberg B, Borné Y, Barregard L, Sallsten G, Forsgard N, Hedblad B, Persson M, Engström G. Cadmium exposure is associated with soluble urokinase plasminogen activator receptor, a circulating marker of inflammation and future cardiovascular disease. Environ Res 2017; 152:185-191. [PMID: 27792942 DOI: 10.1016/j.envres.2016.10.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/26/2016] [Accepted: 10/19/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Diet and smoking are the main sources of cadmium exposure in the general population. Cadmium increases the risk of cardiovascular diseases, and experimental studies show that it induces inflammation. Blood cadmium levels are associated with macrophages in human atherosclerotic plaques. Soluble urokinase-type plasminogen activator receptor (suPAR) is an emerging biomarker for cardiovascular events related to inflammation and atherosclerotic plaques. The aim was to examine whether blood cadmium levels are associated with circulating suPAR and other markers of inflammation. METHODS A population sample of 4648 Swedish middle-aged women and men was examined cross-sectionally in 1991-1994. Plasma suPAR was assessed by ELISA, leukocytes were measured by standard methods, and blood cadmium was analysed by inductively coupled plasma mass spectrometry. Prevalent cardiovascular disease, ultrasound-assessed carotid plaque occurrence, and several possible confounding factors were recorded. RESULTS After full adjustment for risk factors and confounding variables, a 3-fold increase in blood cadmium was associated with an 10.9% increase in suPAR concentration (p<0.001). In never-smokers, a 3-fold increase in blood cadmium was associated with a 3.7% increase in suPAR concentration (p<0.01) after full adjustment. Blood cadmium was not associated with C-reactive protein, white blood cell count and Lp-PLA2 but with neutrophil/lymphocyte ratio in one of two statistical models. CONCLUSIONS Exposure to cadmium was associated with increased plasma suPAR in the general population, independently of smoking and cardiovascular disease. These results imply that cadmium is a possible cause for raised levels of this inflammatory marker.
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Affiliation(s)
- Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Yan Borné
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, CRC, Jan Waldenströms gata 35, Lund University, Skåne University Hospital, Malmö, SE-205 02 Malmö, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Bo Hedblad
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, CRC, Jan Waldenströms gata 35, Lund University, Skåne University Hospital, Malmö, SE-205 02 Malmö, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, CRC, Jan Waldenströms gata 35, Lund University, Skåne University Hospital, Malmö, SE-205 02 Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, CRC, Jan Waldenströms gata 35, Lund University, Skåne University Hospital, Malmö, SE-205 02 Malmö, Sweden
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Akerstrom M, Almerud P, Andersson EM, Strandberg B, Sallsten G. Personal exposure to benzene and 1,3-butadiene during petroleum refinery turnarounds and work in the oil harbour. Int Arch Occup Environ Health 2016; 89:1289-1297. [PMID: 27568022 PMCID: PMC5052356 DOI: 10.1007/s00420-016-1163-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/22/2016] [Indexed: 11/28/2022]
Abstract
Purpose Petroleum refinery workers’ exposure to the carcinogens benzene and 1,3-butadiene has decreased during normal operations. However, certain occupational groups or events at the refineries still involve a risk of higher exposures. The aim of this study was to examine the personal exposure to benzene and 1,3-butadiene at refinery turnarounds and during work in the oil harbour. Methods Personal exposure measurements of benzene and 1,3-butadiene were taken during work shifts, with a priori assumed higher benzene exposure, using PerkinElmer diffusive samplers filled with Carbopack X. Mean exposure levels were calculated, and repeated exposure measurements, when available, were assessed using mixed effect models. Group and individual compliance with the Swedish occupational exposure limit (OEL) was tested for the different exposure groups. Results Mean benzene exposure levels for refinery workers during the three measured turnarounds were 150, 610 and 960 µg/m3, and mean exposures for oil harbour workers and sewage tanker drivers were 310 and 360 µg/m3, respectively. Higher exposures were associated with handling benzene-rich products. Most occupational groups did not comply with the Swedish OEL for benzene nor did the individuals within the groups. The exposure to 1,3-butadiene was very low, between <1 and 3 % of the Swedish OEL. Conclusions Work within the petroleum refinery industry, with potential exposure to open product streams containing higher fractions of benzene, pose a risk of personal benzene exposures exceeding the OEL. Refinery workers performing these work tasks frequently, such as contractors, sewage tanker drivers and oil harbour workers, need to be identified and protected.
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Affiliation(s)
- M Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden.
| | - P Almerud
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden
| | - E M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden
| | - B Strandberg
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden
| | - G Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden
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Gambelunghe A, Sallsten G, Borné Y, Forsgard N, Hedblad B, Nilsson P, Fagerberg B, Engström G, Barregard L. Low-level exposure to lead, blood pressure, and hypertension in a population-based cohort. Environ Res 2016; 149:157-163. [PMID: 27208466 DOI: 10.1016/j.envres.2016.05.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/25/2016] [Accepted: 05/10/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Environmental lead exposure is a possible causative factor for increased blood pressure and hypertension, but large studies at low-level exposure are scarce, and results inconsistent. OBJECTIVE We aimed to examine the effects of environmental exposure to lead in a large population-based sample. METHODS We assessed associations between blood lead and systolic/diastolic blood pressure and hypertension in 4452 individuals (46-67 years) living in Malmö, Sweden, in 1991-1994. Blood pressure was measured using a mercury sphygmomanometer after 10min supine rest. Hypertension was defined as high systolic (≥140mmHg) or diastolic (≥90mmHg) blood pressure and/or current use of antihypertensive medication. Blood lead was calculated from lead in erythrocytes and haematocrit. Multivariable associations between blood lead and blood pressure or hypertension were assessed by linear and logistic regression. Two-thirds of the cohort was re-examined 16 years later. RESULTS At baseline, mean blood pressure was 141/87mmHg, 16% used antihypertensive medication, 63% had hypertension, and mean blood lead was 28µg/L. Blood lead in the fourth quartile was associated with significantly higher systolic and diastolic blood pressure (point estimates: 1-2mmHg) and increased prevalence of hypertension (odds ratio: 1.3, 95% confidence interval: 1.1-1.5) versus the other quartiles after adjustment for sex, age, smoking, alcohol, waist circumference, and education. Associations were also significant with blood lead as a continuous variable. Blood lead at baseline, having a half-life of about one month, was not associated with antihypertensive treatment at the 16-year follow-up. CONCLUSIONS Low-level lead exposure increases blood pressure and may increase the risk of hypertension.
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Affiliation(s)
- Angela Gambelunghe
- Department of Medicine, Section of Occupational Medicine and Toxicology, University of Perugia, Italy.
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, University of Gothenburg, Sweden.
| | - Yan Borné
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden.
| | - Niklas Forsgard
- Department of Clinical Sciences in Malmö, Lund University and Skåne University Hospital, Sweden.
| | - Bo Hedblad
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden.
| | - Peter Nilsson
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, and Sahlgrenska University Hospital, Sweden.
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden.
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, University of Gothenburg, Sweden.
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Barregard L, Sallsten G, Fagerberg B, Borné Y, Persson M, Hedblad B, Engström G. Blood Cadmium Levels and Incident Cardiovascular Events during Follow-up in a Population-Based Cohort of Swedish Adults: The Malmö Diet and Cancer Study. Environ Health Perspect 2016; 124:594-600. [PMID: 26517380 PMCID: PMC4858401 DOI: 10.1289/ehp.1509735] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 10/20/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Cadmium exposure may increase the risk of cardiovascular disease. The only published longitudinal study on cadmium and incident cardiovascular disease was performed in American Indians with relatively high cadmium exposure. OBJECTIVES Our aim was to examine the association between blood cadmium at baseline and incident cardiovascular events in a population-based study of Swedish men and women with cadmium levels similar to those of most European and U.S. METHODS A Swedish population-based cohort (n = 6,103, age 46-67 years) was recruited between 1991 and 1994. After we excluded those with missing data on smoking, 4,819 participants remained. Acute coronary events, other major cardiac events, stroke, and cardiovascular mortality were followed until 2010. Associations with blood cadmium (estimated from cadmium in erythrocytes) were analyzed using Cox proportional hazards regression including potential confounders and important cardiovascular risk factors. RESULTS Hazard ratios for all cardiovascular end points were consistently increased for participants in the 4th blood cadmium quartile (median, 0.99 μg/L). In models that also included sex, smoking, waist circumference, education, physical activity, alcohol intake, serum triglycerides, HbA1c, and C-reactive protein, the hazard ratios comparing the highest and lowest quartiles of exposure were 1.8 (95% CI: 1.2, 2.7) for acute coronary events, and 1.9 (1.3, 2.9) for stroke. Hazard ratios in never-smokers were consistent with these estimates. CONCLUSIONS Blood cadmium in the highest quartile was associated with incident cardiovascular disease and mortality in our population-based samples of Swedish adults. The consistent results among never-smokers are important because smoking is a strong confounder. Our findings suggest that measures to reduce cadmium exposures are warranted, even in populations without unusual sources of exposure. CITATION Barregard L, Sallsten G, Fagerberg B, Borné Y, Persson M, Hedblad B, Engström G. 2016. Blood cadmium levels and incident cardiovascular events during follow-up in a population-based cohort of Swedish adults: the Malmö Diet and Cancer Study. Environ Health Perspect 124:594-600; http://dx.doi.org/10.1289/ehp.1509735.
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Affiliation(s)
- Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
- Address correspondence to L. Barregard, P.B 414, SE 405 30 Gothenburg, Sweden. Telephone: 46 31 734 299383. E-mail
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yan Borné
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
| | - Margaretha Persson
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
| | - Bo Hedblad
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden
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Wallin M, Barregard L, Sallsten G, Lundh T, Karlsson MK, Lorentzon M, Ohlsson C, Mellström D. Low-Level Cadmium Exposure Is Associated With Decreased Bone Mineral Density and Increased Risk of Incident Fractures in Elderly Men: The MrOS Sweden Study. J Bone Miner Res 2016; 31:732-41. [PMID: 26572678 PMCID: PMC4832374 DOI: 10.1002/jbmr.2743] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 11/24/2022]
Abstract
One risk factor for osteoporosis that has attracted increasing attention in recent years is exposure to cadmium. The aim of this study was to examine the associations between low-level cadmium exposure, from diet and smoking, and bone mineral density (BMD) and incident fractures in elderly men. The study population consisted of 936 men from the Swedish cohort of the Osteoporotic Fractures in Men (MrOS) study, aged 70 to 81 years at inclusion (years 2002 to 2004), with reliable data on cadmium in urine (U-Cd) analyzed using inductively coupled plasma mass spectrometry in baseline samples. The participants also answered a questionnaire on lifestyle factors and medical history. BMD was measured at baseline using dual-energy X-ray absorptiometry (DXA) in the total body, hip, and lumbar spine. During the follow-up period (until 2013), all new fractures were registered by date and type. Associations between BMD and U-Cd were assessed using multiple linear regression, and associations between incident fractures and baseline U-Cd were analyzed using Cox regression. In both cases, a number of potential confounders and other risk factors (eg, age, smoking, body mass index [BMI], and physical activity) were included in the models. We found significant negative associations between U-Cd and BMD, with lower BMD (4% to 8%) for all sites in the fourth quartile of U-Cd, using the first quartile as the reference. In addition, we found positive associations between U-Cd and incident fractures, especially nonvertebral osteoporosis fractures in the fourth quartile of U-Cd, with hazard ratios of 1.8 to 3.3 in the various models. U-Cd as a continuous variable was significantly associated with nonvertebral osteoporosis fractures (adjusted hazard ratio 1.3 to 1.4 per μg Cd/g creatinine), also in never-smokers, but not with the other fracture groups (all fractures, hip fractures, vertebral fractures, and other fractures). Our results indicate that even relatively low cadmium exposure through diet and smoking increases the risk of low BMD and osteoporosis-related fractures in elderly men.
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Affiliation(s)
- Maria Wallin
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Skåne University Hospital, Lund, Sweden
| | - Magnus K Karlsson
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bar Y, Barregard L, Sallsten G, Wallin M, Mölne J. Quantitative and semi-quantitative histopathological examination of renal biopsies in healthy individuals, and associations with kidney function. APMIS 2016; 124:393-400. [DOI: 10.1111/apm.12520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Yael Bar
- Department of Occupational and Environmental Medicine; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
| | - Maria Wallin
- Department of Occupational and Environmental Medicine; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
| | - Johan Mölne
- Department of Clinical Pathology and Genetics; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
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Fagerberg B, Kjelldahl J, Sallsten G, Barregard L, Forsgard N, Österberg K, Hultén LM, Bergström G. Cadmium exposure as measured in blood in relation to macrophage density in symptomatic atherosclerotic plaques from human carotid artery. Atherosclerosis 2016; 249:209-14. [PMID: 27156912 DOI: 10.1016/j.atherosclerosis.2016.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/12/2015] [Accepted: 01/08/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The general population is exposed to cadmium through diet and smoking. Cadmium is pro-atherogenic and pro-inflammatory in experimental and observational studies. Cadmium levels in blood and carotid plaque endarterectomies correlate. Cadmium concentrations are much higher in plaque-areas that most frequently rupture. Here we investigated if blood cadmium concentrations are associated with macrophage density and the accumulation of CD14 as indicator of macrophage activation by lipopolysaccharide (LPS) in endarterectomies from patients with symptomatic carotid plaques. METHODS Endarterectomies from ninety nine patients were fixed in formalin, embedded in paraffin, serially sectioned and stained for assessment of morphology. As predefined, the two section levels with most prevalent plaque rupture were used for further analyses. Macrophages were assessed as area of staining for CD68 (%). Blood cadmium was measured with ICP-MS. RESULTS The CD68 median [25,75 percentiles] from the average of both sections were higher in cadmium tertile 3 than in tertile 1 (9.8 [4.9,16.1] % and 3.8 (0.6,12.4) %, p = 0.017). This difference remained in a multiple linear regression analysis with (10)log meanCD68 as dependent variable and adjustment for sex, age, smoking, statin treatment, index event, time between event and surgery (beta coefficient 0.44 [95% CI 0.05-0.87]. CD14 was not associated with blood cadmium. CONCLUSIONS The results showed that blood cadmium was associated with proinflammatory macrophage density in the sections of carotid plaques with most frequent rupture, previously shown to contain most cadmium. No association between cadmium and LPS-mediated macrophage-activation was found. Cadmium exposure may promote plaque inflammation.
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Affiliation(s)
- Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Josefin Kjelldahl
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, SE 413 45 Gothenburg, Sweden.
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, SE 413 45 Gothenburg, Sweden.
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Klas Österberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Lillemor Mattsson Hultén
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
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Murgia N, Barregard L, Sallsten G, Almstrand AC, Montuschi P, Ciabattoni G, Olin AC. 8-isoprostane in exhaled breath condensate after experimental exposure to wood smoke in humans. J BIOL REG HOMEOS AG 2016; 30:263-270. [PMID: 27049101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Wood smoke, a well-known indoor and outdoor air pollutant, may cause adverse health effects through oxidative stress. In this study 8-isoprostane, a biomarker of oxidative stress, was measured in exhaled breath condensate (EBC) and urine before and after experimental exposure to wood smoke. The results were compared with measurements of other biomarkers of oxidative stress and inflammation. Thirteen subjects were exposed first to clean air and then, after 1 week, to wood smoke in an exposure chamber during 4-hour sessions. Exhaled breath condensate, exhaled nitric oxide, blood and urine were sampled before and at various intervals after exposure to wood smoke and clean air. Exhaled breath condensate was examined for 8-isoprostane and malondialdehyde (MDA), while exhaled air was examined for nitric oxide, serum for Clara cell protein (CC16) and urine for 8-isoprostane. 8-isoprostane in EBC did not increase after wood smoke exposure and its net change immediately after exposure was inversely correlated with net changes in MDA (r(s)= -0.57, p= 0.041) and serum CC16 (S-CC16) (r(p)= -0.64, p= 0.020) immediately after the exposure. No correlation was found between 8-isoprostane in urine and 8-isoprostane in EBC. In this study controlled wood smoke exposure in healthy subjects did not increase 8-isoprostane in EBC.
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Affiliation(s)
- N Murgia
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden; Section of Occupational Medicine, Respiratory Diseases and Occupational and Environmental Toxicology, University of Perugia, Perugia, Italy
| | - L Barregard
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - G Sallsten
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - A C Almstrand
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - P Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - G Ciabattoni
- Department of Drug Sciences, School of Pharmacy, University of Chieti G. dAnnunzio, Chieti, Italy
| | - A C Olin
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
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Sigsgaard T, Forsberg B, Annesi-Maesano I, Blomberg A, Bølling A, Boman C, Bønløkke J, Brauer M, Bruce N, Héroux ME, Hirvonen MR, Kelly F, Künzli N, Lundbäck B, Moshammer H, Noonan C, Pagels J, Sallsten G, Sculier JP, Brunekreef B. Health impacts of anthropogenic biomass burning in the developed world. Eur Respir J 2015; 46:1577-1588. [PMID: 26405285 DOI: 10.1183/13993003.01865-2014.erj-01865–2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 09/01/2015] [Indexed: 05/22/2023]
Abstract
Climate change policies have stimulated a shift towards renewable energy sources such as biomass. The economic crisis of 2008 has also increased the practice of household biomass burning as it is often cheaper than using oil, gas or electricity for heating. As a result, household biomass combustion is becoming an important source of air pollutants in the European Union.This position paper discusses the contribution of biomass combustion to pollution levels in Europe, and the emerging evidence on the adverse health effects of biomass combustion products.Epidemiological studies in the developed world have documented associations between indoor and outdoor exposure to biomass combustion products and a range of adverse health effects. A conservative estimate of the current contribution of biomass smoke to premature mortality in Europe amounts to at least 40 000 deaths per year.We conclude that emissions from current biomass combustion products negatively affect respiratory and, possibly, cardiovascular health in Europe. Biomass combustion emissions, in contrast to emissions from most other sources of air pollution, are increasing. More needs to be done to further document the health effects of biomass combustion in Europe, and to reduce emissions of harmful biomass combustion products to protect public health.
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Affiliation(s)
- Torben Sigsgaard
- University of Aarhus, Institute of Public Health, Aarhus, Denmark
| | - Bertil Forsberg
- Dept of Public Health and Clinical Medicine/Environmental Medicine, Umeå University, Umeå, Sweden
| | - Isabella Annesi-Maesano
- INSERM UMR-S 1136, Institute Pierre Louis of Epidemiology and Public Health, Epidemiology of Allergic and Respiratory Diseases, Paris, France UPMC, UMR-S 1136, Institute Pierre Louis of Epidemiology and Public Health, Epidemiology of Allergic and Respiratory Diseases, Paris, France
| | - Anders Blomberg
- Dept of Public Health and Clinical Medicine/Medicine, Umeå University, Umeå, Sweden
| | - Anette Bølling
- Norwegian Institute of Public Health, Division of Environmental Medicine, Dept of Air Pollution and Noise, Oslo, Norway
| | - Christoffer Boman
- Thermochemical Energy Conversion Laboratory, Dept of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Jakob Bønløkke
- University of Aarhus, Institute of Public Health, Aarhus, Denmark
| | - Michael Brauer
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada
| | | | | | | | | | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Hanns Moshammer
- Medical University of Vienna, Institute of Environmental Health, Vienna, Austria
| | - Curtis Noonan
- The University of Montana, Center for Environmental Health Sciences, Missoula, MT, USA
| | - Joachim Pagels
- Lund University, Ergonomics and Aerosol Technology, Lund, Sweden
| | - Gerd Sallsten
- Division of Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Bert Brunekreef
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Stockfelt L, Andersson EM, Molnár P, Rosengren A, Wilhelmsen L, Sallsten G, Barregard L. Long term effects of residential NO(x) exposure on total and cause-specific mortality and incidence of myocardial infarction in a Swedish cohort. Environ Res 2015; 142:197-206. [PMID: 26163761 DOI: 10.1016/j.envres.2015.06.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/23/2015] [Accepted: 06/30/2015] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND AIMS Exposure to air pollution has been linked to total and cardiopulmonary mortality. However, few studies have examined the effects of exposure over decades, or which time windows of long term exposure are most relevant. We investigated the long term effects of residential air pollution on total and cause-specific mortality and incidence of myocardial infarction in a well-characterized cohort of men in Sweden. METHODS A cohort of 7494 men in Gothenburg was examined in 1970-1973 and followed subsequently to determine predictors of cardiovascular disease. We collected data on residential address and cause-specific mortality for the years 1973-2007. Each individual was assigned yearly nitrogen oxides (NOx) exposure based on dispersion models. Using multivariable Cox regression and generalized additive models with time-dependent exposure, we studied the association between three different time windows of residential NOx exposure, and selected outcomes. RESULTS In the years 1973-2007, a total of 5669 deaths, almost half of which were due to cardiovascular diseases, occurred in the cohort. Levels of NOx exposure decreased during the study period, from a median of 38 µg/m(3) in 1973 to 17 µg/m(3) in 2007. Total non-accidental mortality was associated with participants' NOx exposure in the last year (the year of outcome) (HR 1.03, 95% CI 1.01-1.05, per 10 µg/m(3)), with the mean NOx exposure during the last 5 years, and with the mean NOx exposure since enrolment (HR 1.02, 95% CI 1.01-1.04 for both). The associations were similar (HR 1.01-1.03), but generally not statistically significant, for cardiovascular, ischemic heart disease, and acute myocardial infarction mortality, and weaker for cerebrovascular and respiratory mortality. There was no association between NOx exposure and incident myocardial infarction. DISCUSSION AND CONCLUSIONS Long term residential exposure to NOx at these relatively low exposure levels in Gothenburg was associated with total non-accidental mortality. The association was as strong for NOx exposure in the last year as for longer exposure windows. The effect was near linear, and only marginally affected by confounders and effect modifiers. The improved air quality in Gothenburg has by these estimates led to a 6% decrease in excess non-accidental mortality during the study period.
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Affiliation(s)
- Leo Stockfelt
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Eva M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Molnár
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Wilhelmsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Sigsgaard T, Forsberg B, Annesi-Maesano I, Blomberg A, Bølling A, Boman C, Bønløkke J, Brauer M, Bruce N, Héroux ME, Hirvonen MR, Kelly F, Künzli N, Lundbäck B, Moshammer H, Noonan C, Pagels J, Sallsten G, Sculier JP, Brunekreef B. Health impacts of anthropogenic biomass burning in the developed world. Eur Respir J 2015; 46:1577-88. [PMID: 26405285 DOI: 10.1183/13993003.01865-2014] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 09/01/2015] [Indexed: 11/05/2022]
Abstract
Climate change policies have stimulated a shift towards renewable energy sources such as biomass. The economic crisis of 2008 has also increased the practice of household biomass burning as it is often cheaper than using oil, gas or electricity for heating. As a result, household biomass combustion is becoming an important source of air pollutants in the European Union.This position paper discusses the contribution of biomass combustion to pollution levels in Europe, and the emerging evidence on the adverse health effects of biomass combustion products.Epidemiological studies in the developed world have documented associations between indoor and outdoor exposure to biomass combustion products and a range of adverse health effects. A conservative estimate of the current contribution of biomass smoke to premature mortality in Europe amounts to at least 40 000 deaths per year.We conclude that emissions from current biomass combustion products negatively affect respiratory and, possibly, cardiovascular health in Europe. Biomass combustion emissions, in contrast to emissions from most other sources of air pollution, are increasing. More needs to be done to further document the health effects of biomass combustion in Europe, and to reduce emissions of harmful biomass combustion products to protect public health.
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Affiliation(s)
- Torben Sigsgaard
- University of Aarhus, Institute of Public Health, Aarhus, Denmark
| | - Bertil Forsberg
- Dept of Public Health and Clinical Medicine/Environmental Medicine, Umeå University, Umeå, Sweden
| | - Isabella Annesi-Maesano
- INSERM UMR-S 1136, Institute Pierre Louis of Epidemiology and Public Health, Epidemiology of Allergic and Respiratory Diseases, Paris, France UPMC, UMR-S 1136, Institute Pierre Louis of Epidemiology and Public Health, Epidemiology of Allergic and Respiratory Diseases, Paris, France
| | - Anders Blomberg
- Dept of Public Health and Clinical Medicine/Medicine, Umeå University, Umeå, Sweden
| | - Anette Bølling
- Norwegian Institute of Public Health, Division of Environmental Medicine, Dept of Air Pollution and Noise, Oslo, Norway
| | - Christoffer Boman
- Thermochemical Energy Conversion Laboratory, Dept of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Jakob Bønløkke
- University of Aarhus, Institute of Public Health, Aarhus, Denmark
| | - Michael Brauer
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada
| | | | | | | | | | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Hanns Moshammer
- Medical University of Vienna, Institute of Environmental Health, Vienna, Austria
| | - Curtis Noonan
- The University of Montana, Center for Environmental Health Sciences, Missoula, MT, USA
| | - Joachim Pagels
- Lund University, Ergonomics and Aerosol Technology, Lund, Sweden
| | - Gerd Sallsten
- Division of Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Bert Brunekreef
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bergström G, Fagerberg B, Sallsten G, Lundh T, Barregard L. Is cadmium exposure associated with the burden, vulnerability and rupture of human atherosclerotic plaques? PLoS One 2015; 10:e0121240. [PMID: 25816093 PMCID: PMC4376860 DOI: 10.1371/journal.pone.0121240] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/29/2015] [Indexed: 11/23/2022] Open
Abstract
The general population is exposed to cadmium from food and smoking. Cadmium is a widely spread toxic pollutant that seems to be associated with cardiovascular diseases, although little is known if it contributes to the occurrence of atherosclerotic plaques and the process whereby plaques become vulnerable and are prone to rupture. We tested the hypotheses that cadmium exposure is associated not only with an increased subclinical burden of atherosclerotic plaques in different vascular territories and early signs of plaque vulnerability, but also with cadmium content and plaque-rupture in the clinical phase of the disease. Ultrasound technique was used to measure plaque prevalence and echogenicity in the carotid and femoral arteries in a population sample of women (n = 599) in whom blood cadmium was measured. In addition cadmium was measured in snap-frozen endarterectomies and whole blood obtained from patients who were referred to surgery because of symptomatic carotid plaques (n = 37). Sixteen endarterectomies were divided into three parts corresponding to different flow conditions and plaque vulnerability. In the population sample blood cadmium was associated with the number of vascular territories with plaques (p = 0.003 after adjustment for potential confounders). The cadmium concentrations in symptomatic plaques were 50-fold higher in plaque tissue than in blood. Cadmium levels in blood and plaque correlated, also after adjustment for smoking and other cardiovascular risk factors (p<0.001). Compared with the other parts of the plaque, the cadmium content was double as high in the part where plaque rupture usually occurs. In conclusion, the results show that cadmium exposure is associated with the burden of subclinical atherosclerosis in middle-aged women with different degrees of glucose tolerance, and that the content of cadmium in symptomatic plaques in patients is related to that in blood, but much higher, and preferentially located in the part of plaque where rupture often occurs.
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Affiliation(s)
- Göran Bergström
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Björn Fagerberg
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
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Hemmingsen JG, Rissler J, Lykkesfeldt J, Sallsten G, Kristiansen J, Møller P P, Loft S. Controlled exposure to particulate matter from urban street air is associated with decreased vasodilation and heart rate variability in overweight and older adults. Part Fibre Toxicol 2015; 12:6. [PMID: 25890359 PMCID: PMC4374502 DOI: 10.1186/s12989-015-0081-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/11/2015] [Indexed: 01/07/2023] Open
Abstract
Background Exposure to particulate matter (PM) is generally associated with elevated risk of cardiovascular morbidity and mortality. Elderly and obese subjects may be particularly susceptible, although short-term effects are poorly described. Methods Sixty healthy subjects (25 males, 35 females, age 55 to 83 years, body mass index > 25 kg/m2) were included in a cross-over study with 5 hours of exposure to particle- or sham-filtered air from a busy street using an exposure-chamber. The sham- versus particle-filtered air had average particle number concentrations of ~23.000 versus ~1800/cm3 and PM2.5 levels of 24 versus 3μg/m3, respectively. The PM contained similar fractions of elemental and black carbon (~20-25%) in both exposure scenarios. Reactive hyperemia and nitroglycerin-induced vasodilation in finger arteries and heart rate variability (HRV) measured within 1 h after exposure were primary outcomes. Potential explanatory mechanistic variables included markers of oxidative stress (ascorbate/dehydroascorbate, nitric oxide-production cofactor tetrahydrobiopterin and its oxidation product dihydrobiopterin) and inflammation markers (C-reactive protein and leukocyte differential counts). Results Nitroglycerin-induced vasodilation was reduced by 12% [95% confidence interval: −22%; −1.0%] following PM exposure, whereas hyperemia-induced vasodilation was reduced by 5% [95% confidence interval: −11.6%; 1.6%]. Moreover, HRV measurements showed that the high and low frequency domains were significantly decreased and increased, respectively. Redox and inflammatory status did not change significantly based on the above measures. Conclusions This study indicates that exposure to real-life levels of PM from urban street air impairs the vasomotor function and HRV in overweight middle-aged and elderly adults, although this could not be explained by changes in inflammation, oxidative stress or nitric oxide-cofactors. Electronic supplementary material The online version of this article (doi:10.1186/s12989-015-0081-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jette G Hemmingsen
- Department of Public Health, Section of Environmental Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark.
| | - Jenny Rissler
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, P.O. Box 118, SE-221 00, Lund, Sweden.
| | - Jens Lykkesfeldt
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 9, 1870 Frb. C., Copenhagen, Denmark.
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
| | - Jesper Kristiansen
- The National Research Centre for the Working Environment, Lersø Parkalle 105, 2100, Copenhagen, Denmark.
| | - Peter Møller P
- Department of Public Health, Section of Environmental Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark.
| | - Steffen Loft
- Department of Public Health, Section of Environmental Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5A, DK-1014, Copenhagen K, Denmark.
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Fagerstrom P, Sallsten G, Akerstrom M, Haraldsson B, Barregard L. Urinary albumin excretion in healthy adults: a cross sectional study of 24-hour versus timed overnight samples and impact of GFR and other personal characteristics. BMC Nephrol 2015; 16:8. [PMID: 25616740 PMCID: PMC4417247 DOI: 10.1186/1471-2369-16-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/13/2015] [Indexed: 12/02/2022] Open
Abstract
Background Urinary albumin can be measured in 24 h or spot samples. The 24 h urinary albumin excretion rate is considered the gold standard, but is cumbersome to collect. Instead, often an overnight sample is collected, and adjusted for dilution. Proxies for 24 h excretion rate have been studied in diabetics, but seldom in healthy individuals. Our aims were to compare 24 h and overnight albumin excretion, to assess the impact of personal characteristics, and to examine correlations between the 24 h excretion rate and proxies such as the albumin to creatinine ratio (ACR). Methods Separate 24 h and overnight urine samples were collected from 152 healthy kidney donors. Urinary creatinine, specific gravity, collection time, and sample volume determined. Differences between 24 h and overnight samples were examined, and the effects of age, sex, smoking, body mass, glomerular filtration rate, and urinary flow rate were assessed. Results The 24 h albumin excretion rate and ACR were both significantly higher than their overnight counterparts. Unadjusted albumin was unsurprisingly higher in the more concentrated overnight samples, while concentrations adjusted for specific gravity were similar. In multivariate analysis, the 24 h excretion rate and proxies were positively associated with glomerular filtration rate, as was ACR in overnight samples. There were positive associations between urinary albumin and body mass. Conclusions Proxies for the 24 h albumin excretion rate showed relatively high correlations with this gold standard, but differences due to sampling period, adjustment method, and personal characteristics were large enough to be worth considering in studies of albumin excretion in healthy individuals.
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Affiliation(s)
- Peter Fagerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg, S-405 30, Sweden.
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg, S-405 30, Sweden.
| | - Magnus Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg, S-405 30, Sweden.
| | - Borje Haraldsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg, S-405 30, Sweden.
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Fagerberg B, Barregard L, Sallsten G, Forsgard N, Ostling G, Persson M, Borné Y, Engström G, Hedblad B. Cadmium exposure and atherosclerotic carotid plaques--results from the Malmö diet and Cancer study. Environ Res 2015; 136:67-74. [PMID: 25460622 DOI: 10.1016/j.envres.2014.11.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/14/2014] [Accepted: 11/05/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND Epidemiological studies indicate that cadmium exposure through diet and smoking is associated with increased risk of cardiovascular disease. There are few data on the relationship between cadmium and plaques, the hallmark of underlying atherosclerotic disease. OBJECTIVES To examine the association between exposure to cadmium and the prevalence and size of atherosclerotic plaques in the carotid artery. METHODS A population sample of 4639 Swedish middle-aged women and men was examined in 1991-1994. Carotid plaque was determined by B-mode ultrasound. Cadmium in blood was analyzed by inductively coupled plasma mass spectrometry. RESULTS Comparing quartile 4 with quartile 1 of blood cadmium, the odds ratio (OR) for prevalence of any plaque was 1.9 (95% confidence interval 1.6-2.2) after adjustment for sex and, age; 1.4 (1.1-1.8) after additional adjustment for smoking status; 1.4 (1.1-1.7) after the addition of education level and life style factors; 1.3 (1.03-1.8) after additional adjustment for risk factors and predictors of cardiovascular disease. No effect modification by sex was found in the cadmium-related prevalence of plaques. Similarly, ORs for the prevalence of small and large plaques were after full adjustment 1.4 (1.0-2.1) and 1.4 (0.9-2.0), respectively. The subgroup of never smokers showed no association between cadmium and atherosclerotic plaques. CONCLUSIONS These results extend previous studies on cadmium exposure and clinical cardiovascular events by adding data on the association between cadmium and underlying atherosclerosis in humans. The role of smoking remains unclear. It may both cause residual confounding and be a source of pro-atherogenic cadmium exposure.
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Affiliation(s)
- Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, SE 413 45 Gothenburg, Sweden.
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, SE 413 45 Gothenburg, Sweden.
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Gerd Ostling
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Jan Waldenströms gata 35, Skane University Hospital, Malmö, 205 02 Malmö, Sweden.
| | - Margaretha Persson
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Jan Waldenströms gata 35, Skane University Hospital, Malmö, 205 02 Malmö, Sweden.
| | - Yan Borné
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Jan Waldenströms gata 35, Skane University Hospital, Malmö, 205 02 Malmö, Sweden.
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Jan Waldenströms gata 35, Skane University Hospital, Malmö, 205 02 Malmö, Sweden.
| | - Bo Hedblad
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, CRC, Jan Waldenströms gata 35, Skane University Hospital, Malmö, 205 02 Malmö, Sweden.
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Wallin M, Sallsten G, Lundh T, Barregard L. Low-level cadmium exposure and effects on kidney function. Occup Environ Med 2014; 71:848-54. [PMID: 25286916 PMCID: PMC4251161 DOI: 10.1136/oemed-2014-102279] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The nephrotoxicity of cadmium at low levels of exposure, measured by urinary cadmium, has recently been questioned since co-excretion of cadmium and proteins may have causes other than cadmium toxicity. The aim of this study was to explore the relation between kidney function and low or moderate cadmium levels, measured directly in kidney biopsies. METHODS We analysed cadmium in kidney biopsies (K-Cd), blood (B-Cd) and urine (U-Cd) from 109 living kidney donors in a cross-sectional study. We measured glomerular filtration rate (GFR), cystatin C in serum, albumin, β-2-microglobulin (B2M), retinol-binding protein (RBP), α-1-microglobulin (A1M), N-acetyl-β-d-glucosaminidase and kidney injury molecule 1 (KIM-1) in 24 h and overnight urine. RESULTS We found significant positive associations between A1M excretion and K-Cd in multiple regression models including age, sex, weight, smoking and urinary flow rate. This association was also present in never-smokers. A1M was also positively associated with B-Cd and U-Cd. GFR and the other biomarkers of kidney function were not associated with K-Cd. GFR estimated from serum cystatin C showed a very poor correlation with measured GFR. KIM-1, RBP and possibly albumin were positively associated with U-Cd, but only in overnight urine. No associations were found with B2M. CONCLUSIONS Our results suggest that A1M in urine is a sensitive biomarker for effects of low-level cadmium exposure. A few associations between other renal biomarkers and U-Cd, but not K-Cd, were probably caused by physiological co-excretion or chance.
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Affiliation(s)
- Maria Wallin
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
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Borné Y, Fagerberg B, Persson M, Sallsten G, Forsgard N, Hedblad B, Barregard L, Engström G. Cadmium exposure and incidence of diabetes mellitus--results from the Malmö Diet and Cancer study. PLoS One 2014; 9:e112277. [PMID: 25393737 PMCID: PMC4230984 DOI: 10.1371/journal.pone.0112277] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/05/2014] [Indexed: 02/03/2023] Open
Abstract
Background Cadmium is a pollutant with multiple adverse health effects: renal dysfunction, osteoporosis and fractures, cancer, and probably cardiovascular disease. Some studies have reported associations between cadmium and impaired fasting glucose and diabetes. However, this relationship is controversial and there is a lack of longitudinal studies. Objectives To examine prospectively whether cadmium in blood is associated with incidence of diabetes mellitus. Methods The study population consists of 4585 subjects without history of diabetes (aged 46 to 67 years, 60% women), who participated in the Malmö Diet and Cancer study during 1991–1994. Blood cadmium levels were estimated from hematocrit and cadmium concentrations in erythrocytes. Incident cases of diabetes were identified from national and local diabetes registers. Results Cadmium concentrations in blood were not associated with blood glucose and insulin levels at the baseline examination. However, cadmium was positively associated with HbA1c in former smokers and current smokers. During a mean follow-up of 15.2±4.2 years, 622 (299 men and 323 women) were diagnosed with new-onset of diabetes. The incidence of diabetes was not significantly associated with blood cadmium level at baseline, neither in men or women. The hazard ratio (4th vs 1st quartile) was 1.11 (95% confidence interval 0.82–1.49), when adjusted for potential confounders. Conclusions Elevated blood cadmium levels are not associated with increased incidence of diabetes. The positive association between HbA1c and blood cadmium levels has a likely explanation in mechanisms related to erythrocyte turnover and smoking.
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Affiliation(s)
- Yan Borné
- Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
- * E-mail:
| | - Björn Fagerberg
- Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
- Clinical Research Unit, Emergency Department, Skåne University Hospital, Malmö, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bo Hedblad
- Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
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Johannesson S, Andersson EM, Stockfelt L, Barregard L, Sallsten G. Urban air pollution and effects on biomarkers of systemic inflammation and coagulation: a panel study in healthy adults. Inhal Toxicol 2014; 26:84-94. [PMID: 24495245 DOI: 10.3109/08958378.2013.856968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Urban particulate air pollution is associated with cardiovascular diseases and mortality, possibly mediated through systemic inflammation and increased blood viscosity. OBJECTIVES To examine short-term effects of exposure to urban air pollution on blood biomarkers for systemic inflammation and coagulation in a panel of healthy adults living in Gothenburg, Sweden. MATERIALS AND METHODS The 16 volunteers, all non-smokers, median age 35 years, were called for blood sampling the morning after a day with high levels of urban particulate matter (PM₁₀ > 30 µg/m³) or a day with low levels (PM₁₀ < 15 µg/m³ and NO₂ < 35 µg/m³). Associations between exposure to air pollution and each biomarker (C-reactive protein, fibrinogen, serum amyloid A, coagulation factor VIII, plasminogen activator inhibitor-1, p-selectin, soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, Clara cell protein 16 and surfactant protein D) were examined using a linear mixed-effects model. RESULTS In total, 12 sampling sessions were performed, six after high-pollution and six after low-pollution days, over 21 months. The ratio of air pollution levels between high- and low-pollution days was five for PM₁₀ (median: 49 and 10 µg/m³) and two for NO₂ (median: 47 and 24 µg/m³). No significant increase in blood levels of any of the biomarkers were seen after days with high air pollution levels compared with low levels. CONCLUSION Biomarkers of inflammation and coagulation were not found to be significantly increased in the mornings after days with elevated levels of urban air pollution compared with low levels when performing repeated blood samplings in healthy volunteers.
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Affiliation(s)
- Sandra Johannesson
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden
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