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Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco : Malmö Diet and Cancer Cohort Study

Li, Huiqi LU ; Fagerberg, Björn; Sallsten, Gerd; Borné, Yan LU ; Hedblad, Bo LU ; Engström, Gunnar LU ; Barregard, Lars and Andersson, Eva M. (2019) In Environmental Health: A Global Access Science Source 18(1).
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... (More)

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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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cadmium, Cardiovascular diseases, Mediation analysis, Prospective cohort, Smoking
in
Environmental Health: A Global Access Science Source
volume
18
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85067298794
ISSN
1476-069X
DOI
10.1186/s12940-019-0495-1
language
English
LU publication?
yes
id
654daff8-30ed-4a35-93fc-cd81347582dd
date added to LUP
2019-06-28 08:51:07
date last changed
2019-11-13 05:37:39
@article{654daff8-30ed-4a35-93fc-cd81347582dd,
  abstract     = {<p>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.</p>},
  articleno    = {56},
  author       = {Li, Huiqi and Fagerberg, Björn and Sallsten, Gerd and Borné, Yan and Hedblad, Bo and Engström, Gunnar and Barregard, Lars and Andersson, Eva M.},
  issn         = {1476-069X},
  keyword      = {Cadmium,Cardiovascular diseases,Mediation analysis,Prospective cohort,Smoking},
  language     = {eng},
  month        = {06},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {Environmental Health: A Global Access Science Source},
  title        = {Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco : Malmö Diet and Cancer Cohort Study},
  url          = {http://dx.doi.org/10.1186/s12940-019-0495-1},
  volume       = {18},
  year         = {2019},
}