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Cadmium, carotid atherosclerosis, and incidence of ischemic stroke

Borné, Yan LU ; Fagerberg, Björn; Persson, Margaretha LU ; Östling, Gerd LU ; Söderholm, Martin LU ; Hedblad, Bo LU ; Sallsten, Gerd; Barregard, Lars and Engström, Gunnar LU (2017) In Journal of the American Heart Association 6(12).
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... (More)

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 lg/L versus 0.42 ± 0.49 lg/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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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Arteriosclerosis, Cadmium, Incidence, Ischemic stroke, Plaque
in
Journal of the American Heart Association
volume
6
issue
12
publisher
Wiley-Blackwell
external identifiers
  • scopus:85038877436
ISSN
2047-9980
DOI
10.1161/JAHA.117.006415
language
English
LU publication?
yes
id
c988418a-d2bf-488d-ad9b-b7dc0713d693
date added to LUP
2018-01-10 12:16:28
date last changed
2018-04-12 03:00:10
@article{c988418a-d2bf-488d-ad9b-b7dc0713d693,
  abstract     = {<p>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 lg/L versus 0.42 ± 0.49 lg/L; P &lt; 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.</p>},
  articleno    = {e006415},
  author       = {Borné, Yan and Fagerberg, Björn and Persson, Margaretha and Östling, Gerd and Söderholm, Martin and Hedblad, Bo and Sallsten, Gerd and Barregard, Lars and Engström, Gunnar},
  issn         = {2047-9980},
  keyword      = {Arteriosclerosis,Cadmium,Incidence,Ischemic stroke,Plaque},
  language     = {eng},
  month        = {12},
  number       = {12},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of the American Heart Association},
  title        = {Cadmium, carotid atherosclerosis, and incidence of ischemic stroke},
  url          = {http://dx.doi.org/10.1161/JAHA.117.006415},
  volume       = {6},
  year         = {2017},
}