Association of Blood Cadmium with Cardiovascular Disease in Korea: From the Korea National Health and Nutrition Examination Survey 2008–2013 and 2016
Abstract
:1. Introduction
2. Subjects and Methods
2.1. Study Population
2.2. Covariate Variables and CVD Outcomes
2.3. Determination of BCd Levels
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics and BCd Concentrations
3.2. Related Factor with High Blood Cadmium
3.3. Associations between High BCd Level and Risks of Stroke, IHD, and Hypertension
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Total (n = 10,626) | Non-High BCd (n = 9565) | High BCd (n = 1061) | p-Value b | ||||
---|---|---|---|---|---|---|---|
Variables | Mean ± SD | Mean ± SD | Mean ± SD | ||||
Age (years) | 40.14 ± 11.19 | 39.37 ± 11.17 | 47.12 ± 8.74 | <0.0001 | |||
Age | n | weighted % (SE) | n | weighted % (SE) | n | weighted % (SE) | |
20–29 | 2426 | 22.81 (0.43) | 2369 | 24.66 (0.47) | 57 | 5.83 (0.89) | <0.0001 |
30–39 | 2711 | 26.27 (0.43) | 2564 | 27.54 (0.47) | 147 | 14.62 (1.29) | |
40–49 | 2740 | 27.66 (0.39) | 2370 | 26.51 (0.43) | 370 | 38.22 (1.68) | |
50–59 | 2749 | 23.26 (0.37) | 2262 | 21.29 (0.39) | 487 | 41.33 (1.69) | |
Sex | |||||||
Male | 5081 | 50.37 (0.38) | 4702 | 51.71 (0.42) | 379 | 38.10 (1.69) | <0.0001 |
Female | 5545 | 49.63 (0.38) | 4863 | 48.29 (0.42) | 682 | 61.90 (1.69) | |
Smoking status | |||||||
Never | 5947 | 54.41 (0.49) | 5365 | 54.56 (0.52) | 582 | 53.11 (1.82) | <0.0001 |
Former | 1914 | 18.36 (0.43) | 1841 | 19.61 (0.47) | 73 | 6.87 (0.90) | |
Current | 2765 | 27.23 (0.50) | 2359 | 25.83 (0.52) | 406 | 40.03 (1.79) | |
Daily smoking amount (the number of cigarettes) | 3.93 ± 7.90 | 3.60 ± 7.48 | 6.94 ± 10.54 | <0.0001 | |||
Education | |||||||
Less than high school diploma | 1848 | 17.11 (0.44) | 1471 | 15.31 (0.43) | 377 | 33.59 (1.74) | <0.0001 |
High school diploma | 4386 | 43.21 (0.61) | 3944 | 42.99 (0.64) | 442 | 45.21 (1.88) | |
College diploma or higher | 4392 | 39.68 (0.63) | 4150 | 41.70 (0.66) | 242 | 21.20 (1.51) | |
Household income | |||||||
Quartile 1 | 2668 | 26.21 (0.59) | 2337 | 25.64 (0.60) | 331 | 31.51 (1.67) | 0.0003 |
Quartile 2 | 2672 | 25.00 (0.53) | 2392 | 24.88 (0.55) | 280 | 26.04 (1.52) | |
Quartile 3 | 2607 | 24.62 (0.53) | 2375 | 24.82 (0.56) | 232 | 22.86 (1.47) | |
Quartile 4 | 2679 | 24.17 (0.60) | 2461 | 24.67 (0.63) | 218 | 19.60 (1.43) | |
Frequency of alcohol drinks per week | |||||||
0 | 1994 | 18.13 (0.44) | 1725 | 17.44 (0.45) | 269 | 24.49 (1.58) | <0.0001 |
1 | 6094 | 57.47 (0.57) | 5619 | 58.85 (0.59) | 475 | 44.86 (1.85) | |
2 or 3 | 1845 | 17.57 (0.42) | 1650 | 17.53 (0.44) | 195 | 17.94 (1.46) | |
≥4 | 693 | 6.82 (0.30) | 571 | 6.18 (0.30) | 122 | 12.71 (1.25) | |
LDL cholesterol (mg/dL) | 113.26 ± 31.54 | 112.99 ± 31.15 | 115.62 ± 34.89 | 0.2330 | |||
Fasting glucose level (mg/dL) | 95.58 ± 20.58 | 95.24 ± 20.28 | 98.70 ± 22.86 | <0.0001 | |||
Estimated glomerular filtration rate (eGFR, mL/min/1.73 m2) | 97.67 ± 17.27 | 97.91 ± 17.14 | 95.50 ± 18.20 | 0.0149 | |||
SBP (mmHg) | 114.66 ± 15.06 | 114.06 ± 14.71 | 120.02 ± 16.98 | <0.0001 | |||
DBP (mmHg) | 76.24 ± 10.81 | 75.91 ± 10.69 | 79.19 ± 11.48 | <0.0001 | |||
BMI (kg/m2) | 23.63 ± 3.45 | 23.59 ± 3.46 | 23.95 ± 3.36 | 0.0028 | |||
Obesity c | |||||||
No | 7278 | 67.94 (0.56) | 6569 | 68.18 (0.58) | 709 | 65.81 (1.76) | 0.1887 |
Yes | 3348 | 32.06 (0.56) | 2996 | 31.82 (0.58) | 352 | 34.19 (1.76) | |
Regular walking d | |||||||
No | 6271 | 58.64 (0.57) | 5607 | 58.11 (0.60) | 664 | 63.45 (1.77) | 0.0049 |
Yes | 4355 | 41.36 (0.57) | 3958 | 41.89 (0.60) | 397 | 36.55 (1.77) | |
Diabetes mellitus | |||||||
No | 8151 | 76.83 (0.51) | 7435 | 77.93 (0.53) | 716 | 66.71 (1.69) | <0.0001 |
Impaired fasting glucose | 1877 | 17.62 (0.45) | 1613 | 16.80 (0.47) | 264 | 25.17 (1.61) | |
Yes | 598 | 5.55 (0.25) | 517 | 5.27 (0.26) | 81 | 8.12 (1.00) | |
Stroke | |||||||
No | 10,566 | 99.54 (0.07) | 9517 | 99.60 (0.07) | 1049 | 98.99 (0.36) | 0.0141 |
Yes | 60 | 0.46 (0.07) | 48 | 0.40 (0.07) | 12 | 1.01 (0.36) | |
Hypertension | |||||||
No | 6108 | 57.30 (0.62) | 5640 | 58.72 (0.62) | 468 | 44.23 (1.84) | <0.0001 |
Pre-hypertension | 2588 | 24.41 (0.50) | 2318 | 24.31 (0.53) | 270 | 25.31 (1.67) | |
Yes | 1930 | 18.30 (0.46) | 1607 | 16.97 (0.46) | 323 | 30.46 (1.64) | |
Ischemic heart disease | |||||||
No | 10,546 | 99.25 (0.10) | 9501 | 99.31 (0.10) | 1045 | 98.73 (0.39) | 0.0766 |
Yes | 80 | 0.75 (0.09) | 64 | 0.69 (0.10) | 16 | 1.27 (0.39) |
Total (n = 10,626) | Non-High BCd (n = 9565) | High BCd (n = 1061) | |
---|---|---|---|
Variables | Geometric mean (SE) | Geometric mean (SE) | Geometric mean (SE) |
Total | 0.89 (0.01) | 0.80 (0.01) | 2.40 (0.02) ** |
Age (years) | |||
20–29 | 0.57 (0.01) | 0.55 (0.01) | 2.34 (0.09) |
30–39 | 0.83 (0.01) | 0.78 (0.01) | 2.35 (0.03) |
40–49 | 1.06 (0.01) | 0.93 (0.01) | 2.41 (0.03) |
50–59 | 1.20 (0.01) | 1.04 (0.01) | 2.42 (0.03) |
P for trend b | <0.0001 | <0.0001 | 0.7767 |
Sex | |||
Male | 0.82 (0.01) | 0.75 (0.01) | 2.37 (0.03) |
Female | 0.97 (0.01) ** | 0.85 (0.01) ** | 2.42 (0.02) |
Smoking status | |||
Never | 0.85 (0.01) | 0.76 (0.01) | 2.43 (0.03) |
Former | 0.75 (0.01) | 0.72 (0.01) * | 2.22 (0.04) * |
Current | 1.09 (0.01) ** | 0.96 (0.01) ** | 2.39 (0.03) |
Daily smoking amount (the number of cigarettes) | |||
<10 | 0.83 (0.01) | 0.75 (0.01) | 2.41 (0.02) |
10–14 | 1.00 (0.02) | 0.91 (0.02) | 2.33 (0.02) |
15–19 | 1.10 (0.03) | 0.98 (0.02) | 2.46 (0.10) |
20–70 | 1.30 (0.02) | 1.11 (0.02) | 2.39 (0.04) |
P for trend b | <0.0001 | <0.0001 | 0.2773 |
Education | |||
Less than high school diploma | 1.24 (0.02) | 1.06 (0.01) | 2.40 (0.04) |
High school diploma | 0.89 (0.01) | 0.79 (0.01) | 2.43 (0.03) |
College diploma or higher | 0.77 (0.01) | 0.72 (0.01) | 2.34 (0.03) |
P for trend | <0.0001 | <0.0001 | 0.0694 |
Household income | |||
Quartile 1 | 0.95 (0.01) | 0.83 (0.01) | 2.43 (0.03) |
Quartile 2 | 0.91 (0.01) | 0.81 (0.01) | 2.38 (0.04) |
Quartile 3 | 0.87 (0.01) | 0.79 (0.01) | 2.39 (0.04) |
Quartile 4 | 0.83 (0.01) | 0.76 (0.01) | 2.40 (0.04) |
P for trend | 0.5947 | 0.7332 | 0.6763 |
Frequency of alcohol consumption per week | |||
0 | 0.96 (0.02) | 0.83 (0.01) | 2.42 (0.04) |
1 | 0.83 (0.01) | 0.76 (0.01) | 2.37 (0.03) |
2 or 3 | 0.94 (0.02) | 0.85 (0.01) | 2.39 (0.04) |
≥4 | 1.19 (0.03) | 1.01 (0.02) | 2.48 (0.07) |
P for trend | <0.0001 | <0.0001 | 0.4335 |
Obesity c | |||
No | 0.88 (0.01) | 0.79 (0.01) | 2.41 (0.02) |
Yes | 0.92 (0.01) | 0.82 (0.01) | 2.39 (0.03) |
Regular walking d (n, weighted %) | |||
No | 0.93 (0.01) | 0.83 (0.01) | 2.40 (0.02) |
Yes | 0.84 (0.01) | 0.76 (0.01) | 2.40 (0.03) |
P for trend | 0.0003 | 0.0007 | 0.6745 |
Diabetes mellitus | |||
No | 0.85 (0.01) | 0.77 (0.01) | 2.40 (0.02) |
Impaired fasting glucose | 1.02 (0.02) | 0.89 (0.01) | 2.41 (0.04) |
Yes | 1.05 (0.03) | 0.92 (0.02) | 2.40 (0.08) |
Stroke | |||
No | 0.89 (0.01) | 0.80 (0.01) | 2.40 (0.02) |
Yes | 0.94 (0.07) | 0.74 (0.04) * | 2.28 (0.04) |
Hypertension | |||
No | 0.83 (0.01) | 0.76 (0.01) | 2.33 (0.02) |
Pre-hypertension | 0.90 (0.01) * | 0.80 (0.01) * | 2.46 (0.04) * |
Yes | 1.10 (0.02) ** | 0.94 (0.01) * | 2.46 (0.04) * |
Ischemic heart disease | |||
No | 0.89 (0.01) | 0.80 (0.01) | 2.40 (0.02) |
Yes | 1.10 (0.06) | 0.94 (0.04) | 2.41 (0.09) |
Total (n = 10,626) | |||||
---|---|---|---|---|---|
Cases/Non-Cases | Crude OR (95% CI) | Model 1 b OR (95% CI) | Model 2 c OR (95% CI) | Model 3 d OR (95% CI) | |
Stroke | |||||
Non-high BCd | 48/9517 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
High BCd | 12/1049 | 2.55 (1.18, 5.51) | 2.37 (1.02, 5.49) | 2.39 (1.03, 5.56) | 2.50 (1.01, 6.18) |
Hypertension | |||||
Non-high BCd | 1607/7958 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
High BCd | 323/738 | 2.14 (1.83, 2.51) | 1.45 (1.20, 1.76) | 1.46 (1.20, 1.76) | 1.48 (1.22, 1.79) |
Ischemic heart disease | |||||
Non-high BCd | 64/9501 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
High BCd | 16/1045 | 1.84 (0.93, 3.66) | 1.11 (0.55, 2.24) | 1.12 (0.56, 2.26) | 1.08 (0.54, 2.15) |
Systolic Blood Pressure (mmHg) | Diastolic Blood Pressure (mmHg) | ||||
---|---|---|---|---|---|
BCd level | n | Crude | Adjusted b | Crude | Adjusted b |
BCd (μg/L) | 10,626 | 4.35 (3.83, 4.87) ** | 2.08 (1.50, 2.66) * | 2.67 (2.28, 3.05) ** | 1.39 (0.97, 1.81) * |
Non-high BCd a | 9565 | 0.00 (reference) | 0.00 (reference) | 0.00 (reference) | 0.00 (reference) |
High BCd a | 1,061 | 5.85 (4.61, 7.10) | 3.00 (1.82, 4.17) | 3.33 (2.50, 4.16) | 1.92 (1.14, 2.70) |
P for trend c | <0.0001 | <0.0001 | <0.0001 | <0.0001 |
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Jeong, J.; Yun, S.-m.; Kim, M.; Koh, Y.H. Association of Blood Cadmium with Cardiovascular Disease in Korea: From the Korea National Health and Nutrition Examination Survey 2008–2013 and 2016. Int. J. Environ. Res. Public Health 2020, 17, 6288. https://doi.org/10.3390/ijerph17176288
Jeong J, Yun S-m, Kim M, Koh YH. Association of Blood Cadmium with Cardiovascular Disease in Korea: From the Korea National Health and Nutrition Examination Survey 2008–2013 and 2016. International Journal of Environmental Research and Public Health. 2020; 17(17):6288. https://doi.org/10.3390/ijerph17176288
Chicago/Turabian StyleJeong, Jihyun, Sang-moon Yun, Minkyeong Kim, and Young Ho Koh. 2020. "Association of Blood Cadmium with Cardiovascular Disease in Korea: From the Korea National Health and Nutrition Examination Survey 2008–2013 and 2016" International Journal of Environmental Research and Public Health 17, no. 17: 6288. https://doi.org/10.3390/ijerph17176288