Cadmium exposure and the risk of hypertension: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Simeng , TIAN Peiru , XIN Fangran , WEI Tingting , HE Qiao , AI Cong , NI Ping ,  SHI Jingpu

Department of Clinical Epidemiology and Evidence-based Medicine, the First Affiliated Hospital, China Medical University, Shenyang, 110001, P.R.China;

Corresponding?author：

SHI Jingpu, Email: sjp562013@126.com

Keywords：

Cadmium exposure; Blood cadmium; Urinary cadmium; Hypertension; Case control study; Meta-analysis

DOI：

10.7507/1672-2531.201804004

Video：

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ObjectivesTo systematically review the relationship between cadmium exposure and the risk of hypertension.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were searched online to collect studies of cadmium exposure and hypertension from inception to March 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by Stata 12.0 software.ResultsA total of 9 studies were included, of which 19 841 cases were patients of hypertension, and 27 578 cases were in the control group. The results of meta-analysis showed that blood cadmium was associated with risk of hypertension (OR=1.23, 95%CI 1.17 to 1.30, P<0.001). However, no significant association was found between urinary cadmium and the risk of hypertension (OR=0.77, 95%CI 0.55 to 1.07,P=0.61). The results of subgroup analysis showed non-smokers (OR=1.19, 95%CI 1.09 to 1.31, P<0.001), males (OR=1.19, 95%CI 1.11 to 1.28,P<0.001), females (OR=1.28, 95%CI 1.18 to 1.40,P<0.001), yellow race (OR=1.26, 95%CI 1.19 to 1.34,P<0.001), and the literatures published after 2010 (OR=1.24, 95%CI 1.17 to 1.31,P<0.001) were associated with risk of hypertension in blood cadmium. The current smokers (OR=0.72, 95%CI 0.56 to 0.93,P=0.013), yellow race (OR=0.65, 95%CI 0.50 to 0.83, P=0.001), and the literatures published before 2010(OR=0.61, 95%CI 0.50 to 0.75, P<0.001) were associated with risk of hypertension in urinary cadmium.ConclusionsBlood cadmium is associated with risk of hypertension and high level of blood cadmium is a risk factor for hypertension. The levels of blood cadmium of non-smokers, males, females, yellow race are associated with risk of hypertension in blood cadmium. Urinary cadmium was not significantly associated with the risk of hypertension. The above conclusions are required to be verified by more high quality studies.

Citation： ZHANG Simeng, TIAN Peiru, XIN Fangran, WEI Tingting, HE Qiao, AI Cong, NI Ping, SHI Jingpu. Cadmium exposure and the risk of hypertension: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(10): 1062-1069. doi: 10.7507/1672-2531.201804004 Copy

1.	Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: hypertension at the core. Can J Cardiol, 2015, 31(5): 569-571.
2.	Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365(9455): 217-223.
3.	雷莫章. 護理干預措施對社區老年人高血壓的影響. 當代醫學, 2013, 19(21): 117-119.
4.	da Cunha Martins A Jr, Carneiro MFH, Grotto D, et al. Arsenic, cadmium, and mercury-induced hypertension: mechanisms and epidemiological findings. J Toxicol Environ Health B Crit Rev, 2018, 21(2): 61-82.
5.	路鳳, 趙峰, 蔡嘉旖, 等. 重金屬暴露與心血管疾病關系的流行病學研究進展. 中華流行病學雜志, 2018, 39(1): 102-106.
6.	林程程, 王桂安, 黃瓊, 等. 非職業人群膳食鎘暴露評估研究進展. 中國食品衛生雜志, 2014, 26(6): 624-627.
7.	Tellez-Plaza M, Navas-Acien A, Crainiceanu CM, et al. Cadmium exposure and hypertension in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Environ Health Perspect, 2008, 116(1): 51-56.
8.	Satarug S, Nishijo M, Ujjin P, et al. Cadmium-induced nephropathy in the development of high blood pressure. Toxicol Lett, 2005, 157(1): 57-68.
9.	Whittemore AS, DiCiccio Y, Provenzano G. Urinary cadmium and blood pressure: results from the NHANES II survey. Environ Health Perspect, 1991, 91: 133-140.
10.	Staessen J, Bulpitt CJ, Roels H, et al. Urinary cadmium and lead concentrations and their relation to blood pressure in a population with low exposure. Br J Ind Med, 1984, 41(2): 241-248.
11.	Beevers DG CB, Goldberg A, Moore MR, et al. Blood-cadmium in hypertensives and normotensives. Lancet, 1976, 2(7997): 1222-1224.
12.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
13.	Garner RE, Levallois P. Associations between cadmium levels in blood and urine, blood pressure and hypertension among Canadian adults. Environ Res, 2017, 155: 64-72.
14.	Lee BK, Ahn J, Kim NS, et al. Association of blood pressure with exposure to lead and cadmium: analysis of data from the 2008-2013 Korean national health and nutrition examination survey. Biol Trace Elem Res, 2016, 174(1): 40-51.
15.	Van Larebeke N, Sioen I, Hond ED, et al. Internal exposure to organochlorine pollutants and cadmium and self-reported health status: a prospective study. Int J Hyg Environ Health, 2015, 218(2): 232-245.
16.	Lee BK, Kim Y. Association of blood cadmium with hypertension in the Korean general population: Analysis of the 2008-2010 Korean national health and nutrition examination survey data. Am J Ind Med, 2012, 55(11): 1060-1067.
17.	Lee MS, Park SK, Hu H, et al. Cadmium exposure and cardiovascular disease in the 2005 Korea National Health and Nutrition Examination Survey. Environ Res, 2011, 111(1): 171-176.
18.	Swaddiwudhipong W, Limpatanachote P, Nishijo M, et al. Associations between urinary cadmium and renal dysfunction, hypertension, diabetes, and urinary stones. J Med Assoc Thai, 2010, 93(2): 231-238.
19.	Eum KD, Lee MS, Paek D. Cadmium in blood and hypertension. Sci Total Environ, 2008, 407(1): 147-153.
20.	Kurihara I, Kobayashi E, Suwazono Y, et al. Association between exposure to cadmium and blood pressure in Japanese peoples. Arch Environ Health, 2004, 59(12): 711-716.
21.	Poulter NR, Prabhakaran D, Caulfield M. Hypertension. Lancet, 2015, 386: 801-812.
22.	J?rup L, Akesson A. Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol, 2009, 238(3): 201-208.
23.	J?rup L. Hazards of heavy metal contamination. Br Med Bull, 2003, 68: 167-182.
24.	Buchet JP, Lauwerys, R, Roels, H, et al. Renal effects of cadmium body burden of the general population. Lancet, 1990, 336(8717): 699-702.
25.	O’Brien KM, Upson, K, Cook NR, et al. Environmental chemicals in urine and blood: Improving methods for creatinine and lipid adjustment. Environ Health Perspect, 2016, 124(2): 220-227.
26.	J?rup L, Berglund M, Elinder CG, et al. Health effects of cadmium exposure :a review of the literature and a risk estimate. Scand J Work Environ Health, 1998, 24(Suppl 1): 1-51.
27.	Neutel CI, Campbell N, Canadian Hypertension Society. Changes in lifestyle after hypertension diagnosis in Canada. Can J Cardiol, 2008, 24(3): 199-204.
28.	Vahter M, ?kesson A, Lidén C, et al. Gender differences in the disposition and toxicity of metals. Environ Res, 2007, 104(1): 85-95.
29.	Berglund M, Akesson A, Nermell B, et al. Intestinal absorption of dietary cadmium in women depends on body iron stores and fiber intake. Environ Health Perspect, 1994, 102(12): 1058-1066.
30.	Zhang ZW, Moon CS, Watanabe T, et al. Background exposure of urban populations to lead and cadmium: comparison between China and Japan. Int Arch Occup Environ Health, 1997, 69(4): 273-281.
31.	Ikeda M, Zhang ZW, Shimbo S, et al. Urban population exposure to lead and cadmium in east and south-east Asia. Sci Total Environ, 2000, 249(1-3): 373-384.
32.	Gallagher CM, Meliker JR. Blood and urine cadmium, blood pressure, and hypertension: a systematic review and meta-analysis. Environ Health Perspect, 2010, 118(12): 1676-1684.

1. Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: hypertension at the core. Can J Cardiol, 2015, 31(5): 569-571.
2. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365(9455): 217-223.
3. 雷莫章. 護理干預措施對社區老年人高血壓的影響. 當代醫學, 2013, 19(21): 117-119.
4. da Cunha Martins A Jr, Carneiro MFH, Grotto D, et al. Arsenic, cadmium, and mercury-induced hypertension: mechanisms and epidemiological findings. J Toxicol Environ Health B Crit Rev, 2018, 21(2): 61-82.
5. 路鳳, 趙峰, 蔡嘉旖, 等. 重金屬暴露與心血管疾病關系的流行病學研究進展. 中華流行病學雜志, 2018, 39(1): 102-106.
6. 林程程, 王桂安, 黃瓊, 等. 非職業人群膳食鎘暴露評估研究進展. 中國食品衛生雜志, 2014, 26(6): 624-627.
7. Tellez-Plaza M, Navas-Acien A, Crainiceanu CM, et al. Cadmium exposure and hypertension in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Environ Health Perspect, 2008, 116(1): 51-56.
8. Satarug S, Nishijo M, Ujjin P, et al. Cadmium-induced nephropathy in the development of high blood pressure. Toxicol Lett, 2005, 157(1): 57-68.
9. Whittemore AS, DiCiccio Y, Provenzano G. Urinary cadmium and blood pressure: results from the NHANES II survey. Environ Health Perspect, 1991, 91: 133-140.
10. Staessen J, Bulpitt CJ, Roels H, et al. Urinary cadmium and lead concentrations and their relation to blood pressure in a population with low exposure. Br J Ind Med, 1984, 41(2): 241-248.
11. Beevers DG CB, Goldberg A, Moore MR, et al. Blood-cadmium in hypertensives and normotensives. Lancet, 1976, 2(7997): 1222-1224.
12. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
13. Garner RE, Levallois P. Associations between cadmium levels in blood and urine, blood pressure and hypertension among Canadian adults. Environ Res, 2017, 155: 64-72.
14. Lee BK, Ahn J, Kim NS, et al. Association of blood pressure with exposure to lead and cadmium: analysis of data from the 2008-2013 Korean national health and nutrition examination survey. Biol Trace Elem Res, 2016, 174(1): 40-51.
15. Van Larebeke N, Sioen I, Hond ED, et al. Internal exposure to organochlorine pollutants and cadmium and self-reported health status: a prospective study. Int J Hyg Environ Health, 2015, 218(2): 232-245.
16. Lee BK, Kim Y. Association of blood cadmium with hypertension in the Korean general population: Analysis of the 2008-2010 Korean national health and nutrition examination survey data. Am J Ind Med, 2012, 55(11): 1060-1067.
17. Lee MS, Park SK, Hu H, et al. Cadmium exposure and cardiovascular disease in the 2005 Korea National Health and Nutrition Examination Survey. Environ Res, 2011, 111(1): 171-176.
18. Swaddiwudhipong W, Limpatanachote P, Nishijo M, et al. Associations between urinary cadmium and renal dysfunction, hypertension, diabetes, and urinary stones. J Med Assoc Thai, 2010, 93(2): 231-238.
19. Eum KD, Lee MS, Paek D. Cadmium in blood and hypertension. Sci Total Environ, 2008, 407(1): 147-153.
20. Kurihara I, Kobayashi E, Suwazono Y, et al. Association between exposure to cadmium and blood pressure in Japanese peoples. Arch Environ Health, 2004, 59(12): 711-716.
21. Poulter NR, Prabhakaran D, Caulfield M. Hypertension. Lancet, 2015, 386: 801-812.
22. J?rup L, Akesson A. Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol, 2009, 238(3): 201-208.
23. J?rup L. Hazards of heavy metal contamination. Br Med Bull, 2003, 68: 167-182.
24. Buchet JP, Lauwerys, R, Roels, H, et al. Renal effects of cadmium body burden of the general population. Lancet, 1990, 336(8717): 699-702.
25. O’Brien KM, Upson, K, Cook NR, et al. Environmental chemicals in urine and blood: Improving methods for creatinine and lipid adjustment. Environ Health Perspect, 2016, 124(2): 220-227.
26. J?rup L, Berglund M, Elinder CG, et al. Health effects of cadmium exposure :a review of the literature and a risk estimate. Scand J Work Environ Health, 1998, 24(Suppl 1): 1-51.
27. Neutel CI, Campbell N, Canadian Hypertension Society. Changes in lifestyle after hypertension diagnosis in Canada. Can J Cardiol, 2008, 24(3): 199-204.
28. Vahter M, ?kesson A, Lidén C, et al. Gender differences in the disposition and toxicity of metals. Environ Res, 2007, 104(1): 85-95.
29. Berglund M, Akesson A, Nermell B, et al. Intestinal absorption of dietary cadmium in women depends on body iron stores and fiber intake. Environ Health Perspect, 1994, 102(12): 1058-1066.
30. Zhang ZW, Moon CS, Watanabe T, et al. Background exposure of urban populations to lead and cadmium: comparison between China and Japan. Int Arch Occup Environ Health, 1997, 69(4): 273-281.
31. Ikeda M, Zhang ZW, Shimbo S, et al. Urban population exposure to lead and cadmium in east and south-east Asia. Sci Total Environ, 2000, 249(1-3): 373-384.
32. Gallagher CM, Meliker JR. Blood and urine cadmium, blood pressure, and hypertension: a systematic review and meta-analysis. Environ Health Perspect, 2010, 118(12): 1676-1684.

Chinese Journal of Evidence-Based Medicine

Cadmium exposure and the risk of hypertension: a meta-analysis

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