Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study
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...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | Environmental Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12940-019-0495-1 |
| _version_ | 1811286077812506624 |
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| author | Huiqi Li Björn Fagerberg Gerd Sallsten Yan Borné Bo Hedblad Gunnar Engström Lars Barregard Eva M. Andersson |
| author_facet | Huiqi Li Björn Fagerberg Gerd Sallsten Yan Borné Bo Hedblad Gunnar Engström Lars Barregard Eva M. Andersson |
| author_sort | Huiqi Li |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T02:54:12Z |
| format | Article |
| id | doaj.art-b171cb819f5e4adeb21a01ba0fb14a90 |
| institution | Directory Open Access Journal |
| issn | 1476-069X |
| language | English |
| last_indexed | 2024-04-13T02:54:12Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Environmental Health |
| spelling | doaj.art-b171cb819f5e4adeb21a01ba0fb14a902022-12-22T03:05:45ZengBMCEnvironmental Health1476-069X2019-06-0118111010.1186/s12940-019-0495-1Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort StudyHuiqi Li0Björn Fagerberg1Gerd Sallsten2Yan Borné3Bo Hedblad4Gunnar Engström5Lars Barregard6Eva M. Andersson7Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of GothenburgDepartment of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg and Sahlgrenska University HospitalOccupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of GothenburgCardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University HospitalCardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University HospitalCardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University and Skåne University HospitalOccupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of GothenburgOccupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of GothenburgAbstract 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.http://link.springer.com/article/10.1186/s12940-019-0495-1SmokingCadmiumCardiovascular diseasesMediation analysisProspective cohort |
| spellingShingle | Huiqi Li Björn Fagerberg Gerd Sallsten Yan Borné Bo Hedblad Gunnar Engström Lars Barregard Eva M. Andersson Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study Environmental Health Smoking Cadmium Cardiovascular diseases Mediation analysis Prospective cohort |
| title | Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study |
| title_full | Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study |
| title_fullStr | Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study |
| title_full_unstemmed | Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study |
| title_short | Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study |
| title_sort | smoking induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco malmo diet and cancer cohort study |
| topic | Smoking Cadmium Cardiovascular diseases Mediation analysis Prospective cohort |
| url | http://link.springer.com/article/10.1186/s12940-019-0495-1 |
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