Interrelation of Cadmium, Smoking, and Cardiovascular Disease (from the National Health and Nutrition Examination Survey).

Cadmium biomarker levels are associated with both cigarette smoking and cardiovascular disease. In this cross-sectional survey, we explore whether the association between cadmium and cardiovascular disease differs between cigarette smoking states. A cross-sectional analysis using the National Health and Nutrition Examination Survey in 2003 to 2012 was performed accounting for the nationally representative complex sampling design. All participants 45 to 79 years old with blood and urinary cadmium levels were included (n = 12,511). We explored the inter-relationships of blood and urine cadmium levels with cigarette smoking and a composite cardiovascular outcome that included self-reported myocardial infarction or stroke or both. We used multivariable logistic regressing models to further adjust for age, income, gender, hypercholesterolemia, body mass index, diabetes, smoking intensity, and time period of smoking cessation. Of the 12,511 participants, 1,330 (8.5%) had previous myocardial infarction or stroke or both. The crude prevalence ratio (PR) comparing those in the lowest tertile of blood cadmium with those in the highest tertile for the composite outcome was 1.73 (95% confidence interval [CI] 1.49 to 2.01). After adjustment for age, gender, income, self-reported diabetes, self-reported hypercholesterolemia, body mass index, and smoking status, the PR was 1.54 (95% CI 1.30 to 1.84). The adjusted PRs for each smoking subgroup were 1.54 (95% CI 1.09 to 2.18) for never-smokers, 1.57 (95% CI 1.11 to 2.23) for current smokers, and 1.31 (95% CI 0.96 to 1.78) for former smokers. These descriptive data from a nationally representative sample suggest that cadmium is related to cardiovascular outcomes even after adjustment for smoking status.