ArticleEnvironmental research2021
Urinary cadmium and stroke - a case-cohort study in Danish never-smokers.
Article in Environmental research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Toxic heavy metal exposure and heart health: a systematic review and meta-analysis of 324,331 patients.BMC cardiovascular disorders · 2025Pooled it
- Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis.Environmental science and pollution research international · 2022Pooled it
- Hepatic inflammation after exposure to a mixture of low-dose arsenic and cadmium in a murine model of fatty liver disease.Toxicological sciences : an official journal of the Society of Toxicology · 2026Article
- Metallomic Aspects of Stroke and Recovery: ICP-MS Study with Chemometric Analysis.Molecules (Basel, Switzerland) · 2025Article
- Dietary Minerals and Incident Cardiovascular Outcomes among Never-Smokers in a Danish Case-Cohort Study.International journal of environmental research and public health · 2024Article
- Health effects associated with exposure to secondhand smoke: a Burden of Proof study.Nature medicine · 2024Article
- Urine antimony and risk of cardiovascular disease - A prospective case-cohort study in Danish Non-Smokers.Environment international · 2023Article
- Soil and water pollution and human health: what should cardiologists worry about?Cardiovascular research · 2023Review
- Disturbed Ratios between Essential and Toxic Trace Elements as Potential Biomarkers of Acute Ischemic Stroke.Nutrients · 2023Article
- Overview of the cardiovascular effects of environmental metals: New preclinical and clinical insights.Toxicology and applied pharmacology · 2022Article
- Urinary Cadmium and Incident Heart Failure: A Case-Cohort Analysis Among Never-Smokers in Denmark.Epidemiology (Cambridge, Mass.) · 2022Article
- Trends in Urinary and Blood Cadmium Levels in U.S. Adults with or without Comorbidities, 1999-2018.Nutrients · 2022Article
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Authors and funding
11 authors at 8 institutions in 2 countries.
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Abstract
backgroundand Purpose: Cadmium has been associated with risk of cardiovascular events, including stroke. Human cadmium exposure occurs primarily through diet and tobacco smoke. Recent cohort studies have found an association with stroke, but residual confounding from smoking, could not be ruled out. We therefore conducted a case-cohort study to evaluate whether cadmium is associated with stroke in never-smokers.
methodsThe Danish Diet Cancer and Health cohort consists of Danes 50-64 years old, recruited in 1993-1997. From never-smoking cohort members without previous cancer or stroke we sampled a sub-cohort of 1200 persons. We also identified all (n = 534) cases in the cohort with a validated stroke diagnosis between baseline and 2009. We quantified cadmium and creatinine concentrations from baseline urine samples and used cadmium per creatinine as our main exposure metric. We used Cox proportional hazards models to estimate hazard ratios (HRs) with age as time scale and adjusting for BMI, education and urinary cotinine with and without stratification by sex.
resultsThe median urinary cadmium concentration was 0.21 μg cadmium/g creatinine in cases and 0.19 μg/g in the sub-cohort. The majority (83%) of stroke cases were diagnosed with ischemic stroke. The HR for stroke in the highest quartile of exposure (median 0.44 μg/g creatinine) was 1.11 (95% CI: 0.79-1.54) compared with the lowest quartile (median 0.10 μg/g creatinine). The HR per inter quartile range (IQR, 0.19 μg/g creatinine) was 1.02 (95% CI: 0.92-1.12). Among men, the HR per IQR higher levels of cadmium (0.16 μg/g creatinine) was 1.18 (95% CI: 0.92-1.52), and 1.00 (95% CI: 0.89-1.12) among women. Adjusting for creatinine or using osmolality instead of creatinine standardization generally attenuated observed relationships.
conclusionsOur results do not support that low levels of cadmium exposure among never-smokers are strongly associated with risk of stroke, although results varied somewhat by sex and method of accounting for urinary dilution.
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