Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Cadmium body burden and increased blood pressure in middle-aged American Indians: the Strong Heart Study

Journal of Human Hypertension volume 31, pages 225–230 (2017)Cite this article

Subjects

Abstract

Cadmium (Cd) is an environmental pollutant that has been associated with cardiovascular disease in populations, but the relationship of Cd with hypertension has been inconsistent. We studied the association between urinary Cd concentrations, a measure of total body burden, and blood pressure in American Indians, a US population with above national average Cd burden. Urinary Cd was measured using inductively coupled plasma mass spectrometry, and adjusted for urinary creatinine concentration. Among 3714 middle-aged American Indian participants of the Strong Heart Study (mean age 56 years, 41% male, 67% ever-smokers, 23% taking antihypertensive medications), urinary Cd ranged from 0.01 to 78.48 μg g−1 creatinine (geometric mean=0.94 μg g−1) and it was correlated with smoking pack-year among ever-smokers (r2=0.16, P<0.0001). Participants who were smokers were on average light-smokers (mean 10.8 pack-years), and urinary Cd was similarly elevated in light- and never-smokers (geometric means of 0.88 μg g−1 creatinine for both categories). Log-transformed urinary Cd was significantly associated with higher systolic blood pressure in models adjusted for age, sex, geographic area, body mass index, smoking (ever vs never, and cumulative pack-years) and kidney function (mean blood pressure difference by lnCd concentration (β)=1.64, P=0.002). These associations were present among light- and never-smokers (β=2.03, P=0.002, n=2627), although not significant among never-smokers (β=1.22, P=0.18, n=1260). Cd was also associated with diastolic blood pressure among light- and never-smokers (β=0.94, P=0.004). These findings suggest that there is a relationship between Cd body burden and increased blood pressure in American Indians, a population with increased cardiovascular disease risk.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360 (9349): 1903–1913.

    Article  Google Scholar 

  2. Whittemore AS, DiCiccio Y, Provenzano G . Urinary cadmium and blood pressure: results from the NHANES II survey. Environ Health Perspect 1991; 91: 133–140.

    Article  CAS  Google Scholar 

  3. Jiang J, Liu M, Parvez F, Wang B, Wu F, Eunus M et al. Association between arsenic exposure from drinking water and longitudinal change in blood pressure among HEALS cohort participants. Environ Health Perspect 2015; 123 (8): 806–812.

    Article  CAS  Google Scholar 

  4. Telisman S, Jurasovic J, Pizent A, Cvitkovic P . Blood pressure in relation to biomarkers of lead, cadmium, copper, zinc, and selenium in men without occupational exposure to metals. Environ Res 2001; 87 (2): 57–68.

    Article  CAS  Google Scholar 

  5. Wolf MB, Baynes JW . Cadmium and mercury cause an oxidative stress-induced endothelial dysfunction. Biometals 2007; 20 (1): 73–81.

    Article  CAS  Google Scholar 

  6. Messner B, Knoflach M, Seubert A, Ritsch A, Pfaller K, Henderson B et al. Cadmium is a novel and independent risk factor for early atherosclerosis mechanisms and in vivo relevance. Arterioscler Thromb Vasc Biol 2009; 29 (9): 1392–1398.

    Article  CAS  Google Scholar 

  7. Varoni MV, Palomba D, Gianorso S, Anania V . Cadmium as an environmental factor of hypertension in animals: new perspectives on mechanisms. Vet Res Commun 2003; 27 (Suppl 1): 807–810.

    Article  Google Scholar 

  8. Schroeder HA, Vinton WH Jr . Hypertension induced in rats by small doses of cadmium. Am J Physiol 1962; 202: 515–518.

    Article  CAS  Google Scholar 

  9. Solenkova NV, Newman JD, Berger JS, Thurston G, Hochman JS, Lamas GA . Metal pollutants and cardiovascular disease: mechanisms and consequences of exposure. Am Heart J 2014; 168 (6): 812–822.

    Article  CAS  Google Scholar 

  10. Tellez-Plaza M, Guallar E, Howard BV, Umans JG, Francesconi KA, Goessler W et al. Cadmium exposure and incident cardiovascular disease. Epidemiology 2013; 24 (3): 421–429.

    Article  Google Scholar 

  11. Myong JP, Kim HR, Jang TW, Lee HE, Koo JW . Association between blood cadmium levels and 10-year coronary heart disease risk in the general Korean population: the Korean National Health and Nutrition Examination Survey 2008–2010. PLoS ONE 2014; 9 (11): e111909.

    Article  Google Scholar 

  12. Staessen JA, Kuznetsova T, Roels HA, Emelianov D, Fagard R . Exposure to cadmium and conventional and ambulatory blood pressures in a prospective population study. Public Health and Environmental Exposure to Cadmium Study Group. Am J Hypertens 2000; 13 (2): 146–156.

    Article  CAS  Google Scholar 

  13. Tellez-Plaza M, Navas-Acien A, Crainiceanu CM, Guallar E . Cadmium exposure and hypertension in the 1999–2004 National Health and Nutrition Examination Survey (NHANES). Environ Health Perspect 2008; 116 (1): 51–56.

    Article  CAS  Google Scholar 

  14. Eum KD, Lee MS, Paek D . Cadmium in blood and hypertension. Sci Total Environ 2008; 407 (1): 147–153.

    Article  CAS  Google Scholar 

  15. Vivoli G, Bergomi M, Borella P, Fantuzzi G, Caselgrandi E . Cadmium in blood, urine and hair related to human hypertension. J Trace Elem Electrolytes Health Dis 1989; 3 (3): 139–145.

    CAS  PubMed  Google Scholar 

  16. Kelishadi R, Askarieh A, Motlagh ME, Tajadini M, Heshmat R, Ardalan G et al. Association of blood cadmium level with cardiometabolic risk factors and liver enzymes in a nationally representative sample of adolescents: the CASPIAN-III Study. J Environ Public Health 2013; 2013: 142856.

    PubMed  PubMed Central  Google Scholar 

  17. Caciari T, Sancini A, Tomei F, Antetomaso L, Tomei G, Scala B et al. Cadmium blood/urine levels and blood pressure in workers occupationally exposed to urban stressor. Ann Ig 2012; 24 (5): 417–428.

    CAS  PubMed  Google Scholar 

  18. 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.

    Article  CAS  Google Scholar 

  19. 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.

    Article  CAS  Google Scholar 

  20. Primatesta P, Falaschetti E, Gupta S, Marmot MG, Poulter NR . Association between smoking and blood pressure: evidence from the health survey for England. Hypertension 2001; 37 (2): 187–193.

    Article  CAS  Google Scholar 

  21. Kim SJ, Lee J, Jee SH, Nam CM, Chun K, Park IS et al. Cardiovascular risk factors for incident hypertension in the prehypertensive population. Epidemiol Health 2010; 32: e2010003.

    Article  Google Scholar 

  22. Niskanen L, Laaksonen DE, Nyyssonen K, Punnonen K, Valkonen VP, Fuentes R et al. Inflammation, abdominal obesity, and smoking as predictors of hypertension. Hypertension 2004; 44 (6): 859–865.

    Article  CAS  Google Scholar 

  23. Halperin RO, Gaziano JM, Sesso HD . Smoking and the risk of incident hypertension in middle-aged and older men. Am J Hypertens 2008; 21 (2): 148–152.

    Article  Google Scholar 

  24. Bowman TS, Gaziano JM, Buring JE, Sesso HD . A prospective study of cigarette smoking and risk of incident hypertension in women. J Am Coll Cardiol 2007; 50 (21): 2085–2092.

    Article  CAS  Google Scholar 

  25. Welty TK, Lee ET, Yeh J, Cowan LD, Go O, Fabsitz RR et al. Cardiovascular disease risk factors among American Indians. The Strong Heart Study. Am J Epidemiol 1995; 142 (3): 269–287.

    Article  CAS  Google Scholar 

  26. Lee ET, Cowan LD, Welty TK, Sievers M, Howard WJ, Oopik A et al. All-cause mortality and cardiovascular disease mortality in three American Indian populations, aged 45–74 years, 1984–1988. The Strong Heart Study. Am J Epidemiol 1998; 147 (11): 995–1008.

    Article  CAS  Google Scholar 

  27. Tellez-Plaza M, Navas-Acien A, Caldwell KL, Menke A, Muntner P, Guallar E . Reduction in cadmium exposure in the United States population, 1988–2008: the contribution of declining smoking rates. Environ Health Perspect 2012; 120 (2): 204–209.

    Article  CAS  Google Scholar 

  28. Jarup L, Akesson A . Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol 2009; 238 (3): 201–208.

    Article  Google Scholar 

  29. Lee ET, Welty TK, Fabsitz R, Cowan LD, Le NA, Oopik AJ et al. The Strong Heart Study. A study of cardiovascular disease in American Indians: design and methods. Am J Epidemiol 1990; 132 (6): 1141–1155.

    Article  CAS  Google Scholar 

  30. Hayslett JA, Eichner JE, Yeh JL, Wang W, Henderson J, Devereux RB et al. Hypertension treatment patterns in American Indians: the Strong Heart Study. Am J Hypertens 2001; 14 (9, Part 1): 950–956.

    Article  CAS  Google Scholar 

  31. North KE, Williams JT, Welty TK, Best LG, Lee ET, Fabsitz RR et al. Evidence for joint action of genes on diabetes status and CVD risk factors in American Indians: the strong heart family study. Int J Obes Relat Metab Disord 2003; 27 (4): 491–497.

    Article  CAS  Google Scholar 

  32. Scheer J, Findenig S, Goessler W, Francesconi KA, Howard B, Umans JG et al. Arsenic species and selected metals in human urine: validation of HPLC/ICPMS and ICPMS procedures for a long-term population-based epidemiological study. Anal Methods 2012; 4 (2): 406–413.

    Article  CAS  Google Scholar 

  33. Tobin MD, Sheehan NA, Scurrah KJ, Burton PR . Adjusting for treatment effects in studies of quantitative traits: antihypertensive therapy and systolic blood pressure. Stat Med 2005; 24 (19): 2911–2935.

    Article  Google Scholar 

  34. Ehret GB, Munroe PB, Rice KM, Bochud M, Johnson AD, Chasman DI et al. Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk. Nature 2011; 478 (7367): 103–109.

    Article  CAS  Google Scholar 

  35. Levy D, Ehret GB, Rice K, Verwoert GC, Launer LJ, Dehghan A et al. Genome-wide association study of blood pressure and hypertension. Nat Genet 2009; 41 (6): 677–687.

    Article  CAS  Google Scholar 

  36. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289 (19):2560–2572.

    Article  CAS  Google Scholar 

  37. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150 (9): 604–612.

    Article  Google Scholar 

  38. Drukteinis JS, Roman MJ, Fabsitz RR, Lee ET, Best LG, Russell M et al. Cardiac and systemic hemodynamic characteristics of hypertension and prehypertension in adolescents and young adults: the Strong Heart Study. Circulation 2007; 115 (2): 221–227.

    Article  Google Scholar 

  39. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (5): 507–520.

    Article  CAS  Google Scholar 

  40. Prozialeck WC, Edwards JR . Mechanisms of cadmium-induced proximal tubule injury: new insights with implications for biomonitoring and therapeutic interventions. J Pharmacol Exp Ther 2012; 343 (1): 2–12.

    Article  CAS  Google Scholar 

  41. Farzan SF, Karagas MR, Jiang J, Wu F, Liu M, Newman JD et al. Gene-arsenic interaction in longitudinal changes of blood pressure: Findings from the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh. Toxicol Appl Pharmacol 2015; 288 (1): 95–105.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This research is supported by the NHLBI HL123677-02 (to NF) and the NIEHS training grant (ES007141-32) (to PB). MTP was supported by the Strategic Action for Research in Health sciences (CP12/03080), which is an initiative from Carlos III Health Institute Madrid and the Spanish Ministry of Economy and Competitiveness and are cofunded with European Funds for Regional Development (FEDER).

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA

    N Franceschini

  2. Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC, USA

    R C Fry

  3. Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    P Balakrishnan, A Navas-Acien & M Tellez-Plaza

  4. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

    C Oliver-Williams

  5. Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA

    A G Howard

  6. Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA

    S A Cole & K Haack

  7. Department of Genetics, University of North Carolina, Chapel Hill, NC, USA

    E M Lange

  8. Georgetown-Howard Universities Center for Clinical and Translational Science, Washington DC, USA

    B V Howard & J G Umans

  9. Medstar Health Research Institute, Hyattsville, MD, USA

    B V Howard & J G Umans

  10. Missouri Breaks Industries Research Inc., Timber Lake, SD, USA

    L G Best

  11. Institute of Chemistry-Analytical Chemistry, Graz University, Graz, Austria

    K A Francesconi & W Goessler

  12. Institute for Biomedical Research Hospital Clinic de Valencia INCLIVA, Valencia, Spain

    M Tellez-Plaza

Authors
  1. N Franceschini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R C Fry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P Balakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Navas-Acien
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C Oliver-Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A G Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S A Cole
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K Haack
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E M Lange
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. B V Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. L G Best
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. K A Francesconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. W Goessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. J G Umans
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. M Tellez-Plaza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N Franceschini.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on the Journal of Human Hypertension website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Franceschini, N., Fry, R., Balakrishnan, P. et al. Cadmium body burden and increased blood pressure in middle-aged American Indians: the Strong Heart Study. J Hum Hypertens 31, 225–230 (2017). https://doi.org/10.1038/jhh.2016.67

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2016.67

This article is cited by

Search

Advanced search

Quick links