Introduction/Background: Cadmium (Cd) is a toxic environmental metal with vascular effects. While Cd exposure is linked to cardiovascular disease (CVD), data from large-scale, population-based cohorts are limited. Urinary cadmium (U-Cd) reflects long-term exposure and may offer prognostic utility. Research Hypothesis: We hypothesized that U-Cd levels are independently associated with cardiovascular and mortality risks, regardless of hypertension status. Methods/Approach: In this retrospective cohort of 10,713 adults (2013–2020), U-Cd (μg/g creatinine) was measured and categorized into quartiles. Individuals with prior CVD or cancer were excluded. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE). Cox regression adjusted for cardiovascular risk factors including hypertension; subgroup analyses examined effect modification by hypertension. Results/Data: Median U-Cd was 1.00 μg/g creatinine. The highest quartile was associated with increased risk of MACCE (HR 1.88, 95% CI: 1.20–2.95), stroke (HR 2.22, 95% CI: 1.07–4.61), cardiovascular mortality (HR 2.56, 95% CI: 1.17–5.60), and all-cause mortality (HR 1.67, 95% CI: 1.22–2.29). In subgroup analysis, U-Cd was consistently associated with MACCE in both hypertensive (HR 1.26 per quartile, 95% CI: 1.01–1.57) and non-hypertensive individuals (HR 1.29, 95% CI: 1.01–1.65), with no significant interaction (P-interaction > 0.05). Risk increased linearly up to ~1.3 μg/g. Conclusion(s): Urinary cadmium predicted cardiovascular events and mortality, independent of hypertension. These findings highlight Cd as an environmental biomarker with relevance for risk stratification, particularly in populations with high hypertension burden.
Chu et al. (Mon,) studied this question.