Abstract
The aim of this paper is to investigate the associations of lead and cadmium exposure with all-cause and cardiovascular disease (CVD) mortality among adults with type 2 diabetes (T2D). The prospective cohort study included participants with T2D (n = 7420 for blood lead; n = 5113 for blood cadmium) from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999–2014. Death outcomes were ascertained through linkage with the National Death Index records. The geometric mean (interquartile range) concentrations of blood lead and cadmium were 19.6 (11.8, 35.0) μg/L and 0.39 (0.21, 0.60) μg/L, respectively. During 72,279 and 37,017 person-years of followup, 2818 all-cause deaths (including 832 CVD deaths) for blood lead and 1237 all-cause deaths (including 319 CVD deaths) for blood cadmium were documented, respectively. Comparing extreme quartiles, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality were 1.51 (1.25, 1.82) for blood lead (Ptrend < 0.001) and 1.58 (1.22, 2.03) for blood cadmium (Ptrend < 0.001); and the HRs (95% CIs) of CVD mortality were 2.27 (1.54, 3.34) for blood lead (Ptrend < 0.001) and 1.78 (1.04, 3.03) for blood cadmium (Ptrend = 0.07). In the joint analysis, compared with participants in the lowest tertiles of blood lead and cadmium, participants in the highest tertiles had a HR (95% CI) of 2.09 (1.35, 3.24) for all-cause mortality. Exposure to lead and cadmium alone or in combination was significantly associated with higher risk of mortality among patients with T2D. These findings imply that minimizing exposure to lead and cadmium may aid in the prevention of premature death among individuals with diabetes.
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The National Health and Nutrition Examination Survey (NHANES) is an open-access resources, and data are available at https://www.cdc.gov/nchs/nhanes.
Abbreviations
- BMI:
-
Body mass index
- eGFR:
-
Estimate glomerular filtration rate
- ICP-DRC-MS:
-
Inductively coupled plasma dynamic reaction cell mass spectrometry
- ICP-MS:
-
Inductively coupled plasma mass spectrometry
- NCHS:
-
National Center for Health Statistics
- NHANES:
-
National Health and Nutrition Examination Survey
- T2D:
-
Type 2 diabetes
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Acknowledgements
We are grateful to all the participants and all the people involved in the NHANES study.
Funding
Gang Liu was funded by grants from the National Nature Science Foundation of China (82073554), the Hubei Province Science Fund for Distinguished Young Scholars (2021CFA048), and the Fundamental Research Funds for the Central Universities (2021GCRC076). An Pan was supported by grants from the National Nature Science Foundation of China (81930124 and 82021005) and the Fundamental Research Funds for the Central Universities (2021GCRC075).
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GL designed the research; KZ performed the analysis and wrote the manuscript; YZ wrote the manuscript; QL investigated the research; TG reviewed and edited the manuscript; RL reviewed the manuscript; ZW investigated the research; XZ conducted the analysis; YL conducted the analysis; LL validated the data; ZQ validated the data; MH reviewed and edited manuscript; LL reviewed manuscript; and AP reviewed and edited manuscript. All authors provided critical revisions of the draft and approved the submitted draft. The corresponding author affirms that all authors meet authorship criteria. GL has primary responsibility for final content.
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Kai Zhu and Yuge Zhang contributed equally as co-first authors.
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Zhu, K., Zhang, Y., Lu, Q. et al. Associations of exposure to lead and cadmium with risk of all-cause and cardiovascular disease mortality among patients with type 2 diabetes. Environ Sci Pollut Res 29, 76805–76815 (2022). https://doi.org/10.1007/s11356-022-21273-z
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DOI: https://doi.org/10.1007/s11356-022-21273-z