Cadmium exposure and hypertension: a systematic review and a dose-response meta-analysis

Abstract

Abstract Background Since the shape of the relation between Cd exposure and risk of HTN has not been previously investigated, we aimed to perform a systematic review with dose-response meta-analysis in epidemiological studies. Methods After registration of the review in PROSPERO database (ID: CRD42022382030), we searched for eligible articles in online databases using Mesh-terms/keywords related to Cd, HTN, and BP. Eligible criteria were: adult population, assessment of exposure through Cd concentrations in blood or urine, risk estimates for HTN, observational design. Whenever possible, we computed summary odds ratio (OR) with 95% confidence interval (CI) and performed a dose-response meta-analysis on overall studies and subgroups. Results We eventually included 8 articles for both the qualitative and quantitative analysis published between 2006-2023 almost of cross-sectional design, 7 and 4 assessing blood and urine Cd concentrations, respectively. Comparing the highest versus lowest exposure, we found increased risk of HTN for both blood (OR = 1.12, 95% CI 0.92-1.36) and urine assessment (OR = 1.09, 95% CI 0.94-1.28). Dose-response meta-analysis showed an almost linear increased risk for blood Cd concentrations until 1.5 µg/L above with it plateaued. In contrast when using urine concentrations for exposure assessment, risk started to increase above 0.5 µg/g creatinine. Conclusions Our results confirm the recent findings of non-linear relation between Cd exposure and risk of both CVD and diabetes and the subsequent need to lower Cd exposure on a public health perspective. Key messages • Cadmium exposure showed positive association with risk of hypertension. • Public health efforts should be implemented to lowed cadmium exposure to decrease CVD risk.