Environmental cadmium exposure and noncancer mortality in a general Japanese population in cadmium nonpolluted regions.

The objective of this study was to assess the effect of environmental cadmium exposure according to urinary cadmium concentration (U-Cd) on noncancer mortality in a general Japanese population. We conducted a longitudinal study for 19 years in 2804 inhabitants (1107 men and 1697 women) in some cadmium nonpolluted regions in Japan. The participants were classified into quartiles based on U-Cd (µg/g cre) adjusted for urinary creatinine. Hazard ratio (HR) and 95% confidence interval (95% CI) for continuous U-Cd or the quartiles of U-Cd were calculated for noncancer mortality. By applying a Fine and Gray competing risk model, continuous U-Cd (+1 µg/g cre) showed significant HR for cardiocerebrovascular diseases (HR 1.05, 95% CI: 1.00-1.11), cerebrovascular diseases (HR 1.08, 95% CI: 1.01-1.16), and cerebral infarction (HR 1.11, 95% CI: 1.04-1.20) in men. However, notable significant HR for continuous and quartered U-Cd were not observed in women. In this study, U-Cd was associated with increased cardiocerebrovascular mortality in a general Japanese population, suggesting that environmental cadmium exposure is detrimental to the life prognosis in cadmium nonpolluted regions in Japan.

Itai-itai disease: Lessons from the investigations of environmental epidemiology conducted in the 1970's, with special reference to the studies of the Toyama Institute of Health.

The outbreak of itai-itai disease, which is the most severe stage of chronic cadmium poisoning, has occurred in the cadmium-polluted Jinzu River basin in Toyama. In this area, the river was contaminated by slags from a mine upstream; consequently, the soil in rice paddies became polluted with heavy metals including cadmium through irrigation water streams from around 1910 to the 1960s. The inhabitants of the Jinzu River basin used the river water for drinking and cooking until around 1960. In this paper, we review the geographical features of the Jinzu River basin and the endemic area of itai-itai disease, and reevaluated the studies conducted in 1970's by the Toyama Institute of Health, because these studies have revealed a clear relationship between renal dysfunction or occurrence of itai-itai disease and exposure to cadmium through irrigation water streams.

Threshold limit values of the cadmium concentration in rice in the development of itai-itai disease using benchmark dose analysis.

The aim of this study was to estimate the benchmark dose (BMD) as the threshold limit level of the cadmium (Cd) concentration in rice for itai-itai disease and/or suspected disease; it was based on the data that previously evaluated the association for such diseases with the Cd concentration in rice by using a logistic regression model. From 1971 to 1976, a total of 2446 rice samples were analyzed across the 88 hamlets in the Jinzu river basin. The mean Cd concentration in rice in each hamlet was used as the index of external Cd exposure of the entire population of the hamlet. We employed the incidence of itai-itai disease and/or suspected disease obtained from the available 55 hamlets. As the threshold, the lower limit of the BMD (BMDL) of the Cd concentration in rice for itai-itai disease and/or suspected disease was estimated using a logistic model, setting the benchmark response at 1% or 2%. The estimated BMDLs of the Cd concentration in rice for itai-itai disease and/or suspected disease were 0.62-0.76 and 0.27-0.56 mg kg-1 in men and women, respectively. The lowest BMDL was 0.27 mg kg-1 in women. In the present study, the threshold limit level of the Cd concentration in rice for itai-itai disease, which is the most severe form of chronic Cd poisoning, was estimated for the first time. This result provides important information about the worldwide standard for the Cd concentration in rice. Copyright © 2017 John Wiley & Sons, Ltd.

Epigenetics, obesity and early-life cadmium or lead exposure.

Obesity is a complex and multifactorial disease, which likely comprises multiple subtypes. Emerging data have linked chemical exposures to obesity. As organismal response to environmental exposures includes altered gene expression, identifying the regulatory epigenetic changes involved would be key to understanding the path from exposure to phenotype and provide new tools for exposure detection and risk assessment. In this report, we summarize published data linking early-life exposure to the heavy metals, cadmium and lead, to obesity. We also discuss potential mechanisms, as well as the need for complete coverage in epigenetic screening to fully identify alterations. The keys to understanding how metal exposure contributes to obesity are improved assessment of exposure and comprehensive establishment of epigenetic profiles that may serve as markers for exposures.

Risk of ingesting As, Cd, and Pb in animal products in north Rio de Janeiro state, Brazil.

This study evaluated the levels of As, Cd, and Pb in muscle and liver the cattle and chicken. The risk was estimated for the adult population of a midsized city in southeast Brazil, concerning the tolerable ingestion and cancer risk. Samples of muscle and liver (cattle and chicken) were collected (n = 250). Samples of mineral supplements for cattle (n = 4) and chicken feed samples (n = 4) were evaluated as one of many potential source of contamination. Muscle, liver, mineral supplement, and feed samples were dissolved in acid medium and analyzed by ICP-OES. Daily muscle and liver intake was estimated using a questionnaire (N = 427). Daily intake of trace elements by the population based on the consumption of cattle muscle, cattle liver, chicken muscle, and chicken liver was low, corresponding to 2.76%, 0.33%, 2.12%, and 0.22% of the Tolerable Intake defined by the WHO for As; 0.54%, 0.29% 0.55%, 0.01%, for Cd; and 0.80%, 0.07%, 0.62%, 0.02%, for Pb. The mean of total ingestion of As, Cd and Pb was 5.43%, 1.18% and 1.51%, respectively of Tolerable Intake defined by WHO. Cancer risk was lower than 5 × 10-5 year-1. The results indicate that the muscle and liver consumption is a source of As, Cd, and Pb. Consumers that ingest cattle and chicken muscle need attention in terms the risk of cancer related to intake of As and Cd. Feed and mineral supplementation remain as one of many sources of exposure of As, Cd, and Pb.

Cadmium exposure and incidence of heart failure and atrial fibrillation: a population-based prospective cohort study.

OBJECTIVES: Cadmium is a non-essential toxic metal with multiple adverse health effects. Cadmium has been shown to be associated with cardiovascular diseases, but few studies have investigated heart failure (HF) and none of them reported atrial fibrillation (AF). We examined whether cadmium exposure is associated with incidence of HF or AF. DESIGN: A prospective, observational cohort study with a 17-year follow-up. SETTING: The city of Malmö, Sweden. PARTICIPANTS: Blood cadmium levels were measured in 4378 participants without a history of HF or AF (aged 46-67 years, 60% women), who participated in the Malmö Diet and Cancer (MDC) study during 1992-1994. PRIMARY AND SECONDARY OUTCOME MEASURES: Incidence of HF and AF were identified from the Swedish hospital discharge register. RESULTS: 143 participants (53% men) were diagnosed with new-onset HF and 385 individuals (52% men) were diagnosed with new-onset AF during follow-up for 17 years. Blood cadmium in the sex-specific 4th quartile of the distribution was significantly associated with incidence of HF. The (HR, 4th vs 1st quartile) was 2.64 (95% CI 1.60 to 4.36), adjusted for age, and 1.95 (1.02 to 3.71) after adjustment also for conventional risk factors and biomarkers. The blood cadmium level was not significantly associated with risk of incident AF. CONCLUSIONS: Blood cadmium levels in the 4th quartile were associated with increased incidence of HF in this cohort with comparatively low exposure to cadmium. Incidence of AF was not associated with cadmium.

Environmentally Realistic Doses of Cadmium as a Possible Etiologic Agent for Idiopathic Pathologies.

Cadmium is a heavy metal of increasing environmental concern that has long been associated to several human pathological processes. Recent population surveys have correlated cadmium non-occupational exposure to widespread idiopathic pathologies. Food and tobacco are reported to be the main exposure sources of cadmium to the general population, as phosphate fertilizers are rich in such a metal, thus contaminating the crops. Although its mechanisms of toxicity are not a consensus in the literature, it is well established that reactive oxygen species play a key role in this process, leading to the oxidation of several biological molecules. We have therefore assessed whether three environmentally realistic doses of cadmium alter the oxidative status of Wistar rat testis and eventually result in histological damages. Our results show that even the lowest environmental dose of cadmium was able to disturb the endogenous antioxidant system in Wistar testis, although an increase in lipid peroxidation was observed only within the group exposed to the highest environmental dose. Despite that no remarkable morphological changes were observed in any group, significant alterations in blood vessel lumen were reported for some cadmium-exposed animals, suggesting that endothelium is one of the primary targets involved in cadmium toxicity.

Dietary cadmium intake and risk of breast, endometrial and ovarian cancer in Danish postmenopausal women: a prospective cohort study.

PURPOSE: Cadmium is a human lung carcinogen and possesses estrogen-like activity. This combination of carcinogenic and estrogenic activity makes cadmium a contaminant of high concern for hormone-related cancers. Diet and smoking are the main sources of cadmium exposure. The aim of this study was to investigate the association between dietary cadmium intake and risk of breast, endometrial and ovarian cancer in Danish postmenopausal woman. METHODS: We estimated dietary cadmium intake in the Diet, Cancer and Health cohort at enrolment 1993-97. The estimates were based on food frequency questionnaires and cadmium contents in all foods. Among 23,815 postmenopausal women we identified 1390 breast, 192 endometrial, and 146 ovarian cancer cases from enrolment through December 31, 2010 using the Danish Cancer Registry. Cox regression was used to analyse the association between dietary cadmium intake and cancer risk. RESULTS: Mean dietary cadmium intake was 14 µg/day. Cadmium was not associated with breast cancer, incidence rate ratio (IRR) = 0.99, 95% confidence interval (CI): 0.87-1.13 per 10 µg higher dietary cadmium intake/day; endometrial cancer, IRR = 1.08, 95% CI: 0.76-1.53; or ovarian cancer, IRR = 1.15, 95% CI: 0.78-1.70. We found a positive association between cadmium and endometrial cancer for the women with BMI<25 (IRR = 1.50, 95% CI: 0.94-2.39), whereas an inverse association was seen for the women with BMI≥25 (IRR = 0.69, 95% CI: 0.42-1.12); p value for interaction = 0.02. CONCLUSIONS: Our study does not indicate that our estimated dietary cadmium intake is associated with hormone-related cancers in women.

Tissue distribution of metals in white-fronted geese and spot-billed ducks from Korea.

This study presents concentrations of Fe, Zn, Mn, Cu, Pb and Cd in livers, kidneys, muscles and bones of white-fronted geese Anser albifrons (geese) and spot-billed ducks Anas poecilorhyncha (ducks). Iron in livers, kidneys and muscles, Zn in muscles, Mn and Cd in every tissue, Cu in livers, muscles and bones and Pb in bones differed between species, and there were significant differences among tissues in both species. Essential elements such as Fe, Zn, Mn and Cu concentrations were within the background levels. Lead concentrations in livers of 7 of 14 geese and 7 of 19 ducks and in bones of 4 of 19 ducks exceeded background concentrations for waterfowl (5 µg/g dw for the liver, 10 µg/g dw for the bone). Almost all samples of both species had the background Cd concentrations in the liver (33 of 33 geese and ducks) and kidney (14 geese and 18 ducks). Tissue concentrations of Cd were greater in geese than ducks. In contrast, tissue concentrations of Pb in bones were greater in ducks than in geese. These different trends for Cd and Pb reflect a short and/or long term difference in exposure and degree of accumulation of these metals.

Cadmium exposure induces hematuria in Korean adults.

INTRODUCTION: Toxic heavy metals have adverse effects on human health. However, the risk of hematuria caused by heavy metal exposure has not been evaluated. METHODS: Data from 4701 Korean adults were obtained in the Korean National Health and Nutritional Examination Survey (2008-2010). Blood levels of the toxic heavy metals cadmium, lead, and mercury were measured. Hematuria was defined as a result of ≥+1 on a urine dipstick test. The odds ratios (ORs) for hematuria were measured according to the blood heavy metal levels after adjusting for multiple variables. RESULTS: Individuals with blood cadmium levels in the 3rd and 4th quartiles had a greater OR for hematuria than those in the 1st quartile group: 3rd quartile, 1.35 (1.019-1.777; P=0.037); 4th quartile, 1.52 (1.140-2.017; P=0.004). When blood cadmium was considered as a log-transformed continuous variable, the correlation between blood cadmium and hematuria was significant: OR, 1.97 (1.224-3.160; Ptrend=0.005). In contrast, no significant correlations between hematuria and blood lead or mercury were found in the multivariate analyses. DISCUSSION: The present study shows that high cadmium exposure is associated with a risk of hematuria.

[Itai-itai disease: cadmium-induced renal tubular osteomalacia].

Cadmium (Cd) is one of the most toxic elements to which humans could be exposed at work or in the environment. The outbreak of itai-itai disease, which is the most severe stage of chronic Cd poisoning, occurred in the Cd-polluted Jinzu River basin in Toyama. In this area, the river was contaminated by slag from a mine upstream; as a consequence, the soil in rice paddies was polluted with heavy metals including Cd through irrigation water from around 1910 to the 1960s. The government of Toyama prefecture carried out an extensive survey on Cd concentration in rice and soil of the paddy fields and declared that the upper layer of a total of 1500 ha of paddy fields should be replaced by nonpolluted soil. Then, an intervention program of soil replacement in the polluted paddy fields was continually carried out from 1980 to 2011. As a result, Cd concentration in rice markedly decreased. The kidney is the organ critically affected after long-term exposure to Cd. Proximal tubular dysfunction (RTD) has been found among the inhabitants of the Jinzu River basin. The very recent report by the Environmental Agency in Japan in 2009 has disclosed that b2-microglobulinuria with RTD is still found at a high prevalence among the inhabitants of the Jinzu River basin of both sexes. Twenty patients with itai-itai disease (1 male and 19 females), who attended our hospital and received medical examination during 2000 to 2008, had applied for recognition as itai-itai disease patients to the government of Toyama prefecture. In this paper, the recent epidemiological and clinical features of itai-itai disease are discussed on the basis of a review of the cases of these 19 female patients.

Potential for effects of land contamination on human health. 1.The case of cadmium.

A review of the epidemiological literature on the potential effects of land contamination shows that the largest body of contaminant-specific research relates to cadmium (Cd). First, a brief outline of the key issues related to the study of health impact of land contamination is presented. The recent literature is then reviewed for evidence of associations and possible causal relationships between exposure to Cd from land contamination and health impact. A large number of studies focusing on Cd arise because of the ready availability of biomarkers of exposure and effect and the demonstrated link between soil Cd and itai-itai disease (severe renal and bone disorders) via dietary exposure in Japan and China. Where dietary differences yield lower exposures, links have been established between Cd in soil and biomarkers of renal or bone dysfunctions, but not to health impacts per se. Potential effects of Cd exposure were also investigated for other health outcomes, including hypertension, cancer incidence, preterm delivery, and semen parameters. In contrast to renal and bone disorders, results are generally inconsistent and require further lines of evidence. Residence in locations with elevated concentrations of Cd in soil is a poor surrogate for exposure, and there are examples where residents in locations with elevated concentrations of Cd in soil did not appear to suffer serious health consequences.

Dietary cadmium exposure and prostate cancer incidence: a population-based prospective cohort study.

BACKGROUND: Experimental data convincingly propose the toxic metal cadmium as a prostate carcinogen. Cadmium is widely dispersed into the environment and, consequently, food is contaminated. METHODS: A population-based cohort of 41 089 Swedish men aged 45-79 years was followed prospectively from 1998 through 2009 to assess the association between food frequency questionnaire-based estimates of dietary cadmium exposure (at baseline, 1998) and incidence of prostate cancer (3085 cases, of which 894 were localised and 794 advanced) and through 2008 for prostate cancer mortality (326 fatal cases). RESULTS: Mean dietary cadmium exposure was 19 µg per day±s.d. 3.7. Multivariable-adjusted dietary cadmium exposure was positively associated with overall prostate cancer, comparing extreme tertiles; rate ratio (RR) 1.13 (95% confidence interval (CI): 1.03-1.24). For subtypes of prostate cancer, the RR was 1.29 (95% CI: 1.08-1.53) for localised, 1.05 (95% CI: 0.87-1.25) for advanced, and 1.14 (95% CI: 0.86-1.51) for fatal cases. No statistically significant difference was observed in the multivariable-adjusted risk estimates between tumour subtypes (P(heterogeneity)=0.27). For localised prostate cancer, RR was 1.55 (1.16-2.08) among men with a small waist circumference and RR 1.45 (1.15, 1.83) among ever smokers. CONCLUSION: Our findings provide support that dietary cadmium exposure may have a role in prostate cancer development.

Dietary cadmium and risk of invasive postmenopausal breast cancer in the VITAL cohort.

PURPOSE: The aim of the study was to estimate the association between dietary intake of cadmium, a carcinogenic heavy metal, and risk of invasive postmenopausal breast cancer. METHODS: Study subjects were 30,543 postmenopausal women in the VITamins And Lifestyle (VITAL) cohort who completed a food frequency questionnaire (FFQ) at baseline (2000-2002). Dietary cadmium consumption was estimated by combining FFQ responses with US Food and Drug Administration data on food cadmium content. Incidence of invasive breast cancer was ascertained through linkage of the cohort to the western Washington Surveillance, Epidemiology, and End Results cancer registry through 31 December 2009. Cox regression was applied to estimate adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs) for breast cancer with increasing dietary cadmium intake, adjusted for total energy intake, smoking history, consumption of vegetables, potatoes, and whole grains, multivitamin use, education, race, body mass index, physical activity, age at first birth, postmenopausal hormone use, and mammography. RESULTS: Vegetables and grains together contributed an average of 66 % of estimated dietary cadmium. During a mean of 7.5 years of follow-up, 1,026 invasive postmenopausal breast cancers were identified. Among 899 cases with complete covariate information, no evidence of an association between dietary cadmium intake and breast cancer risk was observed (aHR (95 % CI), highest to lowest quartile cadmium: 1.00 (0.72-1.41), p (trend) = 0.95). No evidence was found for interactions between dietary cadmium and breast cancer risk factors, smoking habits, or total intake of calcium, iron, or zinc from diet, supplements, and multivitamins. CONCLUSIONS: This study does not support the hypothesis that dietary cadmium intake is a risk factor for breast cancer. However, non-differential measurement error in the estimate of cadmium intake is likely the most important factor that could have obscured an association.

Assessing dietary exposure to cadmium in a metal recycling community in Vietnam: age and gender aspects.

This study estimates the dietary exposure to cadmium (Cd), and associated potential health risks, for individuals living and working in a metal recycling community (n=132) in Vietnam in comparison to an agricultural (reference) community (n=130). Individual-level exposure to Cd was estimated through analysis of staple foodstuffs combined with information from a food frequency questionnaire. Individual-level exposure estimates were compared with published 'safe' doses to derive a Hazard Quotient (HQ) for each member of the study population. Looking at the populations as a whole, there were no significant differences in the diets of the two villages. However, significantly more rice was consumed by working age adults (18-60 years) in the recycling village compared to the reference village (p<0.001). Rice was the main staple food with individuals consuming 461±162g/d, followed by water spinach (103±51kg/d). Concentrations of Cd in the studied foodstuffs were elevated in the metal recycling village. Values of HQ exceeded unity for 87% of adult participants of the metal recycling community (39% had a HQ>3), while 20% of adult participants from the reference village had an HQ>1. We found an elevated health risk from dietary exposure to Cd in the metal recycling village compared to the reference community. WHO standard of 0.4mg Cd/kg rice may not be protective where people consume large amounts of rice/have relatively low body weight.

[Comparative characteristics of lead and cadmium intoxication in the Khanty-Mansi autonomous district].

The Khanty-Mansi Autonomous District (KMAD) occupies a prominent place in the economy of Russia in oil and gas production and energy generation. The development of hydrocarbon raw material extraction in the district does great damage to the environment and nature. This results in the accumulation of toxic chemical elements in man. The levels of lead, cadmium, calcium, and zinc were measured in the hair of indigenous and non-indigenous populations of the district. High lead and cadmium and low calcium and zinc concentration were found in indigenous adults and children in the KMAD.

Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause?

BACKGROUND: The rising prevalence of chronic kidney disease (CKD) and subsequent end stage renal failure necessitating renal replacement therapy has profound consequences for affected individuals and health care resources. This community based study was conducted to identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka, where the burden of CKD is pronounced and the underlying cause still unknown. METHODS: Exposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the Micral strip test. RESULTS: Microalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria. CONCLUSIONS: Hypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated.

[The effect of lead and cadmium on the lipid profile and psychosocial functioning of children with developmental disorders]. / Wplyw olowiu i kadmu na profil lipidowy i funkcjonowanie psychospoleczne u dzieci z zaburzeniami rozwoju.

INTRODUCTION: Impulsiveness, hyperactivity, and attention deficit are the most frequent neurocognitive disorders of childhood. Leaving aside the putative role of environmental and nutritive factors, the etiology and pathogenesis of these disorders remains unknown. The aim of this study was to examine the relationship between the concentration of lead, cadmium, and polyunsaturated fatty acids, and functioning of the child with developmental disorders. MATERIAL AND METHODS: The study enrolled 78 children with behavioral disorders. The mean age of the children was eight years. Standardized tools were used: Manfred Cierpka Family Assessment Measures, Children's Health Questionnaire Parent Form-28, and ADHD-Rating Scale-IV. Concentrations of lead and cadmium in venous blood, lipid profile, and the percentage of some omega-3 and omega-6 fatty acids in the erythrocyte membrane were measured. RESULTS: A correlation between higher levels of lead in blood of the child and impulsive and hyperactive behaviors at home was observed. Concentrations of cadmium correlated with increased incidence of attention deficit at school. Analysis of the health profile revealed that lead and cadmium correlate with some of the elements that make up the image of a properly functioning child. Reduced levels of AA and EPA positively correlated with the incidence of hyperactive and impulsive behaviors. Reduced levels of GLA impaired the acceptance of norms and values. Levels of EPA and DHA had an impact on the overall state of health of the child, as well as on physical activity and feeling of loneliness. CONCLUSIONS: 1. Developmental disorders at school and difficulties in functioning at home may be the consequence of dysfunctions caused by lead and cadmium. 2. Deficiencies of AA, GLA, DHA, and EPA fatty acids or a disorder of their metabolism affect the behavior of the child in the form of hyperactivity, impulsiveness, and attention deficit.

The relationship between the bone mineral density and urinary cadmium concentration of residents in an industrial complex.

BACKGROUND: An association between cadmium exposure and bone mineral density (BMD) has been demonstrated in elderly women, but has not been well studied in youths and men. Some studies report either no or a weak association between cadmium exposure and bone damage. OBJECTIVES: This study was designed to investigate the relationship between the urinary cadmium (U-Cd) levels and BMD of females and males of all ages. METHODS: A total of 804 residents near an industrial complex were surveyed in 2007. U-Cd and BMD on the heel (non-dominant calcaneus) were analyzed with AAS-GTA and Dual-Energy X-ray absorptiometry, respectively. Demographic characteristics were collected by structured questionnaires. Osteoporosis and osteopenia were defined by BMD cut-off values and T-scores set by the WHO; T score>-1, normal; -2.5

Cadmium exposure and cardiovascular disease in the 2005 Korea National Health and Nutrition Examination Survey.

BACKGROUND: Limited epidemiologic data are available concerning the cardiovascular effects of cadmium exposure, although recent studies suggest associations with myocardial infarction and peripheral arterial disease. We examined the associations of cadmium exposure with cardiovascular disease in nationally representative general Korean adults. METHODS: We used cross-sectional data on blood cadmium and self-reported diagnoses of ischemic heart disease (IHD), stroke, and hypertension in a sub-sample of 1908 adults, aged 20 years and older, who participated in the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). We used survey logistic regression models accounting for the complex sampling design to estimate the odds ratios (OR), adjusting for age, education, income, alcohol, smoking, body mass index, waist circumference, family history of hypertension, blood pressure, and blood lead. RESULTS: The geometric mean of blood cadmium was 1.53 µg/L. After adjusting for potential confounders, an interquartile range (IQR) increase in blood cadmium (0.91 µg/L) was found to be associated with an increased risk for IHD (OR 2.1, 95% confidence interval (CI) 1.3-3.4). An IQR increase in blood cadmium was found to be associated with an elevated risk for hypertension only among men (OR 1.4, 95% CI 1.1-1.8) but not among women. No association was observed with stroke in both genders. CONCLUSIONS: These findings suggest that cadmium in blood may be associated with an increased risk for IHD and hypertension in the general Korean adult population.