| Metals in Urine and Peripheral Arterial Disease Ana Navas-Acien,1,2,3 Ellen K. Silbergeld,4 A. Richey Sharrett,1 Emma Calderon-Aranda,4,5 Elizabeth Selvin,1,2 and Eliseo Guallar1,2,3 1Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; 2Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; 3Johns Hopkins Center for Excellence in Environmental Public Health Tracking, Baltimore, Maryland, USA; 4Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; 5Sección de Toxicología, Cinvestav, México Abstract
Exposure to metals may promote atherosclerosis. Blood cadmium and lead were associated with peripheral arterial disease (PAD) in the 1999-2000 National Health and Nutrition Examination Survey (NHANES) . In the present study we evaluated the association between urinary levels of cadmium, lead, barium, cobalt, cesium, molybdenum, antimony, thallium, and tungsten with PAD in a cross-sectional analysis of 790 participants  40 years of age in NHANES 1999-2000. PAD was defined as a blood pressure ankle brachial index < 0.9 in at least one leg. Metals were measured in casual (spot) urine specimens by inductively coupled plasma-mass spectrometry. After multivariable adjustment, subjects with PAD had 36% higher levels of cadmium in urine and 49% higher levels of tungsten compared with noncases. The adjusted odds ratio for PAD comparing the 75th to the 25th percentile of the cadmium distribution was 3.05 [95% confidence interval (CI) , 0.97 to 9.58] ; that for tungsten was 2.25 (95% CI, 0.97 to 5.24) . PAD risk increased sharply at low levels of antimony and remained elevated beyond 0.1 µg/L. PAD was not associated with other metals. In conclusion, urinary cadmium, tungsten, and possibly antimony were associated with PAD in a representative sample of the U.S. population. For cadmium, these results strengthen previous findings using blood cadmium as a biomarker, and they support its role in atherosclerosis. For tungsten and antimony, these results need to be interpreted cautiously in the context of an exploratory analysis but deserve further study. Other metals in urine were not associated with PAD at the levels found in the general population. Key words: antimony, atherosclerosis, cadmium, lead, metals, peripheral arterial disease, tungsten. Environ Health Perspect 113:164-169 (2005) . doi:10.1289/ehp.7329 available via http://dx.doi.org/ [Online 22 November 2004]
Address correspondence to E. Guallar, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, 2024 East Monument St., Room 2-639, Baltimore, MD 21205-2223 USA. Telephone: (410) 614-0574. Fax: (410) 955-0476. E-mail: eguallar@jhsph.edu E.G. was supported in part by an American Heart Association Scientist Development Award (0230232N) . A.N.-A. and E.G. were supported by the Johns Hopkins Center of Excellence in Environmental Public Health Tracking. E.S. was supported by National Heart, Lung, and Blood Institute grant T32 HL07024. E.K.S. and E.C.-A. were supported in part by National Institute of Environmental Health Sciences grant 1 R21 ES11717. Received 14 June 2004 ; accepted 22 November 2004.
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