Cadmium Exposure and Clinical Cardiovascular Disease: A Systematic Review

  • Maria Tellez-PlazaEmail author
  • Miranda R. Jones
  • Alejandro Dominguez-Lucas
  • Eliseo Guallar
  • Ana Navas-Acien
Nutrition (BV Howard, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nutrition


Mounting evidence supports that cadmium, a toxic metal found in tobacco, air and food, is a cardiovascular risk factor. Our objective was to conduct a systematic review of epidemiologic studies evaluating the association between cadmium exposure and cardiovascular disease. Twelve studies were identified. Overall, the pooled relative risks (95 % confidence interval) for cardiovascular disease, coronary heart disease, stroke, and peripheral arterial disease were: 1.36 (95 % CI: 1.11, 1.66), 1.30 (95 % CI: 1.12, 1.52), 1.18 (95 % CI: 0.86, 1.59), and 1.49 (95 % CI: 1.15, 1.92), respectively. The pooled relative risks for cardiovascular disease in men, women and never smokers were 1.29 (1.12, 1.48), 1.20 (0.92, 1.56) and 1.27 (0.97, 1.67), respectively. Together with experimental evidence, our review supports the association between cadmium exposure and cardiovascular disease, especially for coronary heart disease. The number of studies with stroke, heart failure (HF) and peripheral arterial disease (PAD) endpoints was small. More studies, especially studies evaluating incident endpoints, are needed.


Cadmium Cardiovascular disease Meta-analysis Systematic review 



Confidence interval


Coronary heart disease


Cardiovascular disease


Peripheral arterial disease


Heart failure



This research is supported by grants from the US National Heart Lung and Blood Institute (R01HL090863) and the US National Institute of Environmental Health Sciences (R01ES021367). M.T.-P. and A.D.L. were supported by a Miguel Servet grant from the Funds for Research in Health Sciences, Ministry of Economy and Competitiveness, Spain (CP12/03080). M.R.J. was also supported by the Cardiovascular Epidemiology Institutional Training from the National Heart, Lung and Blood Institute (T32HL007024).

Conflict of Interest

Maria Tellez-Plaza, Miranda R Jones, Alejandro Dominguez-Lucas, Eliseo Guallarm and Ana Navas-Acien declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

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ESM 1 (PDF 95 kb)
11883_2013_356_MOESM2_ESM.pdf (66 kb)
ESM 2 (PDF 66 kb)


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Maria Tellez-Plaza
    • 1
    • 2
    Email author
  • Miranda R. Jones
    • 2
    • 3
    • 4
  • Alejandro Dominguez-Lucas
    • 1
  • Eliseo Guallar
    • 3
    • 4
    • 5
  • Ana Navas-Acien
    • 2
    • 3
    • 4
    • 6
  1. 1.Fundacion de Investigacion del Hospital Clinico de Valencia-INCLIVAValenciaSpain
  2. 2.Department of Environmental Health SciencesJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of MedicineJohns Hopkins School of MedicineBaltimoreUSA
  6. 6.Department of OncologyJohns Hopkins School of MedicineBaltimoreUSA

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