Cadmium exposure and cardiovascular disease risk: A systematic review and dose-response meta-analysis

: Exposure to toxic metals is a global public health threat. Among other adverse effects, exposure to the heavy metal cadmium has been associated with greater risk of cardiovascular disease (CVD). Nonetheless, the shape of the association between cadmium exposure and CVD risk is not clear. This systematic review summarizes data on the association between cadmium exposure and risk of CVD using a dose-response approach. We carried out a literature search in PubMed, Web of Science, and Embase from inception to December 30, 2023. Inclusion criteria were: studies on adult populations, assessment of cadmium exposure, risk of overall CVD and main CVD subgroups as endpoints, and observational study design (cohort, cross-sectional, or case-control). We retrieved 26 eligible studies published during 2005-2023, measuring cadmium exposure mainly in urine and whole blood. In a dose-response meta-analysis using the one-stage method within a random-effects model, we observed a positive association between cadmium exposure and risk of overall CVD. When using whole blood cadmium as a biomarker, the association with overall CVD risk was linear, yielding a risk ratio (RR) of 2.58 (95 % confidence interval-CI 1.78-3.74) at 1 μg/L. When using urinary cadmium as a biomarker, the association was linear until 0.5 μg/g creatinine (RR = 2.79, 95 % CI 1.26-6.16), after which risk plateaued. We found similar patterns of association of cadmium exposure with overall CVD mortality and risks of heart failure, coronary heart disease, and overall stroke, whereas for ischemic stroke there was a positive association with mortality only. Overall, our results suggest that cadmium exposure, whether measured in urine or whole blood, is associated with increased CVD risk, further highlighting the importance of reducing environmental pollution from this heavy metal

Influence of dietary patterns on urinary excretion of cadmium in an Italian population: A cross-sectional study

Introduction: Cadmium is a toxic heavy metal with detrimental effects on human health. Apart from smoking and occupational factors, diet is the main source of cadmium. However, the relation between adherence to so-called "healthy" dietary patterns and cadmium exposure has not been investigated in detail. In this study, we aimed at assessing such association in a Northern Italian population. Methods: Using a cross-sectional study design, we investigated a population of non-smokers aged 30-60 years in the period 2017-2019. Each subject completed a validated food frequency questionnaire (FFQ) in order to estimate adherence to four dietary patterns, namely the Dietary Approach to Stopping Hypertension-DASH diet, Greek Mediterranean Index-GMI, the Italian Mediterranean Index-IMI, and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. We collected a fasting morning urinary sample to measure urinary levels of cadmium and cotinine. The association between increasing adherence to dietary patterns and cadmium exposure was evaluated using a cubic spline regression non-linear model and adjusting for relevant confounders (age, sex, body mass index, urinary cotinine levels, intake of fiber, and alcohol). Results: We recruited 137 participants (males/females: 62/75) with median (interquartile range-IQR) age of 47 (IQR: 43-53) years. Median scores for the investigated dietary patterns were 24 (IQR: 21-28), 4 (IQR: 3-6), 4 (IQR: 3-5), and 7.5 (IQR: 6.5-8.5) for DASH, GMI, IMI and MIND diets, respectively. The median urinary cadmium level was 0.21 μg/L (IQR: 0.11-0.34 μg/L). Spline regression analysis showed an inverse linear association between increasing adherence to the DASH and MIND diets and urinary cadmium levels, reaching a plateau at high adherence scores, approximately > 25 and > 9 for DASH and MIND diets, respectively. An increase of cadmium exposure with increasing MIND score also emerged. Conversely, the association was almost null for IMI, and slightly positive for GMI. Conclusions: The present findings suggest that increasing adherence to the DASH and MIND diets are associated with decreased cadmium levels only at moderate level. Overall, these results indicate that public health strategies, including the decrease of cadmium contamination in healthy foods should be implemented

Climate change-related factors and west nile virus spread in italy: a systematic review

West Nile Virus (WNV) is a vector-transmitted pathogen affecting both humans and animals, whose presence has recently risen in Europe and particularly in Italy, concurrently with climate changes that favoured the diffusion of mosquitoes. Our review aims to assess such relation with environmental and meteorological factors focusing on the WNV spread in the Italian territory. Following PRISMA guidelines, we performed a literature search in online databases up to May 31, 2023 on four different databases: PubMed, Web of Science, Embase, Scopus. We used keywords and MeSH terms related to WNV and its vectors (C. pipiens and modestus). Following the PECOS criteria, we included observational studies examining vector dynamics and the WNV infection epidemiology in the Italian population and the possible association with environmental factors. The protocol registration on PROSPERO is in process. Out of the 341 articles retrieved, 222 remained after duplicates exclusion and 44 papers were selected after screening of title and abstract by two blinded reviewers. After full-text screening, 31 studies (published between 2011 and 2023) were included. Climatic factors such as temperature, daylight hours and humidity seem to be strongly associated with the spread of WNV and its vectors, while rainfall showed less influence. Among environmental factors, soil characteristics and population dynamics (of both vector and host) were found to be the most predictive. By contrast, distance from specific areas (e.g. urban or protected areas) seems to have no influence. These findings suggest that some climatic and environmental factors linked with climate change strongly affect the presence of WNV and its vectors. This issue can be considered a warning bell about the potential future increase in cases related to climate change, but offers helpful resources for predicting its spread and implement tailored public health interventions