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Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function.
Am J Epidemiol. 2006 Apr 15; 163(8):700-8.AJ

Abstract

Homocysteine levels are associated with peripheral arterial disease (PAD) in observational studies. Lead and cadmium are risk factors for PAD that affect thiol metabolism, and they may partly explain the association of homocysteine with PAD. To evaluate the roles of lead and cadmium exposure in confounding the association between homocysteine and PAD, the authors performed a cross-sectional study among 4,447 persons aged > or = 40 years who participated in the 1999-2002 National Health and Nutrition Examination Survey (NHANES). PAD was defined as an ankle-brachial blood pressure index less than 0.90 in at least one leg. After adjustment for sociodemographic variables, the odds ratio for PAD in the highest quintile of homocysteine compared with the lowest was 1.92 (p(trend) = 0.004). Adjusting for blood lead and cadmium levels reduced this odds ratio to 1.37 (p(trend) = 0.13), and further adjusting for estimated glomerular filtration rate and smoking reduced it to 0.89 (p(trend) = 0.87). Adjustment for other risk factors did not affect this association. In the general population, the association of homocysteine level with PAD can be completely explained by confounding due to smoking, increased blood lead and cadmium levels, and impaired renal function. The association of lead and cadmium with PAD risk deserves further investigation.

Authors+Show Affiliations

Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. eguallar@jhsph.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16484446

Citation

Guallar, Eliseo, et al. "Confounding of the Relation Between Homocysteine and Peripheral Arterial Disease By Lead, Cadmium, and Renal Function." American Journal of Epidemiology, vol. 163, no. 8, 2006, pp. 700-8.
Guallar E, Silbergeld EK, Navas-Acien A, et al. Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function. Am J Epidemiol. 2006;163(8):700-8.
Guallar, E., Silbergeld, E. K., Navas-Acien, A., Malhotra, S., Astor, B. C., Sharrett, A. R., & Schwartz, B. S. (2006). Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function. American Journal of Epidemiology, 163(8), 700-8.
Guallar E, et al. Confounding of the Relation Between Homocysteine and Peripheral Arterial Disease By Lead, Cadmium, and Renal Function. Am J Epidemiol. 2006 Apr 15;163(8):700-8. PubMed PMID: 16484446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function. AU - Guallar,Eliseo, AU - Silbergeld,Ellen K, AU - Navas-Acien,Ana, AU - Malhotra,Saurabh, AU - Astor,Brad C, AU - Sharrett,A Richey, AU - Schwartz,Brian S, Y1 - 2006/02/16/ PY - 2006/2/18/pubmed PY - 2006/5/12/medline PY - 2006/2/18/entrez SP - 700 EP - 8 JF - American journal of epidemiology JO - Am. J. Epidemiol. VL - 163 IS - 8 N2 - Homocysteine levels are associated with peripheral arterial disease (PAD) in observational studies. Lead and cadmium are risk factors for PAD that affect thiol metabolism, and they may partly explain the association of homocysteine with PAD. To evaluate the roles of lead and cadmium exposure in confounding the association between homocysteine and PAD, the authors performed a cross-sectional study among 4,447 persons aged > or = 40 years who participated in the 1999-2002 National Health and Nutrition Examination Survey (NHANES). PAD was defined as an ankle-brachial blood pressure index less than 0.90 in at least one leg. After adjustment for sociodemographic variables, the odds ratio for PAD in the highest quintile of homocysteine compared with the lowest was 1.92 (p(trend) = 0.004). Adjusting for blood lead and cadmium levels reduced this odds ratio to 1.37 (p(trend) = 0.13), and further adjusting for estimated glomerular filtration rate and smoking reduced it to 0.89 (p(trend) = 0.87). Adjustment for other risk factors did not affect this association. In the general population, the association of homocysteine level with PAD can be completely explained by confounding due to smoking, increased blood lead and cadmium levels, and impaired renal function. The association of lead and cadmium with PAD risk deserves further investigation. SN - 0002-9262 UR - https://www.unboundmedicine.com/medline/citation/16484446/Confounding_of_the_relation_between_homocysteine_and_peripheral_arterial_disease_by_lead_cadmium_and_renal_function_ L2 - https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kwj090 DB - PRIME DP - Unbound Medicine ER -