Dose-response between Cadmium exposure and stroke risk: a dose-response meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LU Huqiang ^1,2 , WANG Fang ³ , HUI Xu ¹ , CHEN Jianli ^1,4 , LIU Yijun ^1,5 ,  WANG Jingcheng ² ,  LU Yongbin ¹ ,  WANG Shizhong ⁶ ,  YANG Kehu ¹

1. Evidence Based Medicine Center, School of Basic Medicine, Lanzhou University, Lanzhou 730099, P. R. China;
2. Department of Critical Care Medicine, Wuwei People's Hospital, Wuwei 733000, P. R. China;
3. Department of Oncological Surgery, Wuwei People's Hospital, Wuwei 733000, P. R. China;
4. Department of Nephrology, Wuwei People's Hospital, Wuwei 733000, P. R. China;
5. Department of Integrative Medicine, Wuwei People's Hospital, Wuwei 733000, P. R. China;
6. Department of Osteology, Wuwei People's Hospital, Wuwei 733000, P. R. China;

Corresponding?author：

LU Yongbin, Email: luyb09@lzu.edu.cn; WANG Shizhong, Email: 413199705@qq.com; YANG Kehu, Email: yangkh@lzu.edu.cn

Keywords：

Cadmium exposure; Stroke; Meta-analysis; Dose-response relationship

DOI：

10.7507/1672-2531.202408121

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the dose-response relationship between cadmium exposure and the risk of stroke onset. Methods The PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, WanFang Data, and CBM databases were electronically searched to collect studies related to objectives from inception to June 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 15.1 software. Results There were 10 studies that involved 28 250 participants, and 7 of them were prospective cohort studies and 3 were case-control studies. Meta-analysis results showed that cadmium exposure significantly increased the risk of stroke (RR=1.39, 95%CI 1.20 to 1.59, P<0.01), blood cadmium exposure significantly increased the risk of stroke (RR=1.79, 95%CI 1.34 to 2.25, P<0.01), urinary cadmium exposure significantly increased the risk of stroke (RR=1.30, 95%CI 1.09 to 1.52, P<0.01). Blood cadmium exposure had a significantly nonlinear dose-response relationship associated with an increased risk of stroke (χ²=8.56, P<0.05). The risk of stroke increased by 15% with the blood cadmium exposure concentration of 0.8 μg/L (RR=1.15, 95%CI 0.98 to 1.36), and 51% with the blood cadmium exposure concentration of 1.2 μg/L (RR=1.51, 95%CI 1.14 to 2.01) than those without blood cadmium exposure. Urinary cadmium exposure had significantly linear dose-response relationship associated with an increased risk of stroke (χ²=2.47, P=0.12). The risk of stroke increased by 26% with the urinary cadmium exposure concentration of 0.8 μg/g (RR=1.26, 95%CI 1.20 to 1.31), and 31% with the urinary cadmium exposure concentration of 1.2 μg/g (RR=1.31, 95%CI 1.27 to 1.36) than those without urinary cadmium exposure. Conclusion Cadmium exposure increases the risk of stroke. There was a significant dose-response relationship between cadmium exposure and the risk of stroke.

Citation： LU Huqiang, WANG Fang, HUI Xu, CHEN Jianli, LIU Yijun, WANG Jingcheng, LU Yongbin, WANG Shizhong, YANG Kehu. Dose-response between Cadmium exposure and stroke risk: a dose-response meta-analysis. Chinese Journal of Evidence-Based Medicine, 2025, 25(4): 420-426. doi: 10.7507/1672-2531.202408121 Copy

1.	Guo J, Chai G, Song X, et al. Long-term exposure to particulate matter on cardiovascular and respiratory diseases in low- and middle-income countries: a systematic review and meta-analysis. Front Public Health, 2023, 11: 1134341.
2.	Tchounwou PB, Yedjou CG, Patlolla AK, et al. Heavy metal toxicity and the environment. Exp Suppl, 2012, 101: 133-164.
3.	J?rup L. Hazards of heavy metal contamination. Br Med Bull, 2003, 68: 167-182.
4.	張永欣, 曾勇, 王婷, 等. 枸杞多糖和亞硒酸鈉對氯化鎘暴露誘導大鼠腎臟毒性的拮抗作用研究. 蘭州大學學報(醫學版), 2022, 48(8): 11-16.
5.	Li Z, Ma Z, van der Kuijp TJ, et al. A review of soil heavy metal pollution from mines in China: pollution and health risk assessment. Sci Total Environ, 2014, 15: 468-469.
6.	Rehman K, Fatima F, Waheed I, et al. Prevalence of exposure of heavy metals and their impact on health consequences. J Cell Biochem, 2018, 119(1): 157-184.
7.	Kim JH, Byun HM, Chung EC, et al. Loss of integrity: impairment of the blood-brain barrier in heavy metal-associated ischemic stroke. Toxicol Res, 2013, 29(3): 157-164.
8.	Liu J, Li Y, Li D, et al. The burden of coronary heart disease and stroke attributable to dietary cadmium exposure in Chinese adults, 2017. Sci Total Environ, 2022, 825: 153997.
9.	Larsson SC, Burgess S, Micha?lsson K. Smoking and stroke: a Mendelian randomization study. Ann Neurol, 2019, 86(3): 468-471.
10.	Verhoeven JI, Allach Y, Vaartjes ICH, et al. Ambient air pollution and the risk of ischaemic and haemorrhagic stroke. Lancet Planet Health, 2021, 5(8): e542-e552.
11.	Li Q, Nishijo M, Nakagawa H, et al. Relationship between urinary cadmium and mortality in habitants of a cadmium-polluted area: a 22-year follow-up study in Japan. Chin Med J (Engl), 2011, 124(21): 3504-3509.
12.	Elliott P, Arnold R, Cockings S, et al. Risk of mortality, cancer incidence, and stroke in a population potentially exposed to cadmium. Occup Environ Med, 2000, 57(2): 94-97.
13.	Bao QJ, Zhao K, Guo Y, et al. Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis. Environ Sci Pollut Res Int, 2022, 29(22): 32545-32565.
14.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
15.	李樸, 王梅, 宇麗, 等. 神經重癥患兒早期活動的最佳證據總結. 護理學報, 2023, 30(2): 48-53.
16.	劉倩倩, 嚴雪, 詹柳艷, 等. 咖啡攝入量與肝癌風險的劑量-反應Meta分析. 中國循證醫學雜志, 2023, 23(7): 814-819.
17.	Xu L, Liu Y, Zhao Q, et al. Urinary element profiles and associations with cardiometabolic diseases: a cross-sectional study across ten areas in China. Environ Res, 2022, 205: 112535.
18.	蔣青青, 王世琦, 黃申, 等. 劑量反應Meta分析中常見的統計學問題. 數理醫藥學雜志, 2023, 36(2): 81-87.
19.	Fahmy O, Fahmy UA, Alhakamy NA, et al. Single-port versus multiple-port robot-assisted radical prostatectomy: a systematic review and meta-analysis. J Clin Med, 2021, 10(24): 5723.
20.	林洋, 王芳, 王寒, 等. 老年共病患者衰弱患病率的Meta分析. 中國全科醫學, 2023, 26(25): 3185-3193.
21.	Hamling J, Lee P, Weitkunat R, et al. Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med, 2008, 27(7): 954-970.
22.	徐暢, 劉同族, 鄺心穎, 等. 劑量-反應Meta分析模型中缺失值的評估及效應指標的轉換. 中國循證醫學雜志, 2015, 15(8): 984-987.
23.	Schmidt CO, Kohlmann T. When to use the odds ratio or the relative risk. Int J Public Health, 2008, 53(3): 165-167.
24.	Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
25.	黃育北, 李衛芹, 席波, 等. 劑量反應關系Meta分析的模型選擇及分析流程. 中國循證醫學雜志, 2016, 16(2): 223-228.
26.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
27.	Xu C, Doi SAR. The robust error meta-regression method for dose-response meta-analysis. Int J Evid Based Healthc, 2018, 16(3): 138-144.
28.	Orsini N, Li R, Wolk A, et al. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol, 2012, 175(1): 66-73.
29.	Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol, 1992, 135(11): 1301-1309.
30.	羅美玲, 林希建, 劉如春, 等. 劑量反應關系Meta分析在Stata軟件中的實現. 循證醫學, 2014, 14(3): 182-187.
31.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
32.	Lin CH, Hsu YT, Yen CC, et al. Association between heavy metal levels and acute ischemic stroke. J Biomed Sci, 2018, 25(1): 49.
33.	Barregard L, Sallsten G, Fagerberg B, et al. Blood cadmium levels and incident cardiovascular events during follow-up in a population-based cohort of Swedish adults: the Malm? diet and cancer study. Environ Health Perspect, 2016, 124(5): 594-600.
34.	Wen Y, Huang S, Zhang Y, et al. Associations of multiple plasma metals with the risk of ischemic stroke: a case-control study. Environ Int, 2019, 125: 125-134.
35.	Borné Y, Fagerberg B, Persson M, et al. Cadmium, carotid atherosclerosis, and incidence of ischemic stroke. J Am Heart Assoc, 2017, 6(12): e006415.
36.	Mirończuk A, Kapica-Topczewska K, Socha K, et al. Disturbed ratios between essential and toxic trace elements as potential biomarkers of acute ischemic stroke. Nutrients, 2023, 15(6): 1434.
37.	S?derholm M, Borné Y, Hedblad B, et al. Blood cadmium concentration and risk of subarachnoid haemorrhage. Environ Res, 2020, 180: 108826.
38.	Poulsen AH, Sears CG, Harrington J, et al. Urinary cadmium and stroke - a case-cohort study in Danish never-smokers. Environ Res, 2021, 200: 111394.
39.	T?gt J, Helte E, Donat-Vargas C, et al. Long-term cadmium exposure and fractures, cardiovascular disease, and mortality in a prospective cohort of women. Environ Int, 2022, 161: 107114.
40.	Chen C, Xun P, Tsinovoi C, et al. Urinary cadmium concentration and the risk of ischemic stroke. Neurology, 2018, 91(4): e382-e391.
41.	Dev P, Gupta P, Mahapatra A, et al. Systematic review and meta-analysis of environmental toxic metal contaminants and the risk of ischemic stroke. Ann Indian Acad Neurol, 2022, 25(6): 1159-1166.
42.	柯紅霞, 張建平, 靳思慧, 等. 鎘暴露與肺功能水平及慢性阻塞性肺疾病的關系. 中華勞動衛生職業病雜志, 2023, 41(4): 241-246.
43.	Zhang LL, Lu L, Pan YJ, et al. Baseline blood levels of manganese, lead, cadmium, copper, and zinc in residents of Beijing suburb. Environ Res, 2015, 140: 10-17.
44.	國家衛生和計劃生育委員會. 通告(國衛通〔2016〕7號). 2016.
45.	張宏龍, 嚴俊, 李汛. 膽管癌患者微量金屬質量分數與腫瘤進展的關系. 蘭州大學學報(醫學版), 2023, 49(11): 33-41.
46.	Zheng JL, Yuan SS, Wu CW, et al. Acute exposure to waterborne cadmium induced oxidative stress and immunotoxicity in the brain, ovary and liver of zebrafish (Danio rerio). Aquat Toxicol, 2016, 180: 36-44.
47.	Xu MY, Wang P, Sun YJ, et al. Joint toxicity of chlorpyrifos and cadmium on the oxidative stress and mitochondrial damage in neuronal cells. Food Chem Toxicol, 2017, 103: 246-252.
48.	Genchi G, Sinicropi MS, Lauria G, et al. The effects of cadmium toxicity. Int J Environ Res Public Health, 2020, 17(11): 3782.
49.	Flora SJ, Mittal M, Mehta A. Heavy metal induced oxidative stress & its possible reversal by chelation therapy. Indian J Med Res, 2008, 128(4): 501-523.
50.	王金萍, 王小琴, 崔慧慧, 等. 血漿致動脈硬化指數、甘油三酯葡萄糖指數與急性缺血性腦卒中發病機制的研究進展. 蘭州大學學報(醫學版), 2024, 50(4): 77-82.
51.	Rosenberg GA. Matrix metalloproteinase-mediated neuroinflammation in vascular cognitive impairment of the binswanger type. Cell Mol Neurobiol, 2016, 36(2): 195-202.
52.	Adefegha SA, Omojokun OS, Oboh G, et al. Modulatory effects of ferulic acid on cadmium-induced brain damage. J Evid Based Complementary Altern Med, 2016, 21(4): NP56-NP61.
53.	Pulido G, Trevi?o S, Brambila E, et al. The administration of cadmium for 2, 3 and 4 months causes a loss of recognition memory, promotes neuronal hypotrophy and apoptosis in the hippocampus of rats. Neurochem Res, 2019, 44(2): 485-497.
54.	Yang XF, Fan GY, Liu DY, et al. Effect of cadmium exposure on the histopathology of cerebral cortex in juvenile mice. Biol Trace Elem Res, 2015, 165(2): 167-172.
55.	Monaco A, Capriello T, Grimaldi MC, et al. Neurodegeneration in zebrafish embryos and adults after cadmium exposure. Eur J Histochem, 2017, 61(4): 2833.
56.	Li W, Huang G, Tang N, et al. Effects of heavy metal exposure on hypertension: a machine learning modeling approach. Chemosphere, 2023, 337: 139435.
57.	Satarug S. Is environmental cadmium exposure causally related to diabetes and obesity. Cells, 2023, 13(1): 83.

1. Guo J, Chai G, Song X, et al. Long-term exposure to particulate matter on cardiovascular and respiratory diseases in low- and middle-income countries: a systematic review and meta-analysis. Front Public Health, 2023, 11: 1134341.
2. Tchounwou PB, Yedjou CG, Patlolla AK, et al. Heavy metal toxicity and the environment. Exp Suppl, 2012, 101: 133-164.
3. J?rup L. Hazards of heavy metal contamination. Br Med Bull, 2003, 68: 167-182.
4. 張永欣, 曾勇, 王婷, 等. 枸杞多糖和亞硒酸鈉對氯化鎘暴露誘導大鼠腎臟毒性的拮抗作用研究. 蘭州大學學報(醫學版), 2022, 48(8): 11-16.
5. Li Z, Ma Z, van der Kuijp TJ, et al. A review of soil heavy metal pollution from mines in China: pollution and health risk assessment. Sci Total Environ, 2014, 15: 468-469.
6. Rehman K, Fatima F, Waheed I, et al. Prevalence of exposure of heavy metals and their impact on health consequences. J Cell Biochem, 2018, 119(1): 157-184.
7. Kim JH, Byun HM, Chung EC, et al. Loss of integrity: impairment of the blood-brain barrier in heavy metal-associated ischemic stroke. Toxicol Res, 2013, 29(3): 157-164.
8. Liu J, Li Y, Li D, et al. The burden of coronary heart disease and stroke attributable to dietary cadmium exposure in Chinese adults, 2017. Sci Total Environ, 2022, 825: 153997.
9. Larsson SC, Burgess S, Micha?lsson K. Smoking and stroke: a Mendelian randomization study. Ann Neurol, 2019, 86(3): 468-471.
10. Verhoeven JI, Allach Y, Vaartjes ICH, et al. Ambient air pollution and the risk of ischaemic and haemorrhagic stroke. Lancet Planet Health, 2021, 5(8): e542-e552.
11. Li Q, Nishijo M, Nakagawa H, et al. Relationship between urinary cadmium and mortality in habitants of a cadmium-polluted area: a 22-year follow-up study in Japan. Chin Med J (Engl), 2011, 124(21): 3504-3509.
12. Elliott P, Arnold R, Cockings S, et al. Risk of mortality, cancer incidence, and stroke in a population potentially exposed to cadmium. Occup Environ Med, 2000, 57(2): 94-97.
13. Bao QJ, Zhao K, Guo Y, et al. Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis. Environ Sci Pollut Res Int, 2022, 29(22): 32545-32565.
14. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
15. 李樸, 王梅, 宇麗, 等. 神經重癥患兒早期活動的最佳證據總結. 護理學報, 2023, 30(2): 48-53.
16. 劉倩倩, 嚴雪, 詹柳艷, 等. 咖啡攝入量與肝癌風險的劑量-反應Meta分析. 中國循證醫學雜志, 2023, 23(7): 814-819.
17. Xu L, Liu Y, Zhao Q, et al. Urinary element profiles and associations with cardiometabolic diseases: a cross-sectional study across ten areas in China. Environ Res, 2022, 205: 112535.
18. 蔣青青, 王世琦, 黃申, 等. 劑量反應Meta分析中常見的統計學問題. 數理醫藥學雜志, 2023, 36(2): 81-87.
19. Fahmy O, Fahmy UA, Alhakamy NA, et al. Single-port versus multiple-port robot-assisted radical prostatectomy: a systematic review and meta-analysis. J Clin Med, 2021, 10(24): 5723.
20. 林洋, 王芳, 王寒, 等. 老年共病患者衰弱患病率的Meta分析. 中國全科醫學, 2023, 26(25): 3185-3193.
21. Hamling J, Lee P, Weitkunat R, et al. Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med, 2008, 27(7): 954-970.
22. 徐暢, 劉同族, 鄺心穎, 等. 劑量-反應Meta分析模型中缺失值的評估及效應指標的轉換. 中國循證醫學雜志, 2015, 15(8): 984-987.
23. Schmidt CO, Kohlmann T. When to use the odds ratio or the relative risk. Int J Public Health, 2008, 53(3): 165-167.
24. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
25. 黃育北, 李衛芹, 席波, 等. 劑量反應關系Meta分析的模型選擇及分析流程. 中國循證醫學雜志, 2016, 16(2): 223-228.
26. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
27. Xu C, Doi SAR. The robust error meta-regression method for dose-response meta-analysis. Int J Evid Based Healthc, 2018, 16(3): 138-144.
28. Orsini N, Li R, Wolk A, et al. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol, 2012, 175(1): 66-73.
29. Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol, 1992, 135(11): 1301-1309.
30. 羅美玲, 林希建, 劉如春, 等. 劑量反應關系Meta分析在Stata軟件中的實現. 循證醫學, 2014, 14(3): 182-187.
31. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
32. Lin CH, Hsu YT, Yen CC, et al. Association between heavy metal levels and acute ischemic stroke. J Biomed Sci, 2018, 25(1): 49.
33. Barregard L, Sallsten G, Fagerberg B, et al. Blood cadmium levels and incident cardiovascular events during follow-up in a population-based cohort of Swedish adults: the Malm? diet and cancer study. Environ Health Perspect, 2016, 124(5): 594-600.
34. Wen Y, Huang S, Zhang Y, et al. Associations of multiple plasma metals with the risk of ischemic stroke: a case-control study. Environ Int, 2019, 125: 125-134.
35. Borné Y, Fagerberg B, Persson M, et al. Cadmium, carotid atherosclerosis, and incidence of ischemic stroke. J Am Heart Assoc, 2017, 6(12): e006415.
36. Mirończuk A, Kapica-Topczewska K, Socha K, et al. Disturbed ratios between essential and toxic trace elements as potential biomarkers of acute ischemic stroke. Nutrients, 2023, 15(6): 1434.
37. S?derholm M, Borné Y, Hedblad B, et al. Blood cadmium concentration and risk of subarachnoid haemorrhage. Environ Res, 2020, 180: 108826.
38. Poulsen AH, Sears CG, Harrington J, et al. Urinary cadmium and stroke - a case-cohort study in Danish never-smokers. Environ Res, 2021, 200: 111394.
39. T?gt J, Helte E, Donat-Vargas C, et al. Long-term cadmium exposure and fractures, cardiovascular disease, and mortality in a prospective cohort of women. Environ Int, 2022, 161: 107114.
40. Chen C, Xun P, Tsinovoi C, et al. Urinary cadmium concentration and the risk of ischemic stroke. Neurology, 2018, 91(4): e382-e391.
41. Dev P, Gupta P, Mahapatra A, et al. Systematic review and meta-analysis of environmental toxic metal contaminants and the risk of ischemic stroke. Ann Indian Acad Neurol, 2022, 25(6): 1159-1166.
42. 柯紅霞, 張建平, 靳思慧, 等. 鎘暴露與肺功能水平及慢性阻塞性肺疾病的關系. 中華勞動衛生職業病雜志, 2023, 41(4): 241-246.
43. Zhang LL, Lu L, Pan YJ, et al. Baseline blood levels of manganese, lead, cadmium, copper, and zinc in residents of Beijing suburb. Environ Res, 2015, 140: 10-17.
44. 國家衛生和計劃生育委員會. 通告(國衛通〔2016〕7號). 2016.
45. 張宏龍, 嚴俊, 李汛. 膽管癌患者微量金屬質量分數與腫瘤進展的關系. 蘭州大學學報(醫學版), 2023, 49(11): 33-41.
46. Zheng JL, Yuan SS, Wu CW, et al. Acute exposure to waterborne cadmium induced oxidative stress and immunotoxicity in the brain, ovary and liver of zebrafish (Danio rerio). Aquat Toxicol, 2016, 180: 36-44.
47. Xu MY, Wang P, Sun YJ, et al. Joint toxicity of chlorpyrifos and cadmium on the oxidative stress and mitochondrial damage in neuronal cells. Food Chem Toxicol, 2017, 103: 246-252.
48. Genchi G, Sinicropi MS, Lauria G, et al. The effects of cadmium toxicity. Int J Environ Res Public Health, 2020, 17(11): 3782.
49. Flora SJ, Mittal M, Mehta A. Heavy metal induced oxidative stress & its possible reversal by chelation therapy. Indian J Med Res, 2008, 128(4): 501-523.
50. 王金萍, 王小琴, 崔慧慧, 等. 血漿致動脈硬化指數、甘油三酯葡萄糖指數與急性缺血性腦卒中發病機制的研究進展. 蘭州大學學報(醫學版), 2024, 50(4): 77-82.
51. Rosenberg GA. Matrix metalloproteinase-mediated neuroinflammation in vascular cognitive impairment of the binswanger type. Cell Mol Neurobiol, 2016, 36(2): 195-202.
52. Adefegha SA, Omojokun OS, Oboh G, et al. Modulatory effects of ferulic acid on cadmium-induced brain damage. J Evid Based Complementary Altern Med, 2016, 21(4): NP56-NP61.
53. Pulido G, Trevi?o S, Brambila E, et al. The administration of cadmium for 2, 3 and 4 months causes a loss of recognition memory, promotes neuronal hypotrophy and apoptosis in the hippocampus of rats. Neurochem Res, 2019, 44(2): 485-497.
54. Yang XF, Fan GY, Liu DY, et al. Effect of cadmium exposure on the histopathology of cerebral cortex in juvenile mice. Biol Trace Elem Res, 2015, 165(2): 167-172.
55. Monaco A, Capriello T, Grimaldi MC, et al. Neurodegeneration in zebrafish embryos and adults after cadmium exposure. Eur J Histochem, 2017, 61(4): 2833.
56. Li W, Huang G, Tang N, et al. Effects of heavy metal exposure on hypertension: a machine learning modeling approach. Chemosphere, 2023, 337: 139435.
57. Satarug S. Is environmental cadmium exposure causally related to diabetes and obesity. Cells, 2023, 13(1): 83.

Chinese Journal of Evidence-Based Medicine

Dose-response between Cadmium exposure and stroke risk: a dose-response meta-analysis

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