Association between blood cadmium and prevalent coronary heart disease in NHANES 2013 to 2014: A cross-sectional study with machine-learning analyses.

Authors

Hui Guo, Yi Li, Meng Liu, Ye Zhou, Mei Hong

Published in

Medicine. Volume 105. Issue 27. Pages e49554. Jul 03, 2026.

Abstract

Cadmium is a toxic environmental metal, but its association with prevalent coronary heart disease (CHD) remains uncertain. We examined whether blood cadmium concentrations were associated with prevalent CHD in US adults and explored machine-learning model performance. This cross-sectional study used data from the National Health and Nutrition Examination Survey 2013 to 2014. Adults aged ≥20 years with complete data on self-reported CHD, blood cadmium, and covariates were included. Blood cadmium was measured by inductively coupled plasma mass spectrometry. Survey-weighted logistic regression was used to assess associations between blood cadmium and prevalent CHD. Sensitivity analyses additionally adjusted for serum cotinine and were repeated in never smokers. Ten machine-learning algorithms were developed to assess discrimination, calibration, and feature importance. Among 2219 participants, higher blood cadmium concentrations were associated with higher odds of prevalent CHD. In the fully adjusted model, each 1-unit increase in ln-transformed blood cadmium was associated with prevalent CHD (odds ratio, 1.38; 95% confidence interval, 1.05-1.81). Compared with the lowest quartile, the highest quartile was associated with higher odds of prevalent CHD (odds ratio, 1.95; 95% confidence interval, 1.25-3.04). The association remained after additional adjustment for serum cotinine but was attenuated in never smokers. The multilayer perceptron showed the best overall discrimination and calibration; age ranked first and blood cadmium ranked second by mean absolute Shapley Additive Explanations value. Higher blood cadmium concentrations were associated with higher odds of prevalent CHD in this cross-sectional analysis. These findings should be interpreted cautiously because residual smoking-related confounding remains possible and the CHD outcome was self-reported.

PMID:
42410856
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.