Joint Effect of Alcohol Drinking and Environmental Cadmium Exposure on Hypertension in Korean Adults: Analysis of Data from the Korea National Health and Nutrition Examination Survey, 2008 to 2013

Hypertension is a common disease found in 1.13 billion adults worldwide. Several animal studies have provided evidence of the joint effect of alcohol drinking and cadmium exposure on hypertension. However, no epidemiologic study has examined the association between these 2 risk factors and hypertension. Therefore, we examined the individual effects of alcohol drinking and cadmium and the joint effect of their coexposure on hypertension in the general population. We analyzed data from 8,403 South Korean adults who had been randomly assigned to the Korea National Health and Nutrition Examination Survey from 2008 to 2013. Multiple linear and logistic regression analyses were conducted to estimate the association of alcohol drinking and blood cadmium concentration with blood pressure and the odds ratio (OR) for hypertension. The weighted prevalence of hypertension and high‐risk drinking was 25.7 and 13.6%, respectively. The weighted geometric mean of blood cadmium levels was 0.94 μg/L (95% confidence interval [CI]: 0.93 to 0.96). After adjusting for demographic characteristics, anthropometric measurements, health‐related behaviors, and dietary and disease variables, the OR for hypertension in the group with the high‐risk alcohol drinking was 1.67 (95% CI: 1.34 to 2.06) compared with the group without high‐risk alcohol drinking. When the highest and the lowest blood cadmium quartiles were compared, the OR for hypertension was 1.46 (95% CI: 1.15 to 1.86). The positive joint effect of high‐risk drinking and blood cadmium levels was statistically significant for systolic blood pressure (SBP; p= 0.037) and diastolic blood pressure (DBP; p< 0.001). Our results show that heavy alcohol drinking had a joint effect with cadmium exposure to increase the risk of hypertension. Future efforts are needed to reduce alcohol drinking and environmental cadmium exposure to prevent hypertension in the general population. Alcohol plus cadmium can amplify blood pressure and cardiovascular risk. Alcohol increases the absorption of cadmium in the body, and evidence suggests that the two substances contribute to hypertension via shared physiological pathways. This is the first known epidemiological study that investigates the joint effect of alcohol drinking and exposure to environmental cadmium on the risk of hypertension in the general population. Our findings underline the importance of reducing alcohol consumption and cadmium exposure as a matter of public health.