Table 5.

Studies of barium, nickel and uranium biomarkers and clinical cardiovascular disease outcomes (3 studies available)

Study, year	Population	Men (%)	Age Range (yrs)	Biomarker	Exposed vs. Reference	Endpoint Ascertainment	Outcome (s)	No. of cases / non-cases	Relative Risk estimate (95% CI)	Adjustment Factors
Cross-sectional studies
Barium
Navas-Acien et al. 2005 [58]	General US population NHANES 1999–2000 N=790	NR	≥40	Urine (μg/L) GM: 1.28 μg/L	75th vs 25th percentile GM=1.28 (1.4–6.2) μg/L	Measured ankle-brachial index<0.9	Peripheral arterial disease (PAD)	45/659	0.88 (0.45, 1.78) (Odds ratio)	Age, sex, race,education, smoking status, and urinary creatinine
Nickel
Lind et al. 2012 [59]	Subjects of Uppsala, (Sweden) PIVUS Study (N=1016)	49.8	= 70	Whole blood (0.06µg/L) Median: Men: 5.41 μg/L Women: 5.15 μg/L	Per log 0.06µg/L	Local thickening of the IMT more than 50% thicker than the surrounding IMT, measured by external B-mode ultrasound imaging	Plaque presence prevalence	NR	1.03 (0.91–1.16) p= 0.34 (Odds ratio)	P-value adjusted for gender, waist circumference, body mass index, fasting blood glucose, systolic and diastolic blood pressure, high and low-density lipoprotein cholesterol, serum triglycerides, smoking, antihypertensive treatment and statin use
Uranium
Mendy et al. 2012 [20]	General US population NHANES 2007–2008 (N=1857)	50.4	≥ 20	Urine (µg/g) GM: 0.01 µg/g (95% CI: 0.01–0.01)	Above vs. below the GM (0.01 µg/g)	Self-report	Heart failure Coronary heart disease Heart attack Stroke	NR NR NR NR	5.20 (1.52–17.80) 1.20 (0.44–3.30) 2.37 (0.96–5.86) 1.80 (0.77–4.20) (Odds ratio)	Age, sex, race/ethnicity, education level, ratio family income to poverty, alcohol consumption, cigarette smoking, urinary barium, cadmium, cobalt, cesium, molybdenum, lead, thallium, antimony, and uranium. U levels divided by urinary creatinine

BMI: body mass index. GM: geometric mean; NR: not reported