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American Journal of Epidemiology Advance Access published online on April 7, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn061
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Toenail Nicotine Levels as Predictors of Coronary Heart Disease among Women

Wael K. Al-Delaimy1, Meir J. Stampfer2,3,4, JoAnn E. Manson2,3,5 and Walter C. Willett2,3,4

1 Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, CA
2 Department of Epidemiology, Harvard School of Public Health, Boston, MA
3 Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
4 Department of Nutrition, Harvard School of Public Health, Boston, MA
5 Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA

Correspondence to Dr. Wael K. Al-Delaimy, 3855 Health Sciences Drive, #0901, La Jolla, CA 92093 (e-mail: wael{at}ucsd.edu).

Received for publication November 2, 2007. Accepted for publication February 26, 2008.

The authors assess the ability of toenail nicotine levels as a biomarker to predict incident coronary heart disease (CHD). A nested case-control study was carried out among 62,641 women aged 36–61 years in the Nurses' Health Study cohort who provided toenail clippings in 1982. Between 1984 and 1998, 905 incident CHD cases were diagnosed and matched with two controls by age and date of toenail collection. Using multivariate logistic regression analyses, the authors found a statistically significant dose-response association between increasing toenail nicotine levels and risk of CHD (ptrend < 0.0001); women in the highest quintile had a relative risk of 3.44 (95% confidence interval (CI): 2.56, 4.62) compared with women in the lowest quintile. With each increase in the log-transformed unit of continuous toenail nicotine levels, there was a 42% increase in the risk of CHD (relative risk = 1.42, 95% CI: 1.33, 1.52). The association remained significant when the number of cigarettes smoked and passive smoking were included as covariates (relative risk = 1.12, 95% CI: 1.01, 1.24). In conclusion, toenail nicotine levels are predictive of CHD among women independent of other risk factors and remained significant even after adjustment for history of cigarette smoking.

biological markers; cohort studies; coronary disease; nails; nicotine; tobacco

Abbreviations: CHD, coronary heart disease; CI, confidence interval; RR, relative risk


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