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American Journal of Epidemiology Advance Access published online on June 22, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi180
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved
Received January 10, 2005
Accepted March 16, 2005

ORIGINAL CONTRIBUTIONS

Low Toenail Chromium Concentration and Increased Risk of Nonfatal Myocardial Infarction

Eliseo Guallar 1*, F. Javier Jiménez 2, Pieter van 't Veer 3, Peter Bode 4, Rudolph A. Riemersma 5, Jorge Gómez-Aracena 6, Jeremy D. Kark 7, Lenore Arab 8, Frans J. Kok 3, José M. Martín-Moreno 9, and for the EURAMIC-Heavy Metals and Myocardial Infarction Study Group

1 Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; National School of Public Health, Institute of Health Carlos III, Madrid, Spain
2 National School of Public Health, Institute of Health Carlos III, Madrid, Spain; Medical Department, AstraZeneca, Madrid, Spain
3 Division of Human Nutrition, Graduate School of Food Technology, Agrobiotechnology, Nutrition and Health Sciences, Wageningen University, Wageningen, the Netherlands
4 Interfaculty Reactor Institute, Delft University of Technology, Delft, the Netherlands
5 Cardiovascular Research Unit, College of Medicine, University of Edinburgh, Edinburgh, United Kingdom; Department of Medical Physiology, Faculty of Medicine, University of Tromsø, Tromsø, Norway
6 Department of Preventive Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain; Nordic School of Public Health, Göteborg, Sweden
7 Epidemiology Unit, Hadassah Medical Organization, Jerusalem, Israel; Hadassah School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
8 Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA
9 National School of Public Health, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine and Odontology, Universidad de Valencia, Valencia, Spain

* To whom correspondence should be addressed.
Eliseo Guallar, E-mail: eguallar{at}jhsph.edu


  Abstract

Chromium intake may increase insulin sensitivity, glucose tolerance, and the ratio of high density lipoprotein cholesterol to low density lipoprotein cholesterol. However, the epidemiologic evidence on the association between chromium and cardiovascular disease is very limited. To determine whether low toenail chromium concentrations were associated with risk of nonfatal myocardial infarction, the authors conducted an incident, population-based, case-control study in eight European countries and Israel in 1991-1992. Cases (n = 684) were men with a first diagnosis of myocardial infarction recruited from the coronary units of participating hospitals. Controls (n = 724) were men selected randomly from population registers (five study centers) or through other sources, such as hospitalized patients (three centers), general practitioners' practices (one center), or relatives or friends of cases (one center). Toenail chromium concentration was assessed by neutron activation analysis. Average toenail chromium concentrations were 1.10 µg/g in cases (95% confidence interval: 1.01, 1.18) and 1.30 µg/g in controls (95% CI: 1.21, 1.40). Multivariate odds ratios for quintiles 2-5 were 0.82 (95% CI: 0.52, 1.31), 0.68 (95% CI: 0.43, 1.08), 0.60 (95% CI: 0.37, 0.97), and 0.59 (95% CI: 0.37, 0.95). Toenail chromium concentration was inversely associated with the risk of a first myocardial infarction in men. These results add to an increasing body of evidence that points to the importance of chromium for cardiovascular health.

Keywords: case-control studies; chromium; metals, heavy; myocardial infarction; neutron activation analysis.
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