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Previous Volume 347:1747-1754 November 28, 2002 Number 22 Next

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ABSTRACT

Background It has been suggested that mercury, a highly reactive heavy metal with no known physiologic activity, increases the risk of cardiovascular disease. Because fish intake is a major source of exposure to mercury, the mercury content of fish may counteract the beneficial effects of its n–3 fatty acids.

Methods In a case–control study conducted in eight European countries and Israel, we evaluated the joint association of mercury levels in toenail clippings and docosahexaenoic acid (C22:6n–3, or DHA) levels in adipose tissue with the risk of a first myocardial infarction among men. The patients were 684 men with a first diagnosis of myocardial infarction. The controls were 724 men selected to be representative of the same populations.

Results The average toenail mercury level in controls was 0.25 µg per gram. After adjustment for the DHA level and coronary risk factors, the mercury levels in the patients were 15 percent higher than those in controls (95 percent confidence interval, 5 to 25 percent). The risk-factor–adjusted odds ratio for myocardial infarction associated with the highest as compared with the lowest quintile of mercury was 2.16 (95 percent confidence interval, 1.09 to 4.29; P for trend=0.006). After adjustment for the mercury level, the DHA level was inversely associated with the risk of myocardial infarction (odds ratio for the highest vs. the lowest quintile, 0.59; 95 percent confidence interval, 0.30 to 1.19; P for trend=0.02).

Conclusions The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.

Source Information

From the Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore (E.G.); the Department of Epidemiology and Biostatistics, National School of Public Health, Institute of Health Carlos III, Madrid (E.G., M.I.S.-G., J.M.M.-M.); the Service of Preventive Medicine, Hospital 12 de Octubre, Madrid (M.I.S.-G.); the Division of Human Nutrition and Epidemiology, University of Wageningen, Wageningen, the Netherlands (P.V., F.J.K.); the Interfaculty Reactor Institute, Delft University of Technology, Delft, the Netherlands (P.B.); the Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland (A.A.); the Department of Preventive Medicine, University of Málaga, Málaga, Spain (J.G.-A.); the Epidemiology Unit, Department of Social Medicine, Hadassah Medical Organization and Hebrew University–Hadassah School of Public Health and Community Medicine, Jerusalem, Israel (J.D.K.); the Cardiovascular Research Unit, University of Edinburgh, Edinburgh, United Kingdom, and the Department of Medical Physiology, University of Tromsø, Tromsø, Norway (R.A.R.); and the Department of Preventive Medicine, Universidad Autónoma de Madrid, Madrid (J.M.M.-M.)

Address reprint requests to Dr. Guallar at the Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 E. Monument St., Suite 2-639, Baltimore, MD 21205-2223, or at eguallar{at}jhsph.edu.

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Related Letters:

Mercury and the Risk of Myocardial Infarction
Plante M., Babo S., Mutter J., Naumann J., Buettner C., Guallar E., Riemersma R. A., Kok F. J., Yoshizawa K., Rimm E. B., Willett W. C., Bolger P. M., Schwetz B.
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N Engl J Med 2003; 348:2151-2154, May 22, 2003. Correspondence

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