Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Preventive Medicine
Chromium Exposure and Risk of Cardiovascular Disease in High Cardiovascular Risk Subjects ― Nested Case-Control Study in the Prevention With Mediterranean Diet (PREDIMED) Study ―
Mario Gutiérrez-BedmarMiguel Ángel Martínez-GonzálezCarlos Muñoz-BravoMiguel Ruiz-CanelaAlberto MariscalJordi Salas-SalvadóRamón EstruchDolores CorellaFernando ArósMonserrat FitoJosé LapetraLluís Serra-MajemXavier PintóÁngel Alonso-GómezOlga PortolesMiquel FiolMónica BullóOlga CastañerEmilio RosEnrique Gómez-Gracia
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Supplementary material

2017 Volume 81 Issue 8 Pages 1183-1190


Background:Epidemiological data on chromium (Cr) exposure and the risk of cardiovascular disease (CVD) are still limited. Toenail Cr level (TCL) provides a time-integrated measure reflecting long-term Cr exposure. We measured TCL to assess the hypothesis that long-term Cr exposure was inversely associated with incident CVD in a population at high risk for CVD.

Methods and Results:The associations between TCL and CVD were evaluated in a case-control study nested within the “PREvención con DIeta MEDiterránea” (PREDIMED) trial. We randomly selected 147 of the 288 patients diagnosed with CVD during follow-up and matched them on age and sex to 271 controls. Instrumental neutron activation analysis was used to assess TCL. In-person interviews, medical record reviews, and validated questionnaires were used to assess covariates. The fully adjusted OR for the highest vs. lowest quartile of toenail Cr was 0.54 (95% CI: 0.26–1.14; Ptrend=0.189) for the nested case-control study. On stratification for diabetes mellitus (DM), OR was 1.37 (95% CI: 0.54–3.46; Ptrend=0.364) for the DM group, and 0.25 (95% CI: 0.08–0.80; Ptrend=0.030) for the non-DM group (P for interaction=0.078).

Conclusions:The present findings, although not statistically significant, are consistent with previously reported inverse associations between TCL and CVD. These results, especially for non-DM patients, increase the limited epidemiological knowledge about the possible protective role of Cr against CVD. (Trial registration:; ISRCTN35739639.)

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