Chromium Exposure and Risk of Cardiovascular Disease in High Cardiovascular Risk Subjects ― Nested Case-Control Study in the Prevention With Mediterranean Diet (PREDIMED) Study ― Academic Article uri icon


  • 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).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.).


  • Gutiérrez-Bedmar, Mario
  • Martinez-Gonzalez, Miguel
  • Muñoz-Bravo, Carlos
  • Ruiz-Canela, Miguel
  • Mariscal, Alberto
  • Salas-Salvadó, Jordi
  • Estruch, Ramón
  • Corella, Dolores
  • Arós, Fernando
  • Fito, Monserrat
  • Lapetra, José
  • Serra-Majem, Lluís
  • Pintó, Xavier
  • Alonso-Gómez, Ángel
  • Portoles, Olga
  • Fiol, Miquel
  • Bulló, Mónica
  • Castañer, Olga
  • Ros, Emilio
  • Gómez-Gracia, Enrique

publication date

  • 2017