Volume 89, Issue 5, May (2003), pp. 673-678 © The Author 2003
doi:10.1079/BJN2003825

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Myocardial infarction risk in relation to zinc concentration in toenails

J. M. Martin-Moreno^1,2,*, L. Gorgojo¹, R. A. Riemersma³, J. Gomez-Aracena⁴, J. D. Kark⁵, J. Guillen⁶, J. Jimenez⁷, J. J. Ringstad⁸, J. Fernandez-Crehuet⁴, P. Bode⁹ and F. J. Kok¹⁰, for the Heavy Metals and Myocardial Infarction Study Group
¹Institute of Health Carlos III, Ministry of Health and Consumer Affairs, Paseo del Prado 18-20, 28071 Madrid, Spain
²Department of Preventive Medicine, Universidad Autónoma de Madrid, Madrid, Spain
³Cardiovascular Research Unit, University of Edinburgh, Edinburgh, UK
⁴Department of Preventive Medicine, University of Málaga, Málaga, Spain
⁵Epidemiology Unit, Department of Social Medicine, Hadassah Medical Organization and Hebrew University – Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
⁶Department of Preventive Medicine, University of Granada, Granada, Spain
⁷Medical Department, AstraZeneca, Madrid, Spain
⁸Østfold Central Hospital, Fredrikstad, Norway
⁹Interfaculty Reactor Institute, Delft University of Technology, Delft, The Netherlands
¹⁰Division of Human Nutrition and Epidemiology, University of Wageningen, Wageningen, The Netherlands

 (Received 10 September 2002–Revised 20 December 2002–Accepted 9 January 2003)

Zn is an essential mineral. The role of Zn in atherosclerosis is not clear. Epidemiological studies, which have reported contradictory results, are limited by the use of serum Zn levels as a marker of intake. We assessed the association of toenail Zn, which integrates dietary Zn intake over 3 to 12 months, with the risk of a first myocardial infarction. Toenail Zn concentrations were determined by neutron activation analysis in the European multi-centre case–control study on antioxidants, myocardial infarction and breast cancer. This multi-centre case–control study included 684 cases and 724 controls from eight European countries and Israel. Toenail Zn levels of controls (adjusted for age and study centre) were positively associated with age, α-tocopherol and Se, but not with additional dietary variables or with classical risk factors for CHD. Average toenail Zn was 106·0 mg/kg in cases (95 % CI 103·1, 108·9) and 107·5 mg/kg in controls (95 % CI 104·5, 110·7). After controlling for cardiovascular risk factors and for centre, the adjusted odds ratios of myocardial infarction for quintiles 2–5 of toenail Zn with respect to the first quintile were 0·97 (95 % CI 0·59, 1·58), 1·15 (95 % CI 0·72, 1·85), 0·91 (95 % CI 0·56, 1·50), and 0·85 (95 % CI 0·52, 1·39). The P for trend was 0·45. In conclusion toenail Zn levels (reflecting long-term dietary intake) were not significantly associated with acute myocardial infarction.

Keywords:
Case-control studies: Heavy metals: Zinc: Myocardial infarction: Neutron activation analysis