RT Journal Article
T1 Mercury exposure and risk of cardiovascular disease: a nested case-control study in the PREDIMED (PREvention with MEDiterranean Diet) study.
A1 Downer, Mary K
A1 Martínez-González, Miguel A
A1 Gea, Alfredo
A1 Stampfer, Meir
A1 Warnberg, Julia
A1 Ruiz-Canela, Miguel
A1 Salas-Salvadó, Jordi
A1 Corella, Dolores
A1 Ros, Emilio
A1 Fitó, Montse
A1 Estruch, Ramon
A1 Arós, Fernando
A1 Fiol, Miquel
A1 Lapetra, José
A1 Serra-Majem, Lluís
A1 Bullo, Monica
A1 Sorli, Jose V
A1 Muñoz, Miguel A
A1 García-Rodriguez, Antonio
A1 Gutierrez-Bedmar, Mario
A1 Gómez-Gracia, Enrique
A1 PREDIMED Study Investigators, 
K1 Cardiovascular disease
K1 Fish
K1 Mediterranean diet
K1 Mercury
K1 PREDIMED
K1 Toenail biomarker
AB Substantial evidence suggests that consuming 1-2 servings of fish per week, particularly oily fish (e.g., salmon, herring, sardines) is beneficial for cardiovascular health due to its high n-3 polyunsaturated fatty acid content. However, there is some concern that the mercury content in fish may increase cardiovascular disease risk, but this relationship remains unclear. The PREDIMED trial included 7477 participants who were at high risk for cardiovascular disease at baseline. In this study, we evaluated associations between mercury exposure, fish consumption and cardiovascular disease. We randomly selected 147 of the 288 cases diagnosed with cardiovascular disease during follow-up and matched them on age and sex to 267 controls. Instrumental neutron activation analysis was used to assess toenail mercury concentration. In-person interviews, medical record reviews and validated questionnaires were used to assess fish consumption and other covariates. Information was collected at baseline and updated yearly during follow-up. We used conditional logistic regression to evaluate associations in the total nested case-control study, and unconditional logistic regression for population subsets. Mean (±SD) toenail mercury concentrations (μg per gram) did not significantly differ between cases (0.63 (±0.53)) and controls (0.67 (±0.49)). Mercury concentration was not associated with cardiovascular disease in any analysis, and neither was fish consumption or n-3 fatty acids. The fully-adjusted relative risks for the highest versus lowest quartile of mercury concentration were 0.71 (95% Confidence Interval [CI], 0.34, 1.14; ptrend = 0.37) for the nested case-control study, 0.74 (95% CI, 0.32, 1.76; ptrend = 0.43) within the Mediterranean diet intervention group, and 0.50 (95% CI, 0.13, 1.96; ptrend = 0.41) within the control arm of the trial. Associations remained null when mercury was jointly assessed with fish consumption at baseline and during follow-up. Results were similar in different sensitivity analyses. We found no evidence that mercury exposure from regular fish consumption increases cardiovascular disease risk in a population of Spanish adults with high cardiovascular disease risk and high fish consumption. This implies that the mercury content in fish does not detract from the already established cardiovascular benefits of fish consumption. ISRCTN35739639 .
YR 2017
FD 2017-01-05
LK http://hdl.handle.net/10668/10739
UL http://hdl.handle.net/10668/10739
LA en
DS RISalud
RD Apr 9, 2025