title: The association of low selenium and renal insufficiency with coronary heart disease and all-cause mortality: NHANES III follow-up study.
abstract: Although prospective studies suggest that low selenium is a risk factor for cardiovascular disease, most clinical trials of selenium supplementation have not shown this benefit. Prospective studies of renal insufficiency show that it is associated with low-selenium levels, and increased cardiovascular disease risk. We hypothesized that low selenium and renal insufficiency might show biologically important interactions warranting a future trial of selenium supplementation in this high-risk group of patients with both renal insufficiency and low selenium. We evaluated the prospective association of low selenium and renal insufficiency with coronary heart disease and all-cause mortality. A cohort of 10,531 NHANES III participants aged 35 years or older with serum selenium measurements and creatinine were followed longitudinally and linked to the National Death Index. In multivariable-adjusted analysis, low-selenium levels were associated with an increased risk of CHD mortality (HR=1.26; 95% CI: 0.94-1.69) and an increased risk for all-cause mortality (HR=1.41; 95% CI: 1.18-1.68). Renal insufficiency was also associated with increased risk of CHD mortality (HR=1.64; 95% CI: 1.29-2.08) and all-cause mortality (HR=1.51; 95% CI: 1.31-1.74). Despite the findings that adults with impaired renal function and low selenium had an increased risk for CHD mortality (HR=2.06; 95% CI: 1.13-3.75), there was no evidence of supra-additivity between low selenium and renal insufficiency on rate of CHD mortality (relative excess risk due to the interaction [RERI=0.16; 95% CI: -1.34 to 1.65] or all-cause mortality (RERI=-0.85; 95% CI: -1.50 to -0.20). This analysis suggests that the combination of renal insufficiency and low selenium does not represent an extremely high-risk group where a randomized trial of selenium supplementation would be of greater value than focusing on all adults with low-serum selenium.
authors.affiliation: Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, and Department of Internal Medicine/Internal Medicine Residency Program, Alpert Medical School of Brown University, Pawtucket, RI 02860, United States. Charles_Eaton@mhri.org
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.forename: Abdul Rahman
authors.initials: AR
authors.lastname: Abdul Baki
authors.forename: Molly E
authors.initials: ME
authors.lastname: Waring
authors.forename: Mary B
authors.initials: MB
authors.lastname: Roberts
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D012306:Risk; D012307:Risk Factors; D012643:Selenium / Q000097:blood*
chemical_list: D012643:Selenium