title: Chromium Exposure and Risk of Cardiovascular Disease in High Cardiovascular Risk Subjects　- Nested Case-Control Study in the Prevention With Mediterranean Diet (PREDIMED) Study.
abstract: 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.
  
  
  
  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: www.controlled-trials.com; ISRCTN35739639.).
authors.affiliation: Department of Preventive Medicine and Public Health, University of Málaga.|The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).
authors.forename: Mario
authors.initials: M
authors.lastname: Gutiérrez-Bedmar
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).|Department of Preventive Medicine and Public Health, University of Navarra Medical School.|CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Nutrition, Harvard TH Chan School of Public Health.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Martínez-González
authors.affiliation: Department of Preventive Medicine and Public Health, University of Málaga.
authors.forename: Carlos
authors.initials: C
authors.lastname: Muñoz-Bravo
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).|Department of Preventive Medicine and Public Health, University of Navarra Medical School.|CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Canela
authors.affiliation: Department of Preventive Medicine and Public Health, University of Málaga.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mariscal
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).|CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Human Nutrition Unit, Biochemistry and Biotechnology Department, IISPV, Rovira i Virgili University.
authors.forename: Jordi
authors.initials: J
authors.lastname: Salas-Salvadó
authors.affiliation: CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Internal Medicine, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS).
authors.forename: Ramón
authors.initials: R
authors.lastname: Estruch
authors.affiliation: CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia.
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).|CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Cardiology, University Hospital of Araba.
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.affiliation: CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Cardiovascular Risk and Nutrition Unit, Hospital del Mar Institut for Medical Research (IMIM).
authors.forename: Monserrat
authors.initials: M
authors.lastname: Fito
authors.affiliation: CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Family Medicine, Research Unit, Sanitary District Primary Care Sevilla.
authors.forename: José
authors.initials: J
authors.lastname: Lapetra
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).|CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Clinical Sciences, University of Las Palmas de Gran Canaria.
authors.forename: Lluís
authors.initials: L
authors.lastname: Serra-Majem
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).|CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Internal Medicine, Hospital Belvitge.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pintó
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).|CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Cardiology, University Hospital of Araba.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Alonso-Gómez
authors.affiliation: CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia.
authors.forename: Olga
authors.initials: O
authors.lastname: Portoles
authors.affiliation: CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Palma Institute of Health Research (IdISPa), Hospital Son Espases.
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).|CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Human Nutrition Unit, Biochemistry and Biotechnology Department, IISPV, Rovira i Virgili University.
authors.forename: Mónica
authors.initials: M
authors.lastname: Bulló
authors.affiliation: CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Cardiovascular Risk and Nutrition Unit, Hospital del Mar Institut for Medical Research (IMIM).
authors.forename: Olga
authors.initials: O
authors.lastname: Castañer
authors.affiliation: CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute.|Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS).
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.affiliation: Department of Preventive Medicine and Public Health, University of Málaga.|The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III (ISCIII).
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Gracia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000178:diet therapy / Q000453:epidemiology; D016022:Case-Control Studies; D002857:Chromium / Q000633:toxicity*; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D002857:Chromium
keywords: Cardiovascular disease; Chromium; Diabetes; PREDIMED; Toenail biomarker