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Marked
Elevation of Myocardial Trace Elements in Idiopathic Dilated
Cardiomyopathy Compared With Secondary Dysfunction
1Frustaci, A., 2Magnavita,
N., 1Chimenti, C., 2Caldarulo, M.,
3Sabbioni, E., 3Pietra, R., 4Cellini,
C., 4Possati, G.F. and 1Maseri, A.
1Department of Cardiology, 2Department
of Occupational Medicine, and 3Department of
Cardiac Surgery, Catholic University, Rome Italy and CEC
4Environmental Institute Joint Research
Center Ispra, Rome, Italy
Journal of the American College of
Cardiology
Vol. 33, No. 6, 1999, pp. 1578-1583
Objectives: We
sought to investigate the possible pathogenic role of
myocardial trace elements (TE) in patients with various
forms of cardiac failure.
Background: Both
myocardial TE accumulation and deficiency have been
associated with the development of heart failure
indistinguishable from an idiopathic dilated
cardiomyopathy.
Methods:
Myocardial and muscular content of 32 TE has been
assessed in biopsy samples of 13 patients (pts) with
clinical, hemodynamic and histologic diagnosis of
idiopathic dilated cardiomyopathy (IDCM), all without
past or current exposure to TE. One muscular and
one left ventricular (LV) endomyocardial specimen from
each patient, drawn with metal contamination-free
technique, were analyzed by neutron activation analysis
and compared with 1) similar surgical samples from
patients with valvular (12 pts) and ischemic (13 pts)
heart disease comparable for age and degree of LV
dysfunction; 2) papillary and skeletal muscle surgical
biopsies from 10 pts with mitral stenosis and normal LV
function, and 3) LV endomyocardial biopsies from four
normal subjects.
Results: A large
increase (>10,000 times for mercury and antimony) of
TE concentration has been observed in myocardial but not
in muscular samples in all pts with IDCM. Patients
with secondary cardiac dysfunction had mild increase
(<5 times) of myocardial TE and normal muscular TE.
In particular, in pts with IDCM mean mercury
concentration was 22,000 times
(178,400 ng/g vs. 8 ng/g), antimony 12,000 times (19,260
ng/g vs. 1.5 ng/g), gold 11 times (26 ng/g vs. 2.3 ng/g),
chromium 13 times (2,300 ng/g vs. 177 ng/g) and cobalt 4
times (86.5 ng/g vs. 20 ng/g) higher than in control
subjects.
Conclusions: A
large, significant increase of myocardial TE is present
in IDCM but not in secondary cardiac dysfunction.
The increased concentration of TE in pts with IDCM may
adversely affect mitochondrial activity and myocardial
metabolism and worsen cellular function.
To order a copy of this abstract or a complete copy
of this study from the National Library of Medicine see
the following:
Marked elevation of myocardial trace elements in
idiopathic dilated cardiomyopathy compared with
secondary cardiac dysfunction. Frustaci et al.,
(1999). J. Am. Coll. Cardiol. 33:1578-83.
(10334427)

Mercury
Ups Heart Disease Risk
Science Daily Magazine
http://www.sciencedaily.com/releases/2002/04/020429073754.htm
HONOLULU,
April 24 – Finnish men with the highest concentrations
of mercury in their hair also had the highest death rates
from cardiovascular disease, congestive heart failure and
stroke, according to a study presented today at the
American Heart Association’s Asia Pacific Scientific
Forum.
Mercury content in the hair is a marker for the amount
of methyl mercury, a toxic form of the element,
accumulated in the body by eating contaminated fish. Some
scientists believe that the amalgam in dental fillings may
also be a significant source of mercury, but questions
remain about whether the mercury in dental fillings, which
is inorganic, is absorbed into the body.
“Although consumption of fish may be healthy in
general, some fish may contain methyl mercury in amounts
harmful for humans,” says study author Jukka T. Salonen,
M.D., Ph.D, MScP.H., professor of epidemiology at the
Research Institute of Public Health at the University of
Kuopio in Finland.
In the Kuopio Ischemic Heart Disease Risk Factor (KIHD)
study, a total of 2,005 men without heart disease, between
42 and 60 years old were divided into four groups based on
the mercury content of their hair, and tracked for an
average of 12 years.
Heart disease was defined as a history of an acute
coronary event, like a heart attack, or angina pectoris,
stroke or other cardiovascular event. The researchers
controlled for other risk factors that could have affected
their results, including age, levels of high-density
lipoprotein (HDL, “good” cholesterol), low-density
lipoprotein (LDL, “bad” cholesterol), triglycerides,
family history of coronary heart disease, systolic blood
pressure, weight and intake of fatty acids and
antioxidants.
The men who scored in the top 25 percent for hair
mercury content had a 60 percent increased risk of death
from CVD compared to the men in the lower mercury content.
Those same men had a 70 percent increased risk of coronary
heart disease alone, says Salonen. The amount of mercury
in the hair was determined by flow injection analysis-cold
vapor atomic absorption spectrometry and amalgamation, one
of several tests available to determine mercury content.
“Men who consumed 30 grams or more of fish daily –
had 56 percent higher average hair mercury than those
whose daily consumption was less than 30 grams. Those same
men also tended to consume certain types of
‘predatory’ fish,” says Salonen. Fish higher in the
food chain – i.e., those who eat smaller contaminated
fish – tend to have the highest levels of methyl
mercury.
“The results also showed that men whose hair mercury
levels were in the top 20 percent had a 32 percent faster
increase in the thickness of the inner walls of their
arteries, a measure of atherosclerosis, compared to men in
the rest of the group.
Atherosclerosis is the build-up of fatty plaque in
arteries and is the underlying process that causes
cardiovascular disease. Previous studies have shown that
increasing dietary levels of fish containing omega-3 fatty
acids benefits people with cardiovascular disease, as well
as healthy people.
The American Heart Association currently recommends
that individuals consume two servings of fish weekly, both
for the benefits of omega-3 fatty acids, and because fish
tends to be low in saturated fats, which contribute to
elevated cholesterol levels.
“These results from Kuopio are intriguing, but
preliminary, and should be viewed in the context of many
other studies that have shown a clear cardiovascular
benefit to consuming fish on a regular basis,” says
Barbara V. Howard, Ph.D., chair of the American Heart
Association’s Nutrition Committee and president of
MedStar Research Institute in Washington, D.C.
“It is important to note that this is an
observational study, and the conclusions do not prove a
direct relationship between the amount of mercury in the
hair and heart attacks. There may be factors such as the
socio-economic status of the men or other dietary factors
that are hard to measure, that account for the higher
risk,” says Howard.
Researchers became interested in looking at an
association between mercury and cardiovascular disease
because mercury has been shown to promote the oxidation of
low-density lipoproteins in the arteries. Oxidation is a
major component in the development of atherosclerosis. In
addition, mercury can interfere with the antioxidant
effects of selenium, an essential trace element found
mainly in plant foods, and in the U.S., in grains and
meat.
The KIHD study is an ongoing, population-based study
designed to investigate risk factors for cardiovascular
diseases and their outcomes among men in Eastern Finland.
Previous studies with shorter follow-up periods from the
same research group found a strong association between
high hair mercury content and an increased risk of death.
Researchers wanted to retest these results over a longer
follow-up period.
“It should be noted that we are not against eating
fish per se,” adds Salonen. “What these results mainly
say is that one should avoid regular consumption of old,
large predatory fish, in which mercury levels are high,
especially when caught from sources that are known to have
a high mercury content. Our best advice is to consume a
variety of fish, preferably young and small, from
different lakes and seas in order to avoid possible high
local levels of mercury.”
The American Heart Association suggests consuming fish
such as mackerel, lake trout, herring, sardines, albacore
tuna and salmon twice a week.
Co-authors include Jyrki K.Virtanen M.S.c., R.D.; Sari
Voutilainen Ph.D., R.D.; Tiina H. Rissanen, M.Sc, R.D.;
Jaakko Mursu, M.Sc, R.D.; Meri Vanharanta, M.Sc, R.D.;
Kari Seppanen; and Jari Laukkanen, M.D.

Mercury ups heart
disease risk
Co-authors include Jyrki K.Virtanen M.S.c., R.D.; Sari
Voutilainen Ph.D., R.D.; Tiina H. Rissanen, M.Sc, R.D.;
Jaakko Mursu, M.Sc, R.D.; Meri Vanharanta, M.Sc, R.D.;
Kari Seppanen; and Jari Laukkanen, M.D.
American Heart Association Meeting Report 04/24/2002
http://216.185.112.5/presenter.jhtml?identifier=3002342
HONOLULU, April 24 - Finnish men with the highest
concentrations of mercury in their hair also had the
highest death rates from cardiovascular disease,
congestive heart failure and stroke, according to a study
presented today at the American Heart Association's Asia
Pacific Scientific Forum.
Mercury content in the hair is a marker for the amount
of methyl mercury, a toxic form of the element,
accumulated in the body by eating contaminated fish. Some
scientists believe that the amalgam in dental fillings may
also be a significant source of mercury, but questions
remain about whether the mercury in dental fillings, which
is inorganic, is absorbed into the body.
"Although consumption of fish may be healthy in
general, some fish may contain methyl mercury in amounts
harmful for humans," says study author Jukka T.
Salonen, M.D., Ph.D, MScP.H., professor of epidemiology at
the Research Institute of Public Health at the University
of Kuopio in Finland.
In the Kuopio Ischemic Heart Disease Risk Factor (KIHD)
study, a total of 2,005 men without heart disease, between
42 and 60 years old were divided into four groups based on
the mercury content of their hair, and tracked for an
average of 12 years.
Heart disease was defined as a history of an acute
coronary event, like a heart attack, or angina pectoris,
stroke or other cardiovascular event. The researchers
controlled for other risk factors that could have affected
their results, including age, levels of high-density
lipoprotein (HDL, "good" cholesterol),
low-density lipoprotein (LDL, "bad"
cholesterol), triglycerides, family history of coronary
heart disease, systolic blood pressure, weight and intake
of fatty acids and antioxidants.
The men who scored in the top 25 percent for hair
mercury content had a 60 percent increased risk of death
from CVD compared to the men in the lower mercury content.
Those same men had a 70 percent increased risk of coronary
heart disease alone, says Salonen. The amount of mercury
in the hair was determined by flow injection analysis-cold
vapor atomic absorption spectrometry and amalgamation, one
of several tests available to determine mercury content.
"Men who consumed 30 grams or more of fish daily -
had 56 percent higher average hair mercury than those
whose daily consumption was less than 30 grams. Those same
men also tended to consume certain types of 'predatory'
fish," says Salonen. Fish higher in the food chain -
i.e., those who eat smaller contaminated fish - tend to
have the highest levels of methyl mercury.
"The results also showed that men whose hair
mercury levels were in the top 20 percent had a 32 percent
faster increase in the thickness of the inner walls of
their arteries, a measure of atherosclerosis, compared to
men in the rest of the group. Atherosclerosis is the
build-up of fatty plaque in arteries and is the underlying
process that causes cardiovascular disease.
Previous studies have shown that increasing dietary
levels of fish containing omega-3 fatty acids benefits
people with cardiovascular disease, as well as healthy
people.
The American Heart Association currently recommends
that individuals consume two servings of fish weekly, both
for the benefits of omega-3 fatty acids, and because fish
tends to be low in saturated fats, which contribute to
elevated cholesterol levels.
"These results from Kuopio are intriguing, but
preliminary, and should be viewed in the context of many
other studies that have shown a clear cardiovascular
benefit to consuming fish on a regular basis," says
Barbara V. Howard, Ph.D., chair of the American Heart
Association's Nutrition Committee and president of MedStar
Research Institute in Washington, D.C.
"It is important to note that this is an
observational study, and the conclusions do not prove a
direct relationship between the amount of mercury in the
hair and heart attacks. There may be factors such as the
socio-economic status of the men or other dietary factors
that are hard to measure, that account for the higher
risk," says Howard.
Researchers became interested in looking at an
association between mercury and cardiovascular disease
because mercury has been shown to promote the oxidation of
low-density lipoproteins in the arteries. Oxidation is a
major component in the development of atherosclerosis. In
addition, mercury can interfere with the antioxidant
effects of selenium, an essential trace element found
mainly in plant foods, and in the U.S., in grains and
meat.
The KIHD study is an ongoing, population-based study
designed to investigate risk factors for cardiovascular
diseases and their outcomes among men in Eastern Finland.
Previous studies with shorter follow-up periods from the
same research group found a strong association between
high hair mercury content and an increased risk of death.
Researchers wanted to retest these results over a longer
follow-up period.
"It should be noted that we are not against eating
fish per se," adds Salonen. "What these results
mainly say is that one should avoid regular consumption of
old, large predatory fish, in which mercury levels are
high, especially when caught from sources that are known
to have a high mercury content. Our best advice is to
consume a variety of fish, preferably young and small,
from different lakes and seas in order to avoid possible
high local levels of mercury."
The American Heart Association suggests consuming fish
such as mackerel, lake trout, herring, sardines, albacore
tuna and salmon twice a week.
Co-authors include Jyrki K.Virtanen M.S.c., R.D.; Sari
Voutilainen Ph.D., R.D.; Tiina H. Rissanen, M.Sc, R.D.;
Jaakko Mursu, M.Sc, R.D.; Meri Vanharanta, M.Sc, R.D.;
Kari Seppanen; and Jari Laukkanen, M.D.
American Heart Association

Circulation. 1995;91:645-655.
Intake
of Mercury From Fish, Lipid Peroxidation, and the Risk
of Myocardial Infarction and Coronary, Cardiovascular,
and Any Death in Eastern Finnish Men
Jukka T. Salonen, MD, PhD, MScPH;
Kari Seppänen, MSc; Kristiina Nyyssönen, MSc; Heikki
Korpela, MD, PhD; Jussi Kauhanen, MD, PhD; Marjatta
Kantola, MSc; Jaakko Tuomilehto, MD, PhD; Hermann
Esterbauer, PhD; Franz Tatzber, PhD; Riitta Salonen, MD,
PhD
From the Research Institute of Public Health (J.T.S.,
K.S., K.N., J.K., R.S.) and Departments of Community
Health and General Practice (H.K.) and Chemistry (M.K.),
University of Kuopio, Finland; the Department of
Epidemiology and Health Promotion (J.T.), the National
Public Health Institute of Finland, Helsinki, Finland;
and the Institute of Biochemistry (H.E., F.T.),
University of Graz, Austria.
Correspondence to Prof Jukka T. Salonen, University
of Kuopio, PO Box 1627, 70211 Kuopio, Finland.
Background Even though previous studies
have suggested an association between high fish intake
and reduced coronary heart disease (CHD) mortality, men
in Eastern Finland, who have a high fish intake, have an
exceptionally high CHD mortality. We hypothesized that
this paradox could be in part explained by high mercury
content in fish.
Methods and Results We studied the
relation of the dietary intake of fish and mercury, as
well as hair content and urinary excretion of mercury,
to the risk of acute myocardial infarction (AMI) and
death from CHD, cardiovascular disease (CVD), and any
cause in 1833 men aged 42 to 60 years who were free of
clinical CHD, stroke, claudication, and cancer. Of
these, 73 experienced an AMI in 2 to 7 years. Of the 78
deceased men, 18 died of CHD and 24 died of CVD. Men who
had consumed local nonfatty fish species had elevated
hair mercury contents. In Cox models with the major
cardiovascular risk factors as covariates, dietary
intakes of fish and mercury were associated with
significantly increased risk of AMI and death from CHD,
CVD, and any death. Men in the highest tertile (2.0 µg/g)
of hair mercury content had a 2.0-fold (95% confidence
interval, 1.2 to 3.1; P=.005) age- and CHD-adjusted risk
of AMI and a 2.9-fold (95% CI, 1.2 to 6.6; P=.014)
adjusted risk of cardiovascular death compared with
those with a lower hair mercury content. In a nested
case-control subsample, the 24-hour urinary mercury
excretion had a significant (P=.042) independent
association with the risk of AMI. Both the hair and
urinary mercury associated significantly with titers of
immune complexes containing oxidized LDL.
Conclusions These data suggest that a
high intake of mercury from nonfatty freshwater fish and
the consequent accumulation of mercury in the body are
associated with an excess risk of AMI as well as death
from CHD, CVD, and any cause in Eastern Finnish men and
this increased risk may be due to the promotion of lipid
peroxidation by mercury.
http://circ.ahajournals.org/cgi/content/abstract/91/3/645id=988754535598_145
http://circ.ahajournals.org/cgi/content/full/91/3/645id=988754554551_3830

Mortality
in mice infected with an amyocarditic coxsackievirus and
given a subacute dose of mercuric chloride.
South PK, Morris VC, Levander OA,
Smith AD.
Beltsville Human Nutrition Research
Center, US Department of Agriculture, Agricultural
Research Service, Maryland 20705-2350, USA.
J Toxicol Environ Health A (2001)
Aug 10;63(7):511-23.
http://www.ncbi.nlm.nih.gov/entrez/PubMed&list_uids=11497332&dopt=Abstract
An amyocarditic strain of coxsackievirus B3 (CVB3/0)
induces heart damage when inoculated into selenium
(Se)-deficient mice. Mercury (Hg), an Se antagonist, is
known to aggravate viral infections. The experiments
reported here assessed the effect of prior Hg treatment
in mice subsequently inoculated with an amyocarditic
strain of coxsackievirus. A pilot study showed that
under our conditions the maximum tolerated dose of HgCl2
in uninfected mice was 6 mg HgCl2/kg body
weight. In the main study, doses of 0, 3 or 6 mg HgCl2/kg
body weight were administered intraperitoneally (ip) to
7-wk-old male mice fed a standard chow diet. Two hours
later, half the mice were inoculated ip with CVB3/0. Ten
days postinoculation, no mortality was observed in mice
given only virus. In mice not given virus, 10% injected
with 6 mg HgCl2/kg body weight died. On the
other hand, 64% of the mice given both virus and 6 mg
HgCl2/kg body weight died. Fifteen percent of the hearts
from virus-infected mice given 3 mg HgCl2/kg
body weight and 33% of the hearts from virus-infected
mice given 6 mg HgCl2/kg body weight
exhibited a higher incidence of lesions than hearts from
mice-given virus alone. Moreover, viral heart titers
were elevated in infected mice injected with 6 mg HgCl2/kg
body weight compared to infected mice receiving no Hg.
Thus, an amyocarditic coxsackievirus given to mice after
a nonlethal subacute dose of Hg results in mortality,
increased incidence of heart lesions, and elevated viral
heart titers. These results demonstrate the important
role of toxic elements in determining the severity of
viral infections.

For additional studies on mercury exposure and heart
dysfunction see Toxic
Effects of Mercury on the Cardiovascular System |