The association of low selenium and renal insufficiency with coronary heart disease and all-cause mortality: NHANES III follow-up study
Department of Quantitative Health Sciences
Selenium; Renal Insufficiency; Coronary Disease; Mortality
Biostatistics | Epidemiology | Health Services Research
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.
DOI of Published Version
Charles B. Eaton, Abdul Rahman Abdul Baki, Molly E. Waring, Mary B. Roberts, Bing Lu. The association of low selenium and renal insufficiency with coronary heart disease and all-cause mortality: NHANES III follow-up study. Atherosclerosis, Volume 212, Issue 2, October 2010, Pages 689-694, DOI: 10.1016/j.atherosclerosis.2010.07.008.
Eaton, Charles B.; Abdul Baki, Abdul Rahman; Waring, Molly E.; Roberts, Mary B.; and Lu, Bing, "The association of low selenium and renal insufficiency with coronary heart disease and all-cause mortality: NHANES III follow-up study" (2010). Quantitative Health Sciences Publications and Presentations. 886.