Magnesium and trace metals: risk factors for coronary heart disease? Association between blood levels and angiographic findings.

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Abstract
A deficiency or an excessive intake of metals with cardiovascular effects is suspected to be involved in the pathogenesis of coronary heart disease (CHD) and sudden death. In 106 patients undergoing coronary arteriography, serum levels of 6 essential metals (Mg, Cr, Cu, Mn, Se and Zn) and whole blood concentrations of 2 elements without known essential function (Cd and Pb) were measured using atomic absorption spectrophotometry (including the flameless technique) or neutron activation analysis. The patients were classified into 3 groups according to severity of CHD as assessed by coronary angiography: those without coronary lesions (n = 31) and those with moderate (n = 34) or severe CHD (n = 41). Patients with severe CHD had lower mean serum Mg and higher serum Cu and Mn levels than those without CHD (Mg, 1.63 .+-. 0.16 vs. 1.78 .+-. 0.16 meq/l, P < 0.005; Cu, 1.39 .+-. 0.22 vs. 1.24 .+-. 0.24 mg/l, P < 0.05; Mn, 1.30 .+-. 0.43 vs. 1.05 .+-. 0.40 .mu.g/l, P < 0.05). Metal concentrations in patients with moderate CHD did not differ significantly from control values. There was no significant association between prevalence and severity of CHD and the other elements investigated. Analysis of associations between metal concentrations and clinical characteristics revealed markedly elevated blood Cd levels in cigarette smokers compared with nonsmokers (2.49 .+-. 1.72 [n = 28] vs. 0.43 .+-. 0.22 .mu.g/l [n = 18], P < 0.001). A correlation was noted between Cd levels and the number of cigarettes smoked per day (r = 0.725, P < 0.001). A deficiency of Mg but not of the other metals studied may be present in patients with severe CHD; elevated serum Cu and Mg levels do not play a role in the development of CHD in the sample of patients studied, and cigarette smoking may be associated with increased serum Cd levels; this may explain in part the contribution of smoking to the risk of sudden death in patients with CHD.

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