Abstract
Chromium may improve insulin sensitivity, which can modify the risk of diabetes and cardiovascular disease (CVD). Therefore, we evaluated the association between toenail chromium and CVD in diabetic men. We performed cross-sectional and nested case-control analyses among men aged 40-75 years within the Health Professionals Follow-up Study. The cross-sectional analysis compared men with diabetes only (n = 688), diabetes with prevalent CVD (n = 198), and healthy control subjects (n = 361). The nested case-control study included 202 men with baseline diabetes who developed incident CVD and 361 matched control subjects. Mean toenail chromium (microg/g) was 0.71 in healthy control subjects, 0.61 in diabetes-only subjects, and 0.52 in diabetic subjects with prevalent CVD (P for trend = 0.003). In the cross-sectional analysis, the multivariate odds ratio (OR) between extreme quartiles was 0.74 (95% CI 0.49-1.11; P for trend = 0.18), comparing diabetes only with healthy control subjects. A similar comparison between diabetic subjects with prevalent CVD and healthy control subjects yielded an OR of 0.45 (0.24-0.84; P for trend = 0.003). In the nested case-control study, comparing diabetic men with incident CVD with healthy control subjects, the multivariate OR was 0.65 (0.36-1.17; P for trend = 0.16) between extreme quartiles. When we combined prevalent and incident CVD cases among diabetic men and compared them with healthy control subjects, the OR was 0.62 (0.39-1.01; P for trend = 0.02) between extreme quartiles. Our results suggest that diabetic men with CVD have lower toenail chromium than healthy control subjects. However, this study could not distinguish between the effects of chromium on diabetes and those on CVD. Long-term clinical trials are needed to determine whether chromium supplementation is beneficial for preventing CVD among diabetic patients.
Highlights
Chromium may improve insulin sensitivity, which can modify the risk of diabetes and cardiovascular disease (CVD)
M ost of the research on dietary factors affecting the risk of cardiovascular disease (CVD) in people with diabetes has been focused on macronutrients
Because the risk of CVD is substantially higher in individuals with diabetes than in those without diabetes [8], we conducted this study to evaluate the association between toenail chromium and CVD among men with diabetes within the Health Professionals Follow-up Study
Summary
Lower Toenail Chromium in Men With Diabetes and Cardiovascular Disease Compared With Healthy Men. The nested case-control study included 202 men with baseline diabetes who developed incident CVD and 361 matched control subjects. In the nested casecontrol study, comparing diabetic men with incident CVD with healthy control subjects, the multivariate OR was 0.65 (0.36 –1.17; P for trend ϭ 0.16) between extreme quartiles. The case subjects in the nested casecontrol analysis included all men with baseline diabetes who developed incident CVD during the follow-up period from the date of return of the toenail samples in 1987 until 1998 (n ϭ 202). The comparison between diabetic men with CVD and healthy control subjects was designed a priori because it could provide the strongest contrast in toenail chromium levels. The samples from baseline diabetic men in the cross-sectional analysis were analyzed together but separately from the nested case-control study batches. The reported geometric mean of toenail chromium is the antilog of a logtransformed form of this variable
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