Review Article Published on 14 Mar, 2024

A Meta-Analysis of Essential Trace Elements in Patients with Coronary Heart Disease

Meta-analysis of Essential Trace Elements in CHD
Vol. 19 No. 1 : 2024 (1-24)

Megat Kamaruddin PSN Megat Kamaruddin PSN
Mohammed Nawi A Mohammed Nawi A
Ja’afar MH Ja’afar MH
Abd Malek AM Abd Malek AM
Yaman MN Yaman MN

Abstract
There is growing evidence that presence of essential trace elements that pose risk for coronary heart disease (CHD) patients. A meta-analysis was conducted on the levels of trace elements Copper (Cu), Zinc (Zn), Iron (Fe), Manganese (Mn), Cobalt (Co) and Chromium (Cr) in CHD patients. Eligible articles from the databases of Web of Science, Scopus, PubMed, EBSCOHost and Ovid were searched based on PRISMA guidelines. English articles published between 2011 to 2021 were included and analysed by descriptive statistics and RevMan 5.4. Quality assessment was assessed with Newcastle-Ottawa scale. There were six studies selected with 322 participants’ data. Trace elements Cu (SMD=-0.13, 95%CI=[-0.99, 0.73], I2=92%, p=0.77), Zn (SMD=-0.38, 95%CI=[-0.81, 0.06], I2=71%, p=0.09), Fe (SMD=0.47, 95%CI=[-1.19, 2.13], I2=97%, p=0.58) and Mn (SMD=0.11, 95%CI=[-0.11, 0.33], I2=0%, p=0.33) levels were not significant. Sensitivity analysis revealed significant Cu level among patients with CHD (SMD=-0.54, 95%CI=[-0.85, -0.22], I2=0%, p=0.0008) and Fe level among the controls (SMD=1.41, 95%CI=[0.08, 2.73], I2=95%, p=0.04). Whereas Co and Cr levels varied according to dietary and smoking behaviours. Overall quality assessment was medium-to-high quality. Elements Cu was found significant in CHD patients and Fe was found significant among the controls, while other findings were inconclusive.
Keywords : Coronary heart disease, essential trace elements, meta-analysis,
Abstrak
Terdapat bukti yang semakin meningkat bahawa kehadiran unsur surih penting yang menimbulkan risiko untuk pesakit penyakit jantung koronari (CHD). Meta-analisis telah dijalankan ke atas tahap unsur surih Kuprum (Cu), Zink (Zn), Besi (Fe), Mangan (Mn), Kobalt (Co) dan Kromium (Cr) dalam pesakit CHD. Artikel yang sesuai daripada pangkalan data Web of Science, Scopus, PubMed, EBSCOHost dan Ovid telah dicari berdasarkan garis panduan PRISMA. Artikel Bahasa Inggeris yang diterbitkan antara 2011 hingga 2021 disertakan dan dianalisis dengan statistik deskriptif dan RevMan 5.4. Penilaian kualiti dinilai dengan skala Newcastle-Ottawa. Terdapat enam kajian telah dipilih dengan 322 data peserta. Unsur surih Cu (SMD=-0.13, 95%CI=[-0.99, 0.73], I2=92%, p=0.77), Zn (SMD=-0.38, 95%CI=[-0.81, 0.06], I2= 71%, p=0.09), Fe (SMD=0.47, 95%CI=[-1.19, 2.13], I2=97%, p=0.58) dan Mn (SMD=0.11, 95%CI=[-0.11, 0.33 ], I2=0%, p=0.33) menunjukkan tahap tidak signifikan. Analisis sensitiviti mendedahkan tahap Cu yang ketara dalam kalangan pesakit dengan CHD (SMD=-0.54, 95%CI=[-0.85, -0.22], I2=0%, p=0.0008) dan tahap Fe antara kawalan (SMD=1.41, 95% CI=[0.08, 2.73], I2=95%, p=0.04). Dapatan kajian juga menunjukkan paras elemen-elemen surih Co dan Cr berbeza-beza mengikut tingkah laku pemakanan dan tabiat merokok. Penilaian kualiti  secara keseluruhan menunjukkan kadar kualiti yang sederhana tinggi. Dari analisis yang telah dijalankan, elemen surih Cu didapati signifikan pada pesakit jantung koronari dan elemen surih Fe didapati signifikan di kalangan kajian kawalan, manakala penemuan lain tidak menunjukkan hasil kajian yang muktamad. 
Kata Kunci : Meta-analisis, penyakit jantung koronari, unsur surih penting,

Correspondance Address
Mohamad Nurman Yaman, Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia. Tel: +603-9145 9433 Email: mdnurman@ppukm.ukm.edu.my

References
Al-Fartusie, F.S., Mohssan, S.N. 2017. Essential trace elements and their vital roles in human body. Indian J Adv Chem Sci 5(3): 127-36.

Aliasgharpour, M., Farzami, M.R. 2013. Trace elements in human nutrition: A review. Int J Med Invest 2(3): 115-28.

Alshwaiyat, N.M., Ahmad, A., Wan Hassan, W.M.R., Al-Jamal, H.A.N. 2021. Association between obesity and iron deficiency (Review). Exp Ther Med 22(5): 1268.

Anonna, S.N., Ahamed, S.K., Uddin, M.G., Adnan, M.T., Uddin, S.M.N., Hussain, M.S., Millat, M.S., Bulbul, L., Bhatta, R., Sarwar, M.S., Rashid, M.M.U., Chowdhury, J.A., Islam, M.S. 2020. A clinical evaluation of the alterations in the level of serum zinc, copper, iron, and manganese in the ischemic heart disease patients of Bangladesh - A case-control study. Heliyon 6(10): 1-6.

Bagheri, B., Akbari, N., Tabiban, S., Habibi, V., Mokhberi, V. 2015. Serum level of copper in patients with coronary artery disease. Nigerian Med J 56(1): 39-42.

Balali-Mood, M., Naseri, K., Tahergorabi, Z., Khazdair, M.R., Sadeghi, M. 2021. Toxic mechanisms of five heavy metals: Mercury, lead, chromium, cadmium, and arsenic. Front Pharmacol 12: 643972.

Banach, W., Nitschke, K., Krajewska, N., Mongiałło, W., Matuszak, O., Muszyński, J., Skrypnik, D. 2020. The association between excess body mass and disturbances in somatic mineral levels. Int J Mol Sci 21(19): 7306.

Banihani, S.A., Jaradat, S.A., Khader, Y.S. 2019. Serum chromium level is increased in jordanian smokers, decreased in jordanians with prediabetes and type 2 diabetes, but not altered in jordanians with hypertension, with obesity, or with family history of diabetes. Int J Prev Med 10: 145.

Beale, A.L., Meyer, P., Marwick, T.H., Lam, C. S.P., Kaye, D.M. 2018. Sex Differences in cardiovascular pathophysiology: Why women are overrepresented in heart failure with preserved ejection fraction. Circulation 138(2): 198-205.

Bhatnagar, R.S., Padilla-Zakour, O.I. 2021. Plant-based dietary practices and socioeconomic factors that influence anemia in India. Nutrients 13(10): 3538.

Bost, M., Houdart, S., Oberli, M., Kalonji, E., Huneau, J.F., Margaritis, I. 2016. Dietary copper and human health: Current evidence and unresolved issues. J Trace Elem Med Biol 35: 107-15.

Bugiardini, R., Manfrini, O., Cenko, E. 2019. Female sex as a biological variable: A review on younger patients with acute coronary syndrome. Trends Cardiovasc Med 29(1): 50-5.

Bulska, E., Ruszczyńska, A. 2017. Analytical techniques for trace element determination. Phys Sci Rev 2(5): 20178002.

Campbell, M., Mckenzie, J.E., Sowden, A., Katikireddi, S.V., Brennan, S.E., Ellis, S., Hartmann-Boyce, J., Ryan, R., Shepperd, S., Thomas, J., Welch, V., Thomson, H. 2020. Synthesis without meta-analysis (swim) in Systematic reviews: Reporting guideline. BMJ 368: l6890.

Cannas, D., Loi, E., Serra, M., Firinu, D., Valera, P. & Zavattari, P. 2020. Relevance of essential trace elements in nutrition and drinking water for human health and autoimmune disease risk. Nutrients 12(7): 2074.

Cappelletti, R., Ceppi, M., Claudatus, J., Gennaro, V. 2016. Health status of male steel workers at an electric arc furnace (Eaf) in Trentino, Italy. J Occup Med Toxicol 11(1): 1-10.

Cebi, A., Kaya, Y., Gungor, H., Demir, H., Yoruk, I. H., Soylemez, N., Gunes, Y., Tunce, M. 2011. Trace elements, heavy metals and vitamin levels in patients with coronary artery disease. Int J Med Sci 8(6): 456-60.

Choi, H.I., Ko, H.J., Kim, A.S., Moon, H. 2019. The association between mineral and trace element concentrations in hair and the 10-year risk of atherosclerotic cardiovascular disease in healthy community-dwelling elderly individuals. Nutrients 11(3): 637.

Chowdhury, R., Ramond, A., O’keeffe, L.M., Shahzad, S., Kunutsor, S.K., Muka, T., Gregson, J., Willeit, P., Warnakula, S., Khan, H., Chowdhury, S., Gobin, R., Franco, O.H., Angelantonio, E.D. 2018. Environmental toxic metal contaminants and risk of cardiovascular disease: Systematic review and meta-analysis. BMJ 362: k3310.

Clerc Liaudat, C., Vaucher, P., De Francesco, T., Jaunin-Stalder, N., Herzig, L., Verdon, F., Favrat, B., Locatelli, I., Clair, C. 2018. Sex/gender bias in the management of chest pain in ambulatory care. Womens Health 14: 1745506518805641.

Department of Statistics Malaysia. 2021. Overviews: Statistics on Causes of Death. https://www.dosm.gov.my/v1/index.php?r=column/ctwoByCat&parent_id=115&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09#:~:text=Statistics%20on%20Causes%20of%20Death%2C%20Malaysia%2C%202021&text=There%20were%20166.5%20thousand%20deaths,to%202019%20(173.7%20thousand). [10th March 2022].

Dinicolantonio, J.J., Mangan, D., O’keefe, J.H. 2018. Copper deficiency may be a leading cause of ischaemic heart disease. Open Heart (5): e000784.

Doguer, C., Ha, J.H., Collins, J.F. 2018. Intersection of iron and copper metabolism in the mammalian intestine and liver. Compr Physiol 8(4): 1433-61.

Georgi, J.C., Sommer, Y.L., Ward, C.D., Cheng, P.Y., Jones, R.L., Caldwell, K.L. 2017. Biomonitoring Method for the analysis of chromium and cobalt in human whole blood using inductively coupled plasma - Kinetic energy discrimination - Mass spectrometry (Icp-Ked-Ms). Anal Methods 9(23): 3464-76.

Godswill, A.G., Somtochukwu, I.V., Ikechukwu, A.O., Kate, E.C. 2020. Health benefits of micronutrients (vitamins and minerals) and their associated deficiency diseases: A systematic review. Int J Food Sci 3(1): 1-32.

Haehling, S.V., Jankowska, E.A., Veldhuisen, D.J.V., Ponikowski, P., Anker, S.D. 2015. Iron deficiency and cardiovascular disease. Nat Rev Cardiol 12: 659-69.

Higgins, J.P., Altman, D.G., Sterne, J.A. 2011. Chapter 9: Analysing data and undertaking meta-analysis. https://handbook-5-1.cochrane.org/chapter_9/9_analysing_data_and_undertaking_meta_analyses.htm [10th March 2022].

Higgins, J.P., Green, S. 2011. Cochrane handbook for systematic reviews of interventions, Version 5.1.0 (Updated March 2011). https://handbook-5-1.cochrane.org/ [10th March 2021].

Himoto, T., Masaki, T. 2020. Current trends of essential trace elements in patients with chronic liver diseases. Nutrients 12(7): 2084.

Ilyas, A., Shah, M.H. 2015. Abnormalities of selected trace elements in patients with coronary artery disease. Acta Cardiol Sin 31(6): 518-27.

Isiozor, N.M., Kunutsor, S.K., Vogelsang, D., Isiozor, I., Kauhanen, J., Laukkanen, J.A. 2023. Serum copper and the risk of cardiovascular disease death in finnish men. Nutr Metab Cardiovasc Dis 33(1): 151-7.

Kunutsor, S.K., Dey, R.S., Laukkanen, J.A. 2021. Circulating serum copper is associated with atherosclerotic cardiovascular disease, but not venous thromboembolism: A prospective cohort study. Pulse 9: 109-15.

Laudisio, D., De Alteriis, G., Vetrani, C., Aprano, S., Pugliese, G., Zumbolo, F., Colao, A., Savastano, S. 2023. Iron levels and markers of inflammation in a population of adults with severe obesity, a cross-sectional study. Nutrients 15(21): 4702.

Liu, Y., Miao, J. 2022. An emerging role of defective copper metabolism in heart disease. Nutrients 14(3): 700.

Majidi, M., Eslami, V., Ghorbani, P., Foroughi, M. 2021. Are women more susceptible to ischemic heart disease compared to men? A literature overview. J Geriatr Cardiol 18(4): 289-96.

Mehri, A. 2020. Trace elements in human nutrition (Ii) – An update. Int J Prev Med 11: 2.

Meng, H., Wang, Y., Ruan, J., Chen, Y., Wang, X., Zhou, F., Meng, F. 2022. Decreased iron ion concentrations in the peripheral blood correlate with coronary atherosclerosis. Nutrients 14: 319.

Mikulewicz, M., Chojnacka, K., Kawala, B., Gredes, T. 2017. Trace elements in living systems: from beneficial to toxic effects. Biomed Res Int 2017: 8297814.

Mohamed, H., Haris, P.I., Brima, E.I. 2019. Estimated dietary intake of essential elements from four selected staple foods in Najran City, Saudi Arabia. BMC Chem 13(73): 1-11.

Morais, A.L., Rijo, P., Hernán, M.B.B., Nicolai, M. 2020. Biomolecules and electrochemical tools in chronic non-communicable disease surveillance: A systematic review. Biosensors 10(9): 121.

Morfeld, P., Groß, J.V.R., Erren, T.C., Noll, B., Yong, M., Kennedy, K.J., Esmen, N.A., Zimmerman, S.D., Buchanich, J.M., Marsh, G.M. 2017. Mortality among hardmetal production workers: German historical cohort study. J Occup Environ Med 59(12): e288-96.

Nissen, S.B., Magidson, T., Gross, K., Bergstrom, C.T. 2016. Publication bias and the canonization of false facts. eLife 5: e21451.

Page, M.J., Mckenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Glanville, J., Grimshaw, J.M., Hróbjartsson, A., Lalu, M.M., Li, T., Loder, E.W., Mayo-Wilson, E., Mcdonald, S., Mcguinness, L.A., Stewart, L.A., Thomas, J., Tricco, A.C., Welch, V.A., Whiting, P., Moher, D. 2021. The prisma 2020 statement: An updated guideline for reporting systematic reviews. BMJ 372: n71.

Prakash, J. 2020. Chapter 6 - The dietary practices and food-related rituals in Indian tradition and their role in health and nutrition. In Nutritional and health aspects of food in South Asian Countries;. Edited by Prakash, J., Waisundara, V. & Prakash, V. Academic Press; 75-85.

Prashanth, L., Kattapagari, K.K., Chitturi, R.T., Baddam, V.R.R., Prasad, L.K. 2015. A review on role of essential trace elements in health and disease. J Dr YSR Univ Health Sci 4(2): 75-85.

Qiu, F., Wu, L., Yang, G., Zhang, C., Liu, X., Sun, X., Chen, X., Wang, N. 2022. The role of iron metabolism in chronic diseases related to obesity. Mol Med 28(1): 130.

Ramesh, J., Kulkarni, D.G. 2016. Evaluation of effect of trace elements and antioxidants levels in patient with ischaemic heart disease. Int J Biotechnol Biochem 12(2): 145-51.

Schmidt, K.M.T., Nan, J., Scantlebury, D.C., Aggarwal, N.R. 2018. Stable ischemic heart disease in women. Curr Treat Options Cardiovasc Med 20(9): 72.

Shi, Y., Zou, Y., Shen, Z., Xiong, Y., Zhang, W., Liu, C., Chen, S. 2021. Trace elements, ppars, and metabolic syndrome. Int J Mol Sci 21: 2612.

The Cochrane Collaboration. 2014. Review Manager 5 (Revman 5). https://training.cochrane.org/online-learning/core-software/revman/revman-5-download [10th March 2022].

Virani, S.S., Alonso, A., Benjamin, E.J., Bittencourt, M. S., Callaway, C.W., Carson, A.P., Chamberlain, A.M., Chang, A.R., Cheng, S., Delling, F.N., et al. 2020. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation 141(9): e139-e596.

Wells, G.A., Shea, B., O’connell, D., Peterson, J., Welch, V., Losos, M., Tugwell, P., Zello, G.A., Petersen, J.A. 2011. The Newcastle-Ottawa scale (Nos) for assessing the quality of nonrandomised studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [10th March 2021].

Yang, A.M., Lo, K., Zheng, T.Z., Yang, J.L., Bai, Y.N., Feng, Y.Q., Cheng, N., Liu, S.M. 2020. Environmental heavy metals and cardiovascular diseases: Status and future direction. Chron Dis Transl Med 6(4): 251-9.

Zengin, E., Sinning, C., Zeller, T., Rupprecht, H.J., Schnabel, R.B., Lackner, K.J., Blankenberg, S., Westermann, D., Bickel, C. 2015. Activity of superoxide dismutase copper/zinc type and prognosis in a cohort of patients with coronary artery disease. Biomark Med 9(6): 599-606.

Zhu, Q., Yao, Y., Ning, C.X., Zhao, Y.L. 2019. Trace element levels in the elders over 80 from the Hainan Province of China. J Nutr Health Aging 23(9): 883-9.
Correspondance Address

Abbad, F., Idrissi, N.C., Fatih, B., Fakhir, B., Drissi, J., Khouchani, M., Rais, H. 2017. Primary breast angiosarcoma: A rare presentation of rare tumor - Case report. BMC Clin Pathol 17: 17.

 

Alexandrova, E., Sergieva, S., Mihaylova, I., Zarkova, A. 2014. Primary angiosarcoma of the breast complicated by the syndrome of disseminated intravascular coagulation (DIC): Case report and literature review. Rep Pract Oncol Radiother 19(3): 221-5.



Abbad, F., Idrissi, N.C., Fatih, B., Fakhir, B., Drissi, J., Khouchani, M., Rais, H. 2017. Primary breast angiosarcoma: A rare presentation of rare tumor - Case report. BMC Clin Pathol 17: 17.

 

Alexandrova, E., Sergieva, S., Mihaylova, I., Zarkova, A. 2014. Primary angiosarcoma of the breast complicated by the syndrome of disseminated intravascular coagulation (DIC): Case report and literature review. Rep Pract Oncol Radiother 19(3): 221-5.