Mercury, fish oils, and the risk of myocardial infarction

N Engl J Med. 2002 Nov 28;347(22):1747-54. doi: 10.1056/NEJMoa020157.


Background: It has been suggested that mercury, a highly reactive heavy metal with no known physiologic activity, increases the risk of cardiovascular disease. Because fish intake is a major source of exposure to mercury, the mercury content of fish may counteract the beneficial effects of its n-3 fatty acids.

Methods: In a case-control study conducted in eight European countries and Israel, we evaluated the joint association of mercury levels in toenail clippings and docosahexaenoic acid (C22:6n-3, or DHA) levels in adipose tissue with the risk of a first myocardial infarction among men. The patients were 684 men with a first diagnosis of myocardial infarction. The controls were 724 men selected to be representative of the same populations.

Results: The average toenail mercury level in controls was 0.25 microg per gram. After adjustment for the DHA level and coronary risk factors, the mercury levels in the patients were 15 percent higher than those in controls (95 percent confidence interval, 5 to 25 percent). The risk-factor-adjusted odds ratio for myocardial infarction associated with the highest as compared with the lowest quintile of mercury was 2.16 (95 percent confidence interval, 1.09 to 4.29; P for trend=0.006). After adjustment for the mercury level, the DHA level was inversely associated with the risk of myocardial infarction (odds ratio for the highest vs. the lowest quintile, 0.59; 95 percent confidence interval, 0.30 to 1.19; P for trend=0.02).

Conclusions: The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipose Tissue / chemistry
  • Adult
  • Aged
  • Case-Control Studies
  • Docosahexaenoic Acids / analysis*
  • Dose-Response Relationship, Drug
  • Fatty Acids / chemistry
  • Humans
  • Male
  • Mercury / adverse effects*
  • Mercury / analysis
  • Middle Aged
  • Myocardial Infarction / chemically induced*
  • Myocardial Infarction / prevention & control
  • Nails / chemistry
  • Risk Factors


  • Fatty Acids
  • Docosahexaenoic Acids
  • Mercury