What Can We Learn from the Scalp Hair’s Trace Element Content? The Relationship with the Advancement of Coronary Artery Disease

<b>Background</b>: Multiple risk factors for coronary artery disease have been identified without answering one of the leading questions related to the extent of the involvement of the epicardial arteries. Trace elements are involved in various stages of atherosclerotic lesion formation and may play a significant role in the advancement of coronary artery disease. <b>Methods</b>: A total of 157 (92 (59%) men and 65 (41%) women) patients with a median age of 71 (65-75) years presenting with chronic coronary syndrome were enrolled in the prospective single-center analysis. The coronary angiography results were compared with the concentration of trace elements in scalp hair. <b>Results</b>: Through Spearman analysis, a positive correlation between the number of diseased coronary arteries and hair trace element concentration was found for sodium (r = 0.198, <i>p</i> = 0.013), vanadium (r = 0.164, <i>p</i> = 0.040), chromium (r = 0.242, <i>p</i> = 0.002), and nickel (r = 0.176, <i>p</i> = 0.026). A negative relationship was noted between magnesium (r = -0.237, <i>p</i> = 0.003) and calcium (r = -0.217, <i>p</i> = 0.007) and the extent of epicardial lesions. <b>Conclusions</b>: Scalp hair trace element analysis indicates the possible modulatory role of trace elements in advancing coronary artery disease. Since a significant correlation with one- and two-vessel but not with three-vessel disease was noted, it might be considered an "all or nothing" phenomenon. A positive correlation between the number of diseased coronary arteries and sodium, vanadium, chromium, and nickel and an inverse correlation with magnesium and calcium were noted. The presented analysis is hypothesis-generating, and further studies are necessary to corroborate the results from a clinical perspective.