Essential and Toxic Elements in Cardiovascular Disease: Pathophysiological Roles and the Emerging Contribution of Hair Mineral Analysis

Hair mineral analysis (HMA) has emerged as a promising non-invasive method for assessing long-term exposure to trace elements and metals, potentially complementing traditional biochemical and clinical markers of cardiovascular risk. This review synthesizes current evidence on the relationships between hair elemental profiles and cardiovascular disease (CVD), with an emphasis on toxic metals (As, Hg, Pb, Cd, Ni, Al) and essential micronutrients (Mg, Mn, Zn, Cu, Fe, Cr, Li). The reviewed studies consistently show that patients with CVD exhibit elevated levels of toxic elements and reduced concentrations of protective ones, reflecting oxidative stress, inflammation, and endothelial dysfunction as mechanistic links. Methodologically, the review highlights inductively coupled plasma mass spectrometry (ICP-MS) with collision/reaction cell technology and microwave digestion as gold-standard analytical approaches, while underscoring the urgent need for harmonized protocols, validated washing procedures, and certified reference materials. The interpretation of HMA requires consideration of temporal dynamics, external contamination, and regional variability. Although current evidence supports the research utility of HMA, its clinical integration remains limited by the absence of reference ranges and prospective validation. HMA may hold future value in environmental risk stratification and primary prevention in exposed populations, but further standardization and large-scale longitudinal studies are necessary to define its diagnostic and prognostic relevance in cardiovascular medicine.