Evidence map›Paper›PMID 29738916›Full record

ArticleEnvironment international2018

Serum mercury concentration and the risk of ischemic stroke: The REasons for Geographic and Racial Differences in Stroke Trace Element Study.

Cheng Chen, Pengcheng Xun, Leslie A McClure, John Brockman, Leslie MacDonald, Mary Cushman, Jianwen Cai, Lisa Kamendulis, Jason Mackey, Ka He

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Environment international, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.

  1. Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis.Environmental science and pollution research international · 2022
    Pooled it
  2. Review
  3. Mercury Exposure and Health Effects: What Do We Really Know?International journal of molecular sciences · 2025
    Review
  4. Review
  5. Article
  6. Review
  7. Article
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 7 institutions in 1 country.

Cheng ChenDepartment of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA.
Pengcheng XunDepartment of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA.
Leslie A McClureDepartment of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA.
John BrockmanColumbia Research Reactor, University of Missouri, Columbia, MO 65211, USA.
Leslie MacDonaldNational Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA.
Mary CushmanDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT 05401, USA.
Jianwen CaiDepartment of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Lisa KamendulisDepartment of Environmental Health, School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA.
Jason MackeyDepartment of Neurology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA.
Ka HeDepartment of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA. Electronic address: kahe@indiana.edu.
Indiana University Bloomington · USCenters for Disease Control and Prevention · USDrexel University · USIndiana University – Purdue University Indianapolis · USUniversity of Missouri · USUniversity of North Carolina at Chapel Hill · USUniversity of Vermont · US

Funding

VCID and Stroke in a Bi-racial National CohortU01NS041588 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI CUSHMAN, MARY, HOWARD, GEORGE · 2002 to 2022
$96.0M
Understanding Cohort Effects on Stroke, VCID, and Cognition After Major Epidemiologic TransitionsR01NS041588 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI MARY CUSHMAN, VIRGINIA J. HOWARD · 2001 to 2026
$8.8M
Trace element levels and risk of strokeR01ES021735 · NIEHS · TRUSTEES OF INDIANA UNIVERSITY · PI KAHE, KA, MCCLURE, LESLIE AIN · 2012 to 2016
$2.3M
NIEHS NIH HHS R01 ES021735NINDS NIH HHS R01 NS041588NINDS NIH HHS U01 NS041588
6 · The paper itself

Abstract

backgroundAlthough biologically plausible, epidemiological evidence linking exposure to methylmercury with increased risk of ischemic stroke is limited. The effects of methylmercury may be modified by selenium, which is an anti-oxidant that often co-exists with mercury in fish.

objectivesTo examine the association between serum mercury levels with the incidence of ischemic stroke and to explore the possible effect modifications by serum selenium levels and demographic and geographic factors.

methodsA case-cohort study was designed nested in the REasons for Geographic and Racial Differences in Stroke cohort, including 662 adjudicated incident cases of ischemic stroke and 2494 participants in a randomly selected sub-cohort. Serum mercury was measured using samples collected at recruitment. Multivariable-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated using the Barlow-weighting method for the Cox proportional hazards regression model.

resultsNo statistically significant association was observed between serum mercury concentration and the incidence of ischemic stroke (the highest vs. lowest quintile of mercury levels: HR = 0.82; 95% CI = 0.55-1.22; P for linear trend = 0.42). Sex (P for interaction = 0.06), but not serum selenium levels, modified the association; a more evident trend toward lower incidence of ischemic stroke with higher mercury levels was observed among women.

conclusionThis study does not support an association between mercury and the incidence of ischemic stroke within a population with low-to-moderate level of exposure. Further studies are needed to explore the possibility of mercury-induced ischemic stroke toxicity in other populations at higher exposure levels.

Indexed as

Brain IschemiaStrokeCohort StudiesFemaleHumansMaleMethylmercury CompoundsSeleniumMethylmercury CompoundsSeleniumCase-cohort studyIschemic strokeMercuryREGARDS studySelenium

Identifiers

PMID29738916
PMCPMC5997556
OpenAlexW2801308396

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.