Table 1 Evidence linking copper excess and atherosclerosis.

Finland, Reunanen et al. [47]

230 men who died from CVDs and 298 matched controls; 10 years follow up.

The adjusted relative risk of CHD mortality between the highest and lowest tertiles of serum copper were 2.86 (P = 0.03). Elevated serum copper levels were significantly associated with an increased risk of mortality from all CVDs, especially from CHD.

United States, Ford, et al. [48]

4,574 participants aged ≥ 30 years; 151 died from CHD during 16-year follow-up.

There was an ~5% increase in serum copper levels among individuals who died from CHD compared to those who did not (p = 0.072). Elevated serum copper concentrations were associated with an increased risk of mortality from CHD.

Dutch, Kok et al. [49]

Cancer (n = 64) and CVD (n = 62) deaths, together with their respective matched controls, follow-up of six to 9 years.

Individuals with elevated serum copper levels (above 1.43 mg/liter) exhibited a roughly four times higher adjusted risk of mortality from cancer and CVD compared to those with serum copper levels within the normal range.

Eastern Finland, Salonen et al. [50]

1666 randomly selected men aged 42, 48, 54, or 60 years with no symptomatic IHD.

Elevated serum copper level is a risk factor for IHD that acts independently, as shown by a 3.5-fold to 4.0-fold increased risk of AMI associated with high serum copper levels (1.02-1.16 mg/liter and 1.17 mg/liter or more).

Nadina, Robyn et al. [51]

Atherosclerotic patients aged 67.9 ± 8.2 years and healthy controls.

Copper levels in the intima of lesions were notably higher in atherosclerotic patients compared to those in healthy controls (7.51 pmol/mg vs 2.01 pmol/mg tissue, P < 0.05).

Bangladesh, Begum et al. [52]

60 patients diagnosed with AMI and 60 healthy controls.

The mean serum copper level was significantly higher in AMI patients compared to that in controls (146.49 ± 23.52 μg/dl vs 105.44 ± 24.15 μg/dl, p < 0.05).

Grzegorz, Barbara et al. [53]

74 participants of MI and 72 healthy controls.

Higher serum copper level was significantly associated with MI (P < 0.001).

Italy, Tarantino et al. [54]

100 obese patients who had a low prevalence of comorbidities.

Altered copper bioavailability was negatively associated with carotid IMT (t = −2.23, P = 0.028) and may predict early atherosclerosis in obese patients.

Serbia, Tasić et al. [55]

91 patients (mean age 64 ± 7) with carotid atherosclerosis and 27 patients (mean age 58 ± 9) without carotid atherosclerosis.

Patients with hemorrhagic plaque had significantly higher serum copper levels compared to those with calcified plaque; high copper concentrations may contribute to atherosclerosis.