Selenium and Heart Disease

Heart disease. The evidence from clinical studies is increasing. Selenium deficiency is associated with an increased risk of heart trouble [Bomer 2020]. Selenium supplementation of elderly individuals who have low selenium status is associated with improved survival, improved heart function, and improved quality of life [Alehagen 2013].

Map of Europe
Selenium intakes and selenium status in countries in northern Europe are generally quite low. Consequently, clinical trials conducted in northern Europe tend to be more valuable than clinical trials conducted in the USA where dietary selenium intakes are considerably higher for the most part.

Especially in northern Europe, clinical studies show the relationship between the need for selenium and the risk of heart disease. This makes sense because the dietary selenium intake in northern Europe is considerably lower than the dietary selenium intake in much of the United States. Consequently, the mean plasma selenium concentrations in Europe tend to be well below 80–90 mcg/L. In the USA, on the other hand, the mean plasma selenium concentrations are generally above 120 mcg/L [Alehagen 2022].

Studies of Selenium Deficiency and Heart Disease risk
Malmö Preventive Project, Sweden

In the Malmö Preventive Project, the researchers used blood samples from 4,366 study participants to analyze the relationship of plasma selenoprotein P (SELENOP) concentrations to the following outcomes:

  • risk of all-cause mortality
  • risk of cardiovascular mortality
  • risk of a first-time cardiovascular event

The researchers  categorized the data in quintiles. The data analysis showed that the risk in quintile 4 (the next highest SELENOP quintile), compared to the risk in quintile 1 (the lowest SELENOP quintile), was as follows [Schomburg 2019]:

  • 43% lower for all-cause mortality
  • 48% lower for cardiovascular mortality
  • 44% lower a for first-time cardiovascular event.

In their concluding remarks, the researchers wrote [Schomburg 2019]:

  • The 20 percent of the adults living in northern European countries who have the lowest plasma SELENOP concentrations will have an increased risk of cardiovascular disease and mortality.
  • Preventive selenium supplementation seems to be justified for adults with the lowest plasma SELENOP concentrations.

In a 2023 follow-up study, Jujic et al used data from the ongoing Malmö Preventive Project. They showed that each one standard deviation increment in plasma SELENOP levels was associated with lower risk of developing heart failure during a follow-up period of 14.7 years. Furthermore, the analysis showed again that study participants in the lowest plasma SELENOP quintile were at the highest risk of developing heart failure as compared to study participants in the higher quintiles 2-5 [Jujic 2023].

In a 2024 sub-analysis of the Malmö study data, Jujic et al found that low plasma levels of Selenoprotein P were associated with cognitive impairment in patients hospitalized for heart failure [Jujic 2024].

BioStat-CHF Study, 11 European countries

Using data on the serum selenium concentrations in 2,516 heart failure patients in the multi-national BioStat-CHF study, Bomer and a team of researchers found that deficiency levels of serum selenium were significantly associated with the following patient characteristics:

  • more severe signs and symptoms of heart failure
  • poorer exercise capacity
  • poorer quality of life.

The researchers defined selenium deficiency as plasma or serum selenium concentrations of less than 70 mcg/L. They observed, moreover, that serum selenium concentrations between 70 mcg/L and 100 mcg/L were similarly associated with 1) poor quality of life, 2) poor exercise capacity, and 3) poor disease prognosis. In sum, serum selenium values under 100 mcg/L are sub-optimal and should be a cause for special concern [Bomer 2020].

PREVEND Study, The Netherlands

In an analysis of data from the PREVEND (Prevention of REnal and Vascular ENd-stage Disease) cohort (n=5,973), al-Mubarak and his fellow researchers observed that high serum selenium concentrations (greater than 116 mcg/L) were associated with lower all-cause mortality and with lower incidence of new‐onset heart failure in the non‐smokers (n=4,288) [al-Mubarak 2022].

Esther Study, Germany

Schöttker and a team of researchers used data from the Esther Study in Germany to evaluate the association of serum SELENOP concentrations with all-cause mortality and cardiovascular mortality. They used serum selenoprotein P values recorded at baseline (n=7,186) and again at a five-year follow-up (n=4,164). They found the following significant associations [Schöttker 2024]:

  • For cardiovascular mortality, serum SELENOP concentrations in the bottom tertile were associated significantly with increased risk.
  • For all-cause mortality, there was an L-shaped graph such that the all-cause mortality was significantly higher at SELENOP concentrations less than 4.1 mg/L. Then, at SELENOP concentrations above the 4.1 mg/L level, the extent of all-cause mortality flattened out.
  • Curiously, the increased risk of all-cause mortality for study participants in the bottom serum SELENOP tertile was more than twice as strong in men as in women. This shows the importance of analyzing not only the total sample outcomes but also analyzing the sample’s sex-specific outcomes.

Note: In the Malmö Preventive Project, in the PREVEND cohort, and in the Esther Study, the researchers observed that women experienced heart disease events associated with low selenium levels to a lesser extent than men did.

Studies of Selenium Supplementation and Heart Disease risk
KiSel-10 Study, Sweden

In the KiSel-10 Study, combined selenium (200 mcg/day) and Coenzyme Q10 (2 x 100 mg/day) supplementation for 48 months raised serum concentrations as follows [Alehagen 2020]:

  • Selenium from 67.1 mcg/L to 210.3 mcg/L
  • Coenzyme Q10 from 0.82 mg/L to 2.17 mg/L

The supplementation of the elderly Swedish citizens, average age 78 years, who had low selenium concentrations at baseline, was significantly associated with the following health outcomes in up to 12 years of follow-up [Alehagen 2020]:

  • improved cardiac function
  • less cardiac wall tension
  • reduced cardiovascular mortality .

In addition to these positive clinical effects, the combined selenium and CoQ10 intervention also resulted in reduced blood biomarkers of oxidative stress, systemic inflammation, and fibrosis [Alehagen 2022].

In subsequent sub-analyses, Alehagen and the KiSel-10 team found that the combined selenium and CoQ10 supplementation slowed down the shortening of leukocyte telomeres and increased serum sirtuin SIRT1 concentrations. These outcomes reflect an anti-aging effect of the intervention [Opstad 2022; Opstad 2023].

Conclusion: Selenium and Heart Health

Sub-optimal serum selenium concentrations – below the 100 mcg/L level – increase the risk of heart disease.

Selenium supplementation of elderly individuals with low serum selenium levels improves heart function and promotes survival.


Alehagen U, Johansson P, Svensson E, Aaseth J, Alexander J. Improved cardiovascular health by supplementation with selenium and coenzyme Q10: applying structural equation modelling (SEM) to clinical outcomes and biomarkers to explore underlying mechanisms in a prospective randomized double-blind placebo-controlled intervention project in Sweden. Eur J Nutr. 2022 Sep;61(6):3135-3148.

Alehagen U, Aaseth J, Alexander J, Johansson P, Larsson A. Supplemental selenium and coenzyme Q10 reduce glycation along with cardiovascular mortality in an elderly population with low selenium status – A four-year, prospective, randomised, double-blind placebo-controlled trial. J Trace Elem Med Biol. 2020 May 4;61:126541.

Al-Mubarak AA, Grote Beverborg N, Suthahar N, Gansevoort RT, Bakker SJL, Touw DJ, de Boer RA, van der Meer P, Bomer N. High selenium levels associate with reduced risk of mortality and new-onset heart failure: data from PREVEND. Eur J Heart Fail. 2022 Feb;24(2):299-307.

Bomer N, Grote Beverborg N, Hoes MF, Streng KW, Vermeer M, Dokter MM, IJmker J, Anker SD, Cleland JGF, Hillege HL, Lang CC, Ng LL, Samani NJ, Tromp J, van Veldhuisen DJ, Touw DJ, Voors AA, van der Meer P. Selenium and outcome in heart failure. Eur J Heart Fail. 2020 Aug;22(8):1415-1423.

Jujic A, Molvin J, Schomburg L, Hartmann O, Bergmann A, Melander O, Magnusson M. Selenoprotein P deficiency is associated with higher risk of incident heart failure. Free Radic Biol Med. 2023 Oct;207:11-16.

Jujić A, Molvin J, Nilsson ED, Holm Isholth H, Dieden A, Korduner J, Zaghi A, Nezami Z, Bergmann A, Schomburg L, Magnusson M. Low levels of Selenoprotein P are associated with cognitive impairment in patients hospitalized for heart failure. J Card Fail. 2024 Feb 15:S1071-9164(24)0039-3.

Opstad TB, Alexander J, Aaseth JO, Larsson A, Seljeflot I, Alehagen U. Selenium and Coenzyme Q10 intervention prevents telomere attrition, with association to reduced cardiovascular mortality-sub-study of a randomized clinical trial. Nutrients. 2022 Aug 15;14(16):3346.

Opstad TB, Alexander J, Aaseth J, Larsson A, Seljeflot I, Alehagen U. Increased SIRT1 concentration following four years of selenium and Q10 intervention associated with reduced cardiovascular mortality at 10-year follow-up-sub-study of a previous prospective double-blind placebo-controlled randomized clinical trial. Antioxidants (Basel). 2023 Mar 21;12(3):759.

Schomburg L, Orho-Melander M, Struck J, Bergmann A, Melander O. Selenoprotein-P deficiency predicts cardiovascular disease and death. Nutrients. 2019 Aug 9;11(8):1852.

Schöttker B, Holleczek B, Hybsier S, Köhrle J, Schomburg L, Brenner H. Strong associations of serum selenoprotein P with all-cause mortality and mortality due to cancer, cardiovascular, respiratory and gastrointestinal diseases in older German adults. Eur J Epidemiol. 2024 Feb;39(2):121-136.

The information presented in this review article is not intended as medical advice. It should not be used as such.

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