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Dr Barbaro (January 2002 JRSM1) questions whether dilated cardiomyopathy due to selenium deficiency (Keshan disease, named after Keshan County, Heilongjiang Province, China where the disease was first discovered in 19352) can be reversed by selenium replacement and further states that ‘controlled prospective clinical trials are lacking’.
As early as 1964, Gu from China noted the existence of a coincidence between the endemic distribution of Keshan disease and that of the white muscle disease of domestic animals2. In 1965 a farm hospital physician from Shanxi Province administered Na2SeO3 to patients with Keshan disease with promising results2. Subsequently investigators from Xian Medical College, Chinese Academy of Medical Sciences and Institute of Geography of Chinese Academy of Sciences collaborated to confirm the aetiological relation between selenium deficiency and Keshan disease3,4.
To evaluate the efficacy of Na2SeO3 in Keshan disease, a prospective study was carried out under strict control among children in the endemic districts of Sichuan Province from 1974 to 1977. The results clearly showed that Na2SeO3 could not only reduce the morbidity and mortality of Keshan disease but also alleviate its clinical course5. Oral selenium supplementation had been shown to reverse the biochemical evidence of the selenium deficiency state in patients with6 or without7 cardiomyopathy in the United States.