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J R Soc Med. 2002 April; 95(4): 219–220.
PMCID: PMC1279532

Selenium deficiency and cardiomyopathy

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.


1. Barbaro G. Selenium deficiency and HIV-associated cardiomyopathy. J R Soc Med 2002;95: 57 [PMC free article] [PubMed]
2. Gu B-Q, Cheng TO. Keshan disease. In: Cheng TO, ed. The International Textbook of Cardiology. New York: Pergamon, 1987: 752-65
3. Keshan Disease Research Group of Chinese Academy of Medical Sciences. Epidemiologic studies on the etiologic relationship of selenium and Keshan disease. Chin Med J 1979;92: 477-82 [PubMed]
4. Yang GQ, Chen JS, Wen ZM, et al. The role of selenium in Keshan disease. Adv Nutr Rev 1984;6: 203-31 [PubMed]
5. Keshan Disease Research Group of Chinese Academy of Medical Sciences. Antiepidemic Station of Sichuan Province, Chengdu, Antiepidemic Station of Xichang District, Sichuan, and Antiepidemic Station of Mianning County, Sichuan. Observations on effect of sodium selenite in prevention of Keshan disease. Chin Med J 1979;92: 471-6 [PubMed]
6. Collipp PJ, Chen SY. Cardiomyopathy and selenium deficiency in a two-year-old girl. N Engl J Med 1981;304: 1304. [PubMed]
7. King WWK, Michel L, Wood WC, Malt RA, Baker SS, Cohen HJ. Reversal of selenium deficiency with oral selenium. N Engl J Med 1981;304: 1305 [PubMed]

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