promoting the sustainable and responsible use of cobalt in all forms

Heart Disease

Recent studies have indicated that there is no significant risk of heart disease due to cobalt exposure.

Historical use as an additive in beer

A past use of cobalt (in the form of cobalt sulphate or cobalt dichloride) was as an additive in beer to counteract the antifoaming activity of detergent residues on glasses. During the 1960s, breweries used to add cobalt to beer at an average level of 1000 µg/L. During this period of time, cases of a heart disease called cardiomyopathy arose in males who had consumed large amounts of the cobalt-containing beer (approximately 40-140 µg Co/day)[1]. These men had consumed a large amount of alcohol (average alcoholic intake of 24 pints/day) and had a poor diet[2]. It is thought that these additional factors, in combination with the cobalt additive in the beer, led to cardiomyopathy.

Recent studies

In a more recent (2004) occupational exposure study of approximately 200 cobalt refinery workers, no evidence of clinically significant heart disease was discovered[3], despite medium to high exposures to cobalt. At the high exposure level, corresponding to above 50 μg Co/m3 (with urinary peaks as high as 943 µg Co/L) a clinically non-significant change in an electrocardiogram parameter was observed.

In 2013, a study in cobalt exposed workers in a cobalt production facility in Belgium, no correlation was found between exposure to cobalt and cardiomyopathy parameters[4]. In the same year, patients with metal-on-metal hip implants with cobalt blood levels of 18-153 µg/L (mean of 46.8 µg/L) were studied for signs of clinical manifestations. No signs or symptoms of cardiomyopathy could be identified or attributed to elevated cobalt blood levels[5].

In conclusion, clinically significant heart effects have been observed only at high oral intakes in combination with high alcohol intake and malnutrition.

There are no reports of clinically significant adverse heart effects caused by cobalt alone.

Cobalt is a bioessential element to human life as a part of Vitamin B12. The European Food Safety Authority (EFSA, 2012) has suggested an acceptable safe amount of 120 µg Co/day[6] whilst The United Kingdom Expert Group on Vitamins and Minerals concluded in 2012 that ingestion of cobalt-containing supplements up to 1400 µg Co/day (in a 60 kg adult) was unlikely to produce adverse health effects[7].

Under the circumstances of current industrial hygiene in the cobalt industry, and a normal diet for the general population, there is no significant risk of cardiomyopathy due to cobalt.


This summary is intended to provide general information about the topic under consideration. It does not constitute a complete or comprehensive analysis, and reflects the state of knowledge and information at the time of its preparation. This summary should not be relied upon to treat or address health, environmental, or other conditions.

[1] Alexander, C.S. Cobalt and the heart. Ann Intern Med 70:411-413. 1969
Alexander, C.S. Cobalt-beer cardiomyopathy: A clinical and pathologic study of twenty-eight cases. Am J Med 53:395-417.
[2] Morin, Y., Tetu, A., Mercier, G. Cobalt cardiomyopathy: Clinical aspects. Br Heart J 33:175-178. 1971.
[3] Linna, A., Oksa, P., Grounstroem, K., Halkosaari, M., Palnroos, P., Huikka, S., Uitti, J. Exposure to cobalt in the production of cobalt and cobalt compounds and its effect on the heart. Occup Environ med 61:877-885. 2004.
[4] Lantin, A.C., Vermeulen, J., Mallants, A., Vanoverschelde, J.L., Speybroeck, N., Swennen, B., Hoet P., Lison, D. Occupational exposure to cobalt is not associated with incipient signs of dilated cardiomyopathy in a Belgian refinery. Occup Environ Med 70(6):386-392. 2013.
[5] Van Lingen, C.P., Ettema, H.B., Timmer, J.R., de Jong, G., Verheyen, C.C. Clinical manifestions in ten patients with asymptomatic metal-on-metal hip arthroplasty with very high cobalt levels. Hip Int 23(5):441-444. 2013.
[6] European Food Safety Authority. Scientific Opinion on safety and efficacy of cobalt compounds (E3) as feed additives for all animal species: Cobaltous acetate tetrahydrate, basic cobaltous carbonate monohydrate and cobaltous sulphate heptahydrate, based on a dossier submitted by TREAC EEIG1. EFSA J 10(7):1-27. 2012.
[7] Expert Group on Vitamins and Minerals. Safe upper levels for vitamins and minerals. London: Food Standards Agency. 2003.