Copper, a strong prooxidant, may play a role in atherogenesis. The author examined the association between serum copper concentration and mortality from coronary heart disease using data from the Second National Health and Nutrition Examination Survey (1976-1992). Serum copper concentration was determined using atomic absorption spectroscopy. After various exclusions, 151 deaths from coronary heart disease occurred among 4,574 participants aged > or =30 years. At baseline, the age-adjusted serum copper concentration was about 5% higher among participants who died from coronary heart disease than among those who did not (p = 0.072). After adjustment for age, sex, race, education, smoking status, systolic blood pressure, serum cholesterol, serum high density lipoprotein cholesterol, body mass index, recreational activity, nonrecreational activity, history of diabetes, and white blood cell count, the hazard ratios for death from coronary heart disease for serum copper concentrations in the second, third, and fourth quartiles (versus the first quartile) were 1.84 (95% confidence interval (CI): 0.93, 3.66), 2.14 (95% CI: 1.21, 3.77), and 2.87 (95% CI: 1.57, 5.25), respectively. Several prospective studies, including the present analysis, have found elevated serum copper concentrations to be associated with cardiovascular disease. Whether copper directly affects atherogenesis or is a marker of inflammation associated with atherosclerosis remains to be established.