Published online ; Clinical Trial ; Multicenter Study ; Research Support, Non-U.S. Gov't ; BACKGROUND: In recent years there has been an exponential increase in tungsten demand, potentially increasing human exposure to the metal. Currently, the toxicology of tungsten is poorly understood, but mounting evidence suggests that both the elemental metal and its alloys have cytotoxic effects. Here, we investigate the association between tungsten and cardiovascular disease (CVD) or stroke using six waves of the National Health and Nutrition Examination Survey (NHANES). METHODS: We investigated associations using crude and adjusted logistic regression models in a cohort of 8614 adults (18-74 years) with 193 reported stroke diagnoses and 428 reported diagnoses of CVD. We also stratified our data to characterize associations in a subset of younger individuals (18-50 years). RESULTS: Elevated tungsten concentrations were strongly associated with an increase in the prevalence of stroke, independent of typical risk factors (Odds Ratio (OR): 1.66, 95% Confidence Interval (95% CI): 1.17, 2.34). The association between tungsten and stroke in the young age category was still evident (OR: 2.17, 95% CI: 1.33, 3.53). CONCLUSION: This study represents the most comprehensive analysis of the human health effects of tungsten to date. Individuals with higher urinary tungsten concentrations have double the odds of reported stroke. We hypothesize that the pathological pathway resulting from tungsten exposure may involve oxidative stress. ; This work was supported by funding from University of Exeter Medical School. No funding organization or sponsor played any part in the design or conduct of the study, in the analysis or interpretation of the data, or preparation, review, or approval of the manuscript. The European Centre for the Environment and Human Health (part of the University of Exeter Medical School) is supported by investment from the ERDF (European Regional Development Fund) and ESF (European Social Fund) Convergence Programmed for Cornwall and the Isles of Scilly. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.