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Iron stores and the international variation in mortality from coronary artery disease
1Department of Radiology, Massachusetts General Hospital, Boston.
Insights
This study investigated iron
Area of Science:
- Cardiovascular Science
- Nutritional Biochemistry
Background:
- Iron's role in coronary artery disease (CAD) is increasingly recognized.
- Hepatic iron stores may influence myocardial vulnerability to ischemia/reperfusion.
Purpose of the Study:
- To evaluate hepatic storage iron as a risk factor for CAD.
- To assess the combined effect of liver iron and lipoprotein indices on CAD mortality.
Main Methods:
- Analysis of CAD mortality data from 11 countries.
- Correlation of mortality rates with liver iron stores and lipoprotein indices.
- Development of a normal distribution model for CAD incidence based on iron-cholesterol values.
Main Results:
- CAD mortality showed the strongest correlation with the product of liver iron and serum cholesterol (r=0.72 men, r=0.74 combined).
- A non-linear relationship was observed between iron-cholesterol values and estimated CAD incidence.
- Hepatic iron levels help explain variations in CAD related to diet, culture, and sex.
Conclusions:
- Hepatic iron stores are a significant factor in coronary artery disease risk.
- The iron-cholesterol product is a strong predictor of CAD mortality.
- Dietary and sex-related differences in CAD may be partly explained by hepatic iron levels.
Abstract:
Possible roles for iron in coronary artery disease (CAD) have emerged, including contributions to atherogenesis and/or the vulnerability of the myocardium to ischemia/reperfusion events. The value of hepatic storage iron as a potential risk factor for CAD was evaluated independently and in combination with various lipoprotein indices using CAD mortality data from 11 countries along with available data on liver iron stores. CAD mortality rates were found to be best correlated with the liver iron-serum cholesterol product in both men (r = 0.72) and, more importantly, in both genders combined (r = 0.74). It was also found that estimated CAD incidence could be related in a non-linear fashion to iron-cholesterol values in a simple normal distribution model where all subjects above a threshold value of iron-cholesterol were assumed to have CAD. Hepatic iron values thus appear to be useful in describing the differences in CAD due to both diet (and/or culture) and sex.