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Hemoglobin, iron metabolism and angiographic coronary artery disease (The Ludwigshafen Risk and Cardiovascular Health
Tanja B Grammer1, Marcus E Kleber2, Günther Silbernagel3
1Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany; Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetolgy, and Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany.
Insights
Low hemoglobin and iron depletion are independently linked to coronary artery disease (CAD). This study clarifies their distinct roles in CAD development, offering insights into risk factors.
Area of Science:
- Cardiology
- Hematology
- Biochemistry
Background:
- Anemia is a known risk factor for coronary artery disease (CAD) and mortality.
- The role of body iron stores in CAD development is debated.
- Previous studies lacked simultaneous examination of hemoglobin and iron metabolism parameters.
Purpose of the Study:
- To investigate the independent associations of hemoglobin levels and iron status with angiographically confirmed coronary artery disease (CAD).
Main Methods:
- Cross-sectional study involving 1480 patients with stable CAD and 682 controls.
- Assessed hemoglobin, iron status (ferritin, transferrin saturation), and sTfR/log10F index.
- Used multivariate logistic regression to calculate odds ratios (OR) for CAD across quartiles of these markers.
Main Results:
- Low hemoglobin and iron depletion were associated with increased odds of CAD.
- Multivariate adjusted ORs for lowest vs. highest quartiles: Hemoglobin 1.62, Iron 2.05, Transferrin Saturation 1.69, Ferritin 1.98, sTfR/log10F 1.64.
- Associations remained significant even after adjusting for each other, indicating independence.
Conclusions:
- Both low hemoglobin and iron depletion are independently associated with angiographically defined CAD.
- These findings highlight distinct pathophysiological pathways contributing to CAD risk.
Background:
Anemia has been shown to be a risk factor for coronary artery disease and mortality. The involvement of body iron stores in the development of CAD remains controversial. So far, studies that examined hemoglobin and parameters of iron metabolism simultaneously do not exist.
Methods And Results:
Hemoglobin and iron status were determined in 1480 patients with stable angiographic coronary artery disease (CAD) and in 682 individuals in whom CAD had been ruled out by angiography. The multivariate adjusted odds ratios (OR) for CAD in the lowest quartiles of hemoglobin and iron were 1.62 (95%CI: 1.22-2.16), and 2.05 (95%CI: 1.51-2.78), respectively compared to their highest gender-specific quartiles. The fully adjusted ORs for CAD in the lowest quartiles of transferrin saturation, ferritin (F) and soluble transferrin receptor (sTfR)/log10F index were 1.69 (95%CI: 1.25-2.27), 1.98 (95%CI: 1.48-2.65), and 1.64 (95%CI: 1.23-2.18), respectively compared to their highest gender-specific quartiles. When adjusting in addition for iron and ferritin the OR for CAD in the lowest quartiles of hemoglobin was still 1.40 (95%CI: 1.04-1.90) compared to the highest gender-specific quartiles. Thus, the associations between either iron status or low hemoglobin and CAD appeared independent from each other. The sTfR was only marginally associated with angiographic CAD.
Conclusions:
Both low hemoglobin and iron depletion are independently associated with angiographic CAD.
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