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Circulation, Vol 89, 102-108, Copyright © 1994 by American Heart Association
MK Magnusson, N Sigfusson, H Sigvaldason, GM Johannesson, S Magnusson and G Thorgeirsson
BACKGROUND: In a recent Finnish study, ferritin was suggested to be an
independent risk factor for acute myocardial infarction. This study
suggested that high levels of iron stores might thus be atherogenic and
possibly explain partly the sex difference in the incidence of ischemic
heart disease. METHODS AND RESULTS: A randomly selected group (n = 2036),
men and women aged 25 to 74 years, were examined between June and September
1983. All classic risk factors for coronary artery disease were measured as
well as basic hematologic parameters and the parameters of iron metabolism,
ie, iron, total iron-binding capacity (TIBC), and ferritin. During the
follow-up for 8.5 years, 81 subjects experienced acute myocardial
infarction (63 men and 18 women). The differences in the iron parameters
between men and women were almost exclusively seen in ferritin values (198
micrograms/L in men and 91 micrograms/L in women), whereas small
differences were seen in TIBC. The Cox proportional hazards model was used
to estimate the contribution of independent variables to the risk of
myocardial infarction. TIBC was found to be a strong independent negative
risk factor in men (RR = 0.95; 95% CI, 0.92 to 0.98), whereas ferritin (RR
= 0.999; 95% CI, 0.997 to 1.001) or other iron parameters had no
significant predictive power. Each increase in TIBC of 1 mumol/L was
associated with a 5.1% decrease in the risk of myocardial infarction. The
classic major risk factors, ie, blood pressure, smoking, total cholesterol,
and high-density lipoprotein, had significant independent correlation with
myocardial infarction. When Cox multivariate analysis was carried out on
both sexes combined, TIBC was still an independent negative risk factor,
and the logarithmic transform of ferritin had a weak negative correlation
but was not statistically significant. Sex was in this group still a very
strong risk factor after taking into account all classic risk factors as
well as the parameters of iron metabolism. CONCLUSIONS: This study suggests
that transferrin, measured as TIBC, is an independent negative risk factor
for myocardial infarction. Other parameters of iron metabolism, including
ferritin, were not found to contribute to the risk.
ARTICLES
Low iron-binding capacity as a risk factor for myocardial infarction
Department of Medicine, Landspitalinn, University Hospital, Reykjavik, Iceland.
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