Association of Body Iron Status with the Risk of Premature Acute Myocardial Infarction in a Pakistani Population

Abstract

BackgroundCoronary artery disease is very common in Pakistani population. Some of the studies carried out on Western populations have shown a relationship between body iron status as determined by the ratio of concentrations of serum soluble transferrin receptor (sTfR) to ferritin and the risk of acute myocardial infarction (AMI). In order to investigate whether increased body iron status has any relationship with the risk of premature AMI in Pakistani population, a case-control study was carried out.Methodology/Principal findingsIn this case-control study, 203 consecutive AMI patients [146 males and 57 females; age range 18–45 years] admitted to the National Institute for Cardiovascular Diseases, Karachi, were enrolled with informed consent. In addition, 205 healthy controls whose gender and age (within 3 years) matched the patients, and who had a similar socio-economic background were recruited. Fasting venous blood was obtained and assessed for plasma/serum folate, vitamin B12, homocysteine, total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol, sTfR and ferritin and blood lead. It was found that serum concentration of ferritin and blood lead levels were significantly higher in AMI patients compared to their age and gender-matched healthy controls (p value <0.05), while the concentrations of vitamin B12 and HDL-cholesterol were significantly lower in AMI patients compared to controls (p value <0.01). The ratio of sTfR to ferritin was significantly lower in AMI patients compared to controls [mean±SD/median (IQR) values 84.7±295/28.9 (38.4) vs 255±836/49.4 (83.8), respectively; p value <0.001]. Compared with the highest quartile of sTfR/ferritin (low body iron status), the OR for the risk of AMI was 3.29(95% CI, 1.54–7.03) for the lowest quartile (quartile 1) when the model was adjusted for vitamin B12 and HDL-cholesterol (p value for trend <0.01).Conclusions/SignificanceThis study shows a positive association between total body iron status and risk of premature AMI in a Pakistani population.

Serum Ferritin Level in Male with Established Coronary Artery Disease

“…Recently evidence of association of elevated serum ferritin and increased risk of AMI came from the studies in Asian ethnic population. [5,6,7] These findings strongly support the "iron hypothesis" which suggests that iron, as a catalytic agent, could promote formation of highly reactive oxygen. The reactive oxygen species (ROS) has been implicated in lipid peroxidation and atherosclerosis subsequently leading to AMI.…”

Chronic thromboembolic pulmonary hypertension is not associated with iron overload

“…It has been reported that heme iron intake is associated with an increased risk of coronary heart disease [12]. And total body iron status has a positive association with risk of premature acute myocardial infarction [13]. While in patients with acute coronary syndrome, increased iron levels are associated with increased all-cause mortality [14].…”

Evaluation of HFE Gene (C282Y) Mutation and Its Association Relation with Coronary Artery Diseases in Indian Population

“…In an angiographically controlled population, the concentration of ferritin and transferrin showed no association with CAD. In a study, where 174 patients with angiographically confirmed CAD were compared to healthy subjects, no relation between the C282Y mutation and CAD was found [15][16][17][18][19][20]. In an evaluation of 265 patients with proven premature CAD, a lower frequency of the C282Y mutation was found as compared to healthy controls [19].…”

“…A post-mortem study conducted in 41 cases showed no association of the occurrence of CAD with iron overload and multiorgan haemosiderosis [19]. Coronary angiography is considered as the gold standard for detecting CAD and the magnitude of coronary atherosclerosis [15][16][17][18]. Recent data from a large angiographically controlled population, showed no evidence of any association between C282Y mutation and increase in incidence of CAD or MI.…”