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.
Highlights
Body iron because of its ability to induce oxidative stress has been considered to be contributing to the pathogenesis of coronary artery disease (CAD)
Few studies have been carried out to investigate the relationship of serum ferritin and risk of coronary heart disease (CHD) in the South Asian region [4,5]; none of them have focused on the entire spectrum of body iron stores employing the ratio of soluble transferrin receptor (sTfR) to ferritin and investigating its relationship with premature CAD
Analysis of the data revealed that concentrations of serum vitamin B12, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were significantly lower in acute myocardial infarction (AMI) patients compared to age and gender-matched healthy controls (Table 1)
Summary
Body iron because of its ability to induce oxidative stress has been considered to be contributing to the pathogenesis of coronary artery disease (CAD). A systematic review of the literature on this subject revealed that five studies reported significant association between serum ferritin and coronary heart disease (CHD), while nine studies did not show any such relationship [1] Most of these studies used serum ferritin as a marker of body iron stores. Determination of serum soluble transferrin receptor (sTfR) concentration along with serum ferritin provided a more reliable tool for estimation of body iron status. Few studies have been carried out to investigate the relationship of serum ferritin and risk of CHD in the South Asian region [4,5]; none of them have focused on the entire spectrum of body iron stores employing the ratio of sTfR to ferritin and investigating its relationship with premature CAD. Since Pakistani urban population has been found to have high levels of blood lead (Pb) which is associated with hyperhomocysteinemia [6], another objective of the study was to investigate if high blood Pb levels in this population would modulate the relationship (if any) between body iron stores and risk of premature AMI
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