New perspectives of iron deficiency as a risk factor for ischemic stroke

Abstract

Dear Editor, Stroke is the third leading cause of premature death in general population [1]. In childhood, the occurrence of stroke is less frequent than in adulthood; however, the mortality rate reaches 20 % in infants [2]. For instance, sickle cell disease, congenital cardiac disorders, traumatic lesions, and infections contribute to increase the odds for childhood stroke [3]. Recently, iron-deficiency anemia (IDA) has been also suggested as an important risk factor to ischemic cerebrovascular events [4, 5]. In this context, Azab et al. [6] performed a case–control study with 21 stroke children with median age of 36 months. They found a significant effect of IDA predicting stroke. The patients with IDA showed higher median platelet count compared to control and stroke with normal iron parameters groups. Consequently, children with IDA had 2.5-fold greater odds for ischemic stroke. These results suggest that IDA could be a more potent risk factor for perinatal stroke with similar magnitude than the others widely reported. The authors deserve congratulations for this study mainly for two reasons. Firstly, effective stroke treatments must be continuously investigated since the prevention of reversible risk factors is the most indicated therapy to avoid the occurrence and recurrence of stroke. Secondly, these findings may contribute to elucidate the different pathophysiological mechanism involved in the association of stroke and other disorders, such as the periodic limb movements (PLM) [7], for example. PLM is characterized by repeated movements of arms and/ or legs during sleep whose possible etiology comprises an iron deficiency and a consequent dysfunction in dopaminergic transmission [8]. Indeed, children with sickle cell disease showed a higher PLM prevalence than healthy patients [9]. PLM also increase the risk of ischemic stroke. The high prevalence of PLM after stroke may indicate a concomitant pathway of iron deficiency [7]. Indeterminate etiology of stroke can constitute approximately 37 % of all diagnosed patients [10]. Thus, further studies should be performed to analyze underestimated risk factors for stroke. New and common pathophysiological mechanisms of different diseases with stroke must be better understood. The investigations may contribute to elucidate part of the indeterminate stroke.