Does serum ferritin correlate with coronary angiography findings?
Introduction
Ischemic heart disease is a leading cause of death in industrialized nations. Several risk factors have been shown to be related to this condition [1], [2]. Among these, it has been demonstrated that total cholesterol and low-density lipoprotein (LDL) fraction levels are main factors in the genesis and progression of coronary atherosclerosis [3], [4], [5].
Atherosclerosis is a pathological process of the arterial wall which is characterized by deposition of lipids, especially oxidized cholesterol, within the sub-endothelial layer, inside mononuclear cells (foam cells) [6], [7]. Free radicals cause lipid peroxidation, leading to modification at LDL molecular level, facilitating its deposition and leading to the formation of the atherosclerotic plaque [8], [9], [10], [11], [12]. In addition, it has been demonstrated that free radicals injure the endothelial cell membrane, determining alterations in its defense mechanisms, probably facilitating LDL deposition and leukocyte migration into the arterial wall.
In vivo, under physiological pH, free radicals such as the hydroxyl radical (OH−) are generated at low rates, through the reaction of Haber–Weiss, also known as the superoxide-driven Fenton reaction. Since this reaction is catalyzed by iron, more intense free radical production could occur when ferritin levels are higher [13], [14], [15], [16], [17]. This might explain the greater incidence of ischemic heart disease in males as compared to premenopausal females, since in that period body iron stores, as assessed by ferritin levels, are approximately three times higher in men than in women [18], [19], [20], [21], [22], [23], [24], [25].
The putative role of iron in the atherosclerotic process is supported by experimental and clinical studies. The aim of this study was to evaluate the relationship between serum ferritin levels and the presence of coronary atherosclerosis as defined by coronary angiography.
Section snippets
Methods
Patients referred for coronary angiography in our institution between 1996 and 1997 were invited to participate in this study. Before undergoing coronary angiography, a blood sample was drawn and each patient was assessed through a standard questionnaire. The following clinical information was obtained from each patient: history of chest pain; myocardial infarction; smoking; hypertension and diabetes mellitus. Smoking was defined as the use of more than 5 cigarettes per day, at least for 1 year
Results
A total of 307 patients were enrolled in this study; 196 (63.8%) had angiographic defined CAD and 111 (36.2%) had no significant CAD. The mean age was 60.1 years (range 34–89), 60.9% of the patients were male and most were white (88.6%).
Clinical characteristics of patients with and without angiographic significant CAD an presented in Table 1. By univariate analysis, statistically significant differences were found between groups when considering patient age (P<0.001), male sex (P<0.001),
Discussion
Based on experimental findings, the hypothesis that high concentration of iron in the organism is associated with accelerated free radicals production and increased lipid peroxidation seems to be plausible. Balla and colleagues [30] demonstrated that the combination of physiological concentrations of hydrogen peroxide and the heme prostetic group of hemoglobin induced rapid oxidation of LDL in vitro, liberating free iron from this reaction. It has also been demonstrated that superoxide radical
Acknowledgments
We thank CNPq and FAPERGS for financial support and the staff of the Unidade de Hemodinâmica of Hospital de Clinicas de Porto Alegre.
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2022, Biochimica et Biophysica Acta - General SubjectsCitation Excerpt :In a literature review, Muñoz-Bravo et al. (2013) found that from 55 epidemiological studies evaluating the “iron hypothesis”, of which 20 found no evidence and 8 found an opposite effect, illustrating a disparity of findings at that time [71]. In epidemiological studies, ferritin levels did not correlate with atherosclerotic lesions on coronary [72,73] or carotid arteries [74]. Furthermore, no risk associations have been found between iron stores, MI [75] and ischemic stroke [76]; and the reduction on body iron stores did not influence deaths related to cardiovascular diseases [77,78].
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