Iron In Coronary Death

[ironjustice]

"Almost 4-fold risk"

Prognostic evaluation of catalytic iron in patients with acute
coronary syndromes.
Clin Cardiol. 2013 Mar;36(3):139-45.
Steen DL, Cannon CP, Lele SS, Rajapurkar MM, Mukhopadhyay B, Scirica
BM, Murphy SA, Morrow DA.
TIMI Study Group, Cardiovascular Division, Department of Medicine,
Brigham and Women's Hospital, Boston, MA. ste...@gmail.com,
dst...@partners.org.

Abstract
BACKGROUND: The potential of iron to generate reactive oxygen species
has motivated a long-standing interest in whether excess iron is
causally linked to atherosclerotic heart disease. Circulating
catalytic iron ("free" iron) is that which is not bound to transferrin
or ferritin and is available to generate reactive oxygen species that
may have deleterious vascular effects.

HYPOTHESIS: We hypothesized that increased levels of catalytic iron
would be associated with increased cardiovascular events.

METHODS: We investigated the association of catalytic iron with
clinical outcomes in 1701 patients with unstable angina, non-ST-
segment elevation myocardial infarction (MI), or ST-segment elevation
MI who were followed for a median of 10 months. All endpoints were
adjudicated by a blinded Clinical End Points Committee.

RESULTS: The median catalytic iron level was significantly higher in
those who died, 0.45 µmol/L (0.37, 0.57), compared with survivors,
0.37µmol/L (0.31, 0.46; P = 0.016). Catalytic iron was associated with
a stepwise increased risk of death, with the highest quartile at an
almost 4-fold risk compared with baseline (hazard ratio: 3.94, P =
0.035), which persisted after adjustment for age, diabetes, prior MI,
prior congestive heart failure, ST-segment deviation, creatinine
clearance, B-type natriuretic peptide, smoking, and Killip class
(adjusted hazard ratio: 3.97, P = 0.036). There was no association
between catalytic iron and risk of MI, recurrent ischemia, heart
failure, or bleeding.

CONCLUSIONS: Increasing catalytic iron levels were associated with
increased all-cause mortality. Although our findings suggest that
catalytic iron is not likely to add to available tools as a routine
biomarker for risk stratification of recurrent ischemic events, its
association with mortality is intriguing and leaves open the question
of whether cardiovascular therapeutics aimed at catalytic iron may be
useful. The TIMI Study Group has received research grant support from
the Muljibhai Patel Society for Research in Nephro-Urology. There are
no other financial relationships, or conflicts of interest relevant to
this manuscript to disclose.

© 2013 Wiley Periodicals, Inc.

doi: 10.1002/clc.22089. Epub 2013 Feb 3.

PMID:23377899


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