Iron, Atherosclerosis, and Ischemic Heart Disease

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Abstract
In 1981, Sullivan1 proposed that iron depletion protects against ischemic heart disease. He argued that the difference in the incidence of heart disease between men and women could be explained by differences in levels of stored iron. He argued in support of his theory that myocardial failure occurs in patients with iron storage disorders and that there is accumulation of stored iron with age in men and after menopause in women. Because the results of the Framingham Study2-4 showed that the risk of heart disease in women increased equally by natural menopause or by surgical menopause (independent of oophorectomy), uterine factors, especially regular menstrual blood losses, rather than hormonal factors, might be responsible for the protection of premenopausal women against ischemic heart disease.5 A study by Lauffer6 showed a significant correlation between iron stores and cardiovascular mortality. In men, iron stores, assessed by serum ferritin concentration,7 rise after adolescence. In women, iron stores remain low and only begin to rise after the age of 45 years.8 In young men, there is a parallel increase in risk of coronary heart disease (CHD) and iron load.1,5 The maximal sex difference in serum ferritin level is reached at approximately 45 years of age and is about 300%. The maximal sex difference in heart disease is also reached at approximately 45 years and is also about 300%.9