Donation of blood is associated with reduced risk of myocardial infarction. The Kuopio Ischaemic Heart Disease Risk Factor Study

Associations Between Genetically Predicted Iron Status and Cardiovascular Disease Risk: A Mendelian Randomization Study

BACKGROUND

Mendelian randomization (MR) studies suggest a causal effect of iron status on cardiovascular disease (CVD) risk, but it is unknown if these associations are confounded by pleiotropic effects of the instrumental variables on CVD risk factors. We aimed to investigate the effect of iron status on CVD risk controlling for CVD risk factors.

METHODS AND RESULTS

Iron biomarker instrumental variables (total iron-binding capacity [n=208 422], transferrin saturation [n=198 516], serum iron [n=236 612], ferritin [n=257 953]) were selected from a European genome-wide association study meta-analysis. We performed 2-sample univariate MR of each iron trait on CVD outcomes (all-cause ischemic stroke, cardioembolic ischemic stroke, large-artery ischemic stroke, small-vessel ischemic stroke, and coronary heart disease) from MEGASTROKE (n=440 328) and CARDIoGRAMplusC4D (Coronary Artery Disease Genome Wide Replication and Meta-Analysis Plus the Coronary Artery Disease Genetics) (n=183 305). We then implemented multivariate MR conditioning on 7 CVD risk factors from independent European samples to evaluate their potential confounding or mediating effects on the observed iron-CVD associations. With univariate MR analyses, we found higher genetically predicted iron status to be associated with a greater risk of cardioembolic ischemic stroke (transferrin saturation: odds ratio, 1.17 [95% CI, 1.03-1.33]; serum iron: odds ratio, 1.21 [95% CI, 1.02-1.44]; total iron-binding capacity: odds ratio, 0.81 [95% CI, 0.69-0.94]). The detrimental effects of iron status on cardioembolic ischemic stroke risk remained unaffected when adjusting for CVD risk factors (all P<0.05). Additionally, we found diastolic blood pressure to mediate between 7.1 and 8.8% of the total effect of iron status on cardioembolic ischemic stroke incidence. Univariate MR initially suggested a protective effect of iron status on large-artery stroke and coronary heart disease, but controlling for CVD factors using multivariate MR substantially diminished these associations (all P>0.05).

CONCLUSIONS

Higher iron status was associated with a greater risk of cardioembolic ischemic stroke independent of CVD risk factors, and this effect was partly mediated by diastolic blood pressure. These findings support a role of iron status as a modifiable risk factor for cardioembolic ischemic stroke.

An iron rheostat controls hematopoietic stem cell fate

Mechanisms governing the maintenance of blood-producing hematopoietic stem and multipotent progenitor cells (HSPCs) are incompletely understood, particularly those regulating fate, ensuring long-term maintenance, and preventing aging-associated stem cell dysfunction. We uncovered a role for transitory free cytoplasmic iron as a rheostat for adult stem cell fate control. We found that HSPCs harbor comparatively small amounts of free iron and show the activation of a conserved molecular response to limited iron-particularly during mitosis. To study the functional and molecular consequences of iron restriction, we developed models allowing for transient iron bioavailability limitation and combined single-molecule RNA quantification, metabolomics, and single-cell transcriptomic analyses with functional studies. Our data reveal that the activation of the limited iron response triggers coordinated metabolic and epigenetic events, establishing stemness-conferring gene regulation. Notably, we find that aging-associated cytoplasmic iron loading reversibly attenuates iron-dependent cell fate control, explicating intervention strategies for dysfunctional aged stem cells.

Associations between genetically predicted iron status and cardiovascular disease risk: A Mendelian randomization study

Background

Mendelian randomization (MR) studies suggest a causal effect of iron (Fe) status on cardiovascular disease (CVD) risk, but it is unknown if these associations are confounded by pleiotropic effects of the instrumental variables (IV) on CVD risk factors. We aimed to investigate the effect of Fe status on CVD risk controlling for CVD risk factors.

Methods

Fe biomarker IVs (total Fe binding capacity (TIBC, n=208,422), transferrin saturation (TSAT, n=198,516), serum Fe (SI, n=236,612), ferritin (n=257,953)) were selected from a European GWAS meta-analysis. We performed two-sample univariate (UV) MR of each Fe trait on CVD outcomes (all-cause ischemic stroke (IS), cardioembolic IS (CES), large artery IS (LAS), small vessel IS (SVS), and coronary heart disease (CHD)) from MEGASTROKE (n=440,328) and CARDIoGRAMplusC4D (n=183,305). We then implemented multivariate (MV) MR conditioning on six CVD risk factors from independent European samples to evaluate their potential confounding and/or mediating effects on the observed Fe-CVD associations.

Results

With UVMR analyses, we found higher genetically predicted Fe status to be associated with a greater risk of CES (TSAT: OR 1.17 [95%CI 1.03, 1.33], SI: OR 1.21 [ 95%CI 1.02, 1.44]; TIBC: OR 0.81 [95%CI 0.69, 0.94]). The detrimental effects of Fe status on CES risk remained unaffected when adjusting for CVD risk factors (all P<0.05). Additionally, we found diastolic blood pressure (DBP) to mediate between 7.1-8.8% of the total effect of Fe status on CES incidence. While UVMR initially suggested a protective effect of Fe status on LAS and CHD, MVMR analyses factoring CVD risk factors revealed a complete annulment of this perceived protective effect (all P>0.05).

Discussion

Higher Fe status was associated with a greater risk of CES independent of CVD risk factors, and this effect was partly mediated by DBP. These findings support a role of Fe status as a modifiable risk factor for CES.

Biological Clocks: Why We Need Them, Why We Cannot Trust Them, How They Might Be Improved

Late in life, the body is at war with itself. There is a program of self-destruction (phenoptosis) implemented via epigenetic and other changes. I refer to these as type (1) epigenetic changes. But the body retains a deep instinct for survival, and other epigenetic changes unfold in response to a perception of accumulated damage (type (2)). In the past decade, epigenetic clocks have promised to accelerate the search for anti-aging interventions by permitting prompt, reliable, and convenient measurement of their effects on lifespan without having to wait for trial results on mortality and morbidity. However, extant clocks do not distinguish between type (1) and type (2). Reversing type (1) changes extends lifespan, but reversing type (2) shortens lifespan. This is why all extant epigenetic clocks may be misleading. Separation of type (1) and type (2) epigenetic changes will lead to more reliable clock algorithms, but this cannot be done with statistics alone. New experiments are proposed. Epigenetic changes are the means by which the body implements phenoptosis, but they do not embody a clock mechanism, so they cannot be the body's primary timekeeper. The timekeeping mechanism is not yet understood, though there are hints that it may be (partially) located in the hypothalamus. For the future, we expect that the most fundamental measurement of biological age will observe this clock directly, and the most profound anti-aging interventions will manipulate it.

Mixed-methods exploration of the knowledge of young adults about blood donation processes; a one-center cross-sectional study in a tertiary institution

Ghana is a majority youthful population, but is only able to meet 60% of its annual blood donation requirements. Although tertiary students in Ghana may serve as important blood donor resource by virtue of their higher educational attainment, data about their blood donation processes-specific knowledge are scarce. This study therefore explored the perspectives, and experiences of young adults regarding blood donation processes. This exploratory study employed mixed-methods approach (semi-structured questionnaire and focus group discussion, [FGD]). Data collection was sequential; the questionnaire distribution was completed before FGD commenced; themes that emerged from the questionnaire responses guided FGDs. Convenience sampling technique was used to recruit 382 young adults (15-49 years). All statistical analyses were undertaken using the two-tail assumptions; p<0.05 was considered statistically significant. Majority (79.3%) of the participants were in their twenties, with only 1.3% being 40-49 years old. Although two-thirds of participants expressed willingness to donate blood, less than a-third (31.7%; 127/382) had previously donated blood. Overall, less than one-third of participants could correctly identify the minimum weight (26.4%), or the inter-donation interval (14.7%); 37.4% and 58.1% could respectively indicate the required donor age or ≥3 infectious agents screened for prior to blood collection. Among previous donors, 37.2%, 28.1% and 43.0% could identify the required weight, acceptable inter-donation period, and donor age respectively. Two-thirds and a-third of participants preferred voluntary unrelated, and paid donations respectively. Whereas 42.4% of participants indicated intrinsic health benefits of blood donation, 17.0% suggested that blood donation was associated with disease risks. Both previous donors and non-donor groups considered lack of education, fear of post-donation health issues and lack of privacy at blood collection centers as main hindrances to donor recruitment. Targeted intentional blood donation-specific educational campaigns are warranted to address the blood donation processes knowledge gap among the study population.

Consensus Statement on the definition and classification of metabolic hyperferritinaemia

Hyperferritinaemia is a common laboratory finding that is often associated with metabolic dysfunction and fatty liver. Metabolic hyperferritinaemia reflects alterations in iron metabolism that facilitate iron accumulation in the body and is associated with an increased risk of cardiometabolic and liver diseases. Genetic variants that modulate iron homeostasis and tissue levels of iron are the main determinants of serum levels of ferritin in individuals with metabolic dysfunction, raising the hypothesis that iron accumulation might be implicated in the pathogenesis of insulin resistance and the related organ damage. However, validated criteria for the non-invasive diagnosis of metabolic hyperferritinaemia and the staging of iron overload are still lacking, and there is no clear evidence of a benefit for iron depletion therapy. Here, we provide an overview of the literature on the relationship between hyperferritinaemia and iron accumulation in individuals with metabolic dysfunction, and on the associated clinical outcomes. We propose an updated definition and a provisional staging system for metabolic hyperferritinaemia, which has been agreed on by a multidisciplinary global panel of expert researchers. The goal is to foster studies into the epidemiology, genetics, pathophysiology, clinical relevance and treatment of metabolic hyperferritinaemia, for which we provide suggestions on the main unmet needs, optimal design and clinically relevant outcomes.

How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale

BACKGROUND

Advocates for a regulated system to facilitate kidney donation between unrelated donor-recipient pairs argue that monetary compensation encourages people to donate vital organs that save the lives of patients with end-stage organ failure. Scholars support compensating donors as a form of reciprocity. This study aims to assess the compensation system for the unrelated kidney donation program in the Islamic Republic of Iran, with a particular focus on the implications of Islam on organ donation and organ sales.

METHODS

This study reviews secondary documents for philosophical argumentation and ethical analysis of human organ donation and sale for transplantation.

RESULTS AND DISCUSSION

According to Islamic law, organ donation is an act of sadaqatul jariyah, and individuals are permitted to donate organs with the intention of saving lives. The commercialization of humans as organ sellers and buyers is contrary to the Islamic legal maxim eethaar, undermining donors of 'selfless' or 'altruistic' motivations. Such an act should be considered immoral, and the practice should not be introduced into other countries for the sake of protecting human dignity, integrity, solidarity, and respect. I, therefore, argue that Iran's unrelated kidney donation program not only disregards the position of the Islamic religion with respect to the provision or receipt of monetary benefits for human kidneys for transplantation but that it also misinterprets the Islamic legal proscription of the sale of human organs. I also argue that the implementation of Iran's unrelated kidney donor transplantation program is unethical and immoral in that potential donors and recipients engage in a bargaining process akin to that which sellers and buyers regularly face in regulated commodity exchange markets. Conversely, I suggest that a modest fixed monetary remuneration as a gift be provided to a donor as a reward for their altruistic organ donation, which is permissible by Islamic scholars. This may remove the need to bargain for increased or decreased values of payment in exchange for the organ, as well as the transactional nature of 'buyer and seller', ensuring the philosophy of 'donor and recipient' is maintained.

CONCLUSIONS

Offering a fixed modest monetary incentive to organ donors would serve to increase organ supply while protecting donors' health and reducing human suffering without legalizing the human organ trade.

Lipid and Haematologic Profiling of Regular Blood Donors Revealed Health Benefits

Background

Objective

Materials and Methods

Results

Conclusion

Iron accumulation with age alters metabolic pattern and circadian clock gene expression through the reduction of AMP-modulated histone methylation

Iron accumulates with age in mammals, and its possible implications in altering metabolic responses are not fully understood. Here, we report that both high-iron diet and advanced age in mice consistently altered gene expression of many pathways, including those governing the oxidative stress response and the circadian clock. We used a metabolomic approach to reveal similarities between metabolic profiles and the daily oscillation of clock genes in old and iron-overloaded mouse livers. In addition, we show that phlebotomy decreased iron accumulation in old mice, partially restoring the metabolic patterns and amplitudes of the oscillatory expression of clock genes Per1 and Per2. We further identified that the transcriptional regulation of iron occurred through a reduction in AMP-modulated methylation of histone H3K9 in the Per1 and H3K4 in the Per2 promoters, respectively. Taken together, our results indicate that iron accumulation with age can affect metabolic patterns and the circadian clock.

Effects of message framing on recruiting Rh-D-negative blood donors in an emergency situation: Two randomized trials

OBJECTIVES

Prospect theory categorizes message framing according to whether it emphasizes a possible loss or a possible gain. Promotions of blood donation worldwide mainly focus on gain-framed appeal. The objective of the current study is to examine the effects of message framing on recruiting Rh-D-negative blood donors (RDNBDs) in an emergency situation.

DESIGN

Two randomized trials.

METHODS

In Study 1, 813 group O and 500 group B RDNBDs were randomly assigned to three groups receiving three different recruitment text messages: (1) gain-framed, (2) loss-framed, and (3) information messages. In addition, 613 group A and 148 group AB RDNBDs were marked as (4) no message group. In Study 2, 758 RDNBDs were randomly provided one of two versions of materials focusing on either the possible survival (gain-framed) or the death (loss-framed) of a Rh-D-negative patient needed a blood transfusion. These participants then completed a questionnaire to examine the possible mechanisms underlying the observed effects.

RESULTS

Compared to not receiving any message, significantly more RDNBDs re-donated within 14 days after they received a loss-framed message. Study 2 found that RDNBDs who read the loss-framed material expressed more willingness to donate immediately than those who read the gain-framed material. RDNBDs with high-risk perception expressed a greater blood donation intention in the loss-framed group. The loss-framed message made participants perceive others' needs more strongly, which generated more empathy, and thus increased blood donation intention.

CONCLUSIONS

The results suggested that recruiting RDNBDs using a loss-framed message is suitable under an emergency.

Lateral ST-elevation myocardial infarction after donation of COVID-19 convalescent plasma in a naïve donor

A 34-year-old man presented with central chest pain heralded by bilateral arm numbness, tingling and pain soon after donation of 1000 mL of COVID-19 convalescent plasma (CP). ECG showed ST-elevation in lateral leads and coronary angiogram showed large thrombus in diagonal branch of the left anterior descending artery. The patient underwent successful thrombus aspiration and percutaneous coronary intervention of diagonal branch. In this report, we describe a case of coronary thrombosis leading to ST-elevation myocardial infarction in a naïve plasma donor after donation of COVID-19 CP.

Health Behavior and Lifestyle Trends among Platelet Donors: Results from a Questionnaire-Based Survey in Norway

Background

Blood donors are on average healthier than the general population, a phenomenon known as the “healthy donor effect.” Earlier studies have also pointed to healthier behaviors among whole blood donors than the general population. This study is aimed at assessing the prevalence of four healthy behaviors (sufficient physical activity, avoiding cigarette smoking, low to moderate alcohol use, and maintaining a healthy weight) among platelet donors and to compare the results with those in the general population of similar ages.

Methods

Eighty-six platelet donors were asked to complete a questionnaire designed to assess physical activity, smoking, and alcohol use. Sociodemographic information including gender, age, and education was also collected from all participants. Chi-square statistics and logistic regression were used in statistical analysis.

Results

The mean age of the study donors was 51 years, 56% were female. Most were employed (90%), and 48% hold a bachelor's or higher degree. The prevalence of healthy behaviors differed by education gradients but not by gender and age. About 49% of the donors met the weekly physical activity recommendations, less than 5% were daily smokers, and~26% were classified as more frequent drinkers (≥1 to ≤5 times per week). The corresponding percentages for the general population were, respectively, 33%, 13%, and 35%. The prevalence of overweight and obesity, as assessed by body mass index (BMI), among donors were 50% and 29%, respectively, much higher than the current prevalence of overweight and obesity of 37% and 19%, respectively, among adults in the general population.

Conclusions

The individual health behaviors of the majority of the study population could be characterized by a relatively high level of physical activity, low prevalence of daily smoking, and moderate alcohol drinking. The above-average overweight/obesity prevalence among platelet donors in this cohort is of concern because of the potential serious health consequences and it warrants further reflection.

Characterization of blood donors and non-blood donors in Germany using an online survey

Objectives of this study were to analyze characteristics influencing blood donation status, to identify anxieties and reasons for (non-)blood donation, and potential channels for future blood donation campaigns. A random population from Germany was interviewed using the online survey tool SoSci Survey. The access link to the questionnaire was distributed via snowball system and the Bavarian Red Cross. Statistical analysis was performed to identify factors influencing blood donation status. A total of 682 participants (27.3% blood donors) with a mean age of 33.4 and a standard deviation (SD) of 12.0 years were included into the analysis. Strongest factor associated with being blood donor was having a blood donor within family and friends (Odds ratio [OR]: 5.05 [95% confidence interval [95% CI]: 2.63; 9.70]; p≤0.001), whereas having anxiety related to blood donation was the strongest factor for being non-blood donor (OR: 0.11 [95% CI: 0.05; 0.21] p≤0.001). Other factors significantly influencing blood donor status were age, health-related quality of life, knowledge on blood donation, being an organ donor and having pre-conditions. Main anxieties avoiding blood donation were fear of physical consequences, and fear of the injection needle. Most frequently mentioned channels which should be used for blood donation campaigns were Instagram and free TV. Involving blood donors into campaigns to recruit new blood donors from their personal environment and to focus campaign content on physical benefits of blood donations might help to recruit new blood donors. In addition, running campaigns stronger on channels such as Instagram might increase their scope.

Sex-based approach for the clinical impact of polycythaemia on cardiovascular outcomes in the general population

AIMS

Although the adverse cardiovascular effect of anaemia has been well described, the effect of polycythaemia on the cardiovascular outcomes of the general population remain unclear. The primary objective is to identify the association between polycythaemia and major adverse cardiovascular events (MACE), and the secondary objective is to identify the specific haemoglobin concentration more associated with an increased risk for MACE.

METHODS AND RESULTS

This was a retrospective cohort study, 451 107 subjects were enrolled who underwent national health examinations from the Korean National Sample Cohort. We estimated the risk of MACE, a composite of cardiovascular mortality, incident myocardial infarction (MI), and stroke according to haemoglobin-based four categories. During 3.8-year of follow-up, polycythaemia group showed higher MACE [hazard ratio (HR) = 1.27 (1.13-1.44) and HR = 1.76 (1.08-2.88); in men and women, respectively], incident MI [HR = 1.37 (1.05-1.79) and HR = 3.46 (1.06-14.00)], and incident ischaemic stroke [HR = 1.27 (1.10-1.46) and HR = 1.72 (1.02-2.91)] than normal haemoglobin group (P < 0.001 in all cases). In the normal haemoglobin and polycythaemia groups, a 1 g/dL increase in haemoglobin level was associated with increased risks of MACE [HR = 1.04 (1.01-1.07) and HR = 1.05 (1.01-1.10) in men and women, each P < 0.05]. To investigate the specific haemoglobin concentration related to greater MACE incidence, we analysed the sensitivity/specificity of different haemoglobin levels: ≥16.5 g/dL in men and ≥15.0 g/dL in women showed the highest Youden's index (sensitivity + specificity - 1), with c-indices of 0.82 (0.81-0.83) and 0.83 (0.82-0.84), respectively.

CONCLUSION

Even in the Korean general population, polycythaemia was significantly associated with higher rates of MACE, incident MI, and incident ischaemic stroke. Especially, subjects with haemoglobin levels ≥15.0 g/dL in women and ≥16.5 g/dL among men were associated with increased risks of MACE.

Serum ferritin levels is associated with acute myocardial infarction: a meta-analysis

OBJECTIVE

An association between increased serum ferritin levels and acute myocardial infarction (AMI) remains controversial. The purpose of this meta-analysis is to confirm the association between increased serum ferritin levels and AMI.

METHODS

We searched PubMed and China National Knowledge Infrastructure (CNKI) for relevant articles that assessed the association between serum ferritin and acute myocardial infarction using terms that included serum ferritin and acute myocardial infarction up to February 13, 2019.

RESULTS

A total of 11 studies were identified for analysis. All pooled analysis was based on a random-effects models. The variance was exhibited using a forest plot, and the heterogeneity among studies was examined using the I2 index, the publication bias was evaluated using a funnel plot. The pooled standard mean difference of ferritin levels between AMI and controls was 0.78 (95%CI,0.68-0.88).

CONCLUSION

The results of this meta-analysis demonstrate that serum ferritin in acute myocardial infarction patients is higher than that of healthy controls.

The role of hepcidin and iron homeostasis in atherosclerosis

Atherosclerotic cardiovascular disease is a major burden on global health and a leading cause of death worldwide. The pathophysiology of this chronic disease is complex, involving inflammation, lipoprotein oxidation and accumulation, plaque formation, and calcification. In 1981, Dr. Jerome Sullivan formulated the 'Iron Hypothesis', suggesting that higher levels of stored iron promote cardiovascular diseases, whereas iron deficiency may have an atheroprotective effect. This hypothesis has stimulated research focused on clarifying the role of iron in the development of atherosclerosis. However, preclinical and clinical studies have produced contradictory results and the observation that patients with hemochromatosis do not appear to have an increased risk of atherosclerosis seemed incongruous with Sullivan's initial hypothesis. The 'paradox' of systemic iron overload not being accompanied by an increased risk for atherosclerosis led to a refinement of the iron hypothesis focusing on intracellular macrophage iron. More recent in vitro and animal studies have elucidated the complex signaling pathways regulating iron, with a particular focus on hepcidin, the master regulator of body iron homeostasis. Bone morphogenetic protein (BMP) signaling is the major pathway that is required for induction of hepcidin expression in response to increasing levels of iron. Strong links between iron homeostasis, BMP signaling, inflammation and atherosclerosis have been established in both mechanistic and human studies. This review summarizes the current understanding of the role of iron homeostasis and hepcidin in the development of atherosclerosis and discusses the BMP-hepcidin-ferroportin axis as a novel therapeutic target for the treatment of cardiovascular disease.

Relation of Preprocedural Hemoglobin Level to Outcomes After Percutaneous Coronary Intervention

Adverse effects have been reported in patients with preprocedural anemia after percutaneous coronary intervention (PCI), but data regarding the relation between elevated hemoglobin (Hb) level and post-PCI prognosis remain limited. This study assessed the impact of elevated Hb on major adverse cardiac and cerebrovascular event (MACCE) at 12 months, a composite of all-cause mortality, nonfatal myocardial infarction, and ischemic stroke after PCI. We pooled patient-level data from four Korean multicenter drug-eluting stent registries from 2010 to 2016. In total, 5,107 patients were divided into 5 categories according to the baseline Hb level (<10, 10 to 12.9, 13 to 14.9, 15 to 16.9 and ≥17 g/dl). Patients with higher Hb levels were significantly younger, predominantly male, current smokers with higher body mass index, and more frequent dyslipidemia. Hypertension, diabetes, chronic kidney disease, and cerebrovascular accident were more prevalent in lower Hb groups. Categorically, a U-shaped curvilinear relation was observed between baseline Hb and clinical outcomes showing significantly higher MACCE rate in <10g/dl (hazard ratio [HR], 4.62 [2.81 to 7.68]) and ≥17 g/dl (HR, 4.06 [1.57 to 10.5]) groups compared with the reference group (13 to 14.9 g/dl), especially in men. In nonanemic patients (Hb ≥13 g/dl), adjusted HRs of MACCE, mortality, and stroke were significantly higher in ≥17 g/dl group than in the reference group. Furthermore, ≥17 g/dl was an independent predictor for MACCE and all-cause mortality after PCI. In conclusion, not only low Hb but also elevated Hb of ≥17 g/dl was significantly associated with higher MACCE rates and all-cause mortality after PCI. An appropriate treatment strategy for patients with high Hb level should be identified through future studies.

Level of hyperlipidemia in blood donors: A correlative study in North Indian population

BACKGROUND

Hyperlipidemia can be caused by abnormal elevation of lipids and lipoproteins in the blood. This increased can lead to heart disease. Risks which can be controlled include alcohol intake, physical activity, smoking, high blood pressure and genetic factors. Markers of increased cardiovascular risk appear to be lower in regular blood donor compared with single time donors as reflected by significantly lower total cholesterol and LDL levels. And it has been thought that there will be a direct relationship between lower risks of Heart diseases with repeated blood donation.

AIM

The aim of the present study is to determine the effect of blood donation on single time and repeat donors by assessing their lipid levels and their family history of heart diseases.

MATERIAL & METHODS

This cross-sectional study was carried out on (n = 80) random blood donors from the department of Transfusion Medicine KGMU.

RESULTS

A significant correlation was found amongst hyperlipidemic level in single time donor & repeat donors and in donors with family history of heart diseases (p < 0.05). A positive association was found between hyperlipidemia with donor's weight (p < 0.05).

CONCLUSION

Screening random donor platelets for hyperlipidemia and correlating the condition with other donor criteria like family history of heart diseases, types of donors, donors weight age and gender will help in making the patients safe as well as the donor deferral criteria more stringent to improve the quality of blood supply and will enable blood bankers to supply safe blood and improve the guidelines for blood safety.

Cardiovascular risk in 159 934 frequent blood donors while addressing the healthy donor effect

OBJECTIVE

To investigate whether regular blood donation decreases cardiovascular risk.

METHODS

All 159 934 Dutch whole-blood donors with an active donation career of at least 10 years were categorised into sex-specific donation tertiles based on the number of donations during this 10-year qualification period. Cardiovascular endpoints were based on hospital discharge diagnoses and death certificates from Dutch Hospital Data and Statistics Netherlands and occurring after the 10-year qualification period. Cox regression was used to estimate the age-adjusted and starting year-adjusted hazard rate ratio (HRR).

RESULTS

Female high-frequency blood donors had a reduced cardiovascular morbidity (HRR=0.91, 95% CI 0.85 to 0.98) compared with low-frequency blood donors. No effect was observed in men (HRR=1.00, 95% CI 0.95 to 1.05). To rule out a residual healthy donor effect (HDE), additional sensitivity analyses using a 5-year qualification period were conducted. The results supported the absence of a residual HDE.

CONCLUSIONS

This study showed a protective effect of long-term, high-frequency blood donation against cardiovascular disease. This effect was only observed in women and not in men.

Alcohol consumption in adolescence is associated with a lower risk of multiple sclerosis in a Danish cohort

BACKGROUND AND OBJECTIVE

Due to the possible existence of a vulnerable period of multiple sclerosis (MS) susceptibility in adolescence and because Danish teenagers have a high alcohol consumption, we investigated the association between alcohol consumption at ages 15-19 and the risk of developing MS.

METHODS

A total of 1717 patients with MS and 4685 healthy blood donors filled in a comprehensive environmental and lifestyle questionnaire. Data were analysed by logistic regression models and adjusted for selected confounders.

RESULTS

We found an inverse association between alcohol consumption in adolescence and risk of developing MS in both women (p < 0.001) and men (p = 0.012). Women with low alcohol consumption had an odds ratio (OR) of 0.56 (95% confidence interval (CI): 0.47-0.66) compared with non-drinking women. The ORs were similar for women with moderate (OR = 0.49, 95% CI: 0.38-0.62) and high consumption (OR = 0.57, 95% CI: 0.38-0.84). Men with low alcohol consumption had an OR of 0.69 (95% CI: 0.53-0.89) compared with non-drinking men but no decreased risk was found for men with moderate and high consumption.

CONCLUSION

Alcohol consumption in adolescence was associated with lower risk of developing MS among both sexes.

Iron in neurodegenerative disorders: being in the wrong place at the wrong time?

Brain iron deposits have been reported consistently in imaging and histologic examinations of patients with neurodegenerative disorders. While the origins of this finding have not been clarified yet, it is speculated that impaired iron homeostasis or deficient transport mechanisms result in the accumulation of this highly toxic metal ultimately leading to formation of reactive oxygen species and cell death. On the other hand, there are also those who support that iron is just an incidental finding, a by product of neuronal loss. A literature review has been performed in order to present the key findings in support of the iron hypothesis of neurodegeneration, as well as to identify conditions causing or resulting from iron overload and compare and contrast their features with the most prominent neurodegenerative disorders. There is an abundance of experimental and observational findings in support of the hypothesis in question; however, as neurodegeneration is a rare incident of commonly encountered iron-associated disorders of the nervous system, and this metal is found in non-neurodegenerative disorders as well, it is possible that iron is the result or even an incidental finding in neurodegeneration. Understanding the underlying processes of iron metabolism in the brain and particularly its release during cell damage is expected to provide a deeper understanding of the origins of neurodegeneration in the years to come.

Long-term donors versus non-donor men: Iron metabolism and the atherosclerotic process

BACKGROUND AND AIMS

The increased iron level and the labile iron pool (LIP) in circulating monocytes are connected to a higher frequency of cardiovascular events.

METHODS

The study investigates the relationship between LIP in circulating monocytes and markers of iron metabolism and atherosclerosis (inflammation, oxidative stress, endothelial dysfunction and arterial elasticity) in long-term blood donors and non-donor volunteers.

RESULTS

We found that donors had significantly higher LIP values than the control group (1.89 ± 0.47 μM vs. 1.50 ± 0.41 μM, p = 0.007). Despite the observed tendency for the donor group to have higher blood pressure, cholesterol, glucose and HOMAR-IR (homeostasis model assessment of insulin resistance), the groups did not differ in inflammatory markers, markers of endothelial dysfunction and markers of impaired arterial elasticity. The donor group had significant changes in iron metabolism (higher serum Fe, ceruloplasmin, and TfR/Ft ratio (transferrin receptor/ferritin ratio) and lower hepcidin, ferritin, and CD163), indicating depletion of body iron stores and activation of iron turnover.

CONCLUSIONS

LIP seems to be a good marker of iron turnover activity in these individuals despite the lack of a decrease in the hemoglobin concentration. We did not find a significant correlation between LIP levels and atherosclerosis progression in the two groups. However, further studies are needed to assess long-term donorship as a protective factor against atherosclerosis.

Medical and laboratory assessment for regular blood donors in Sulaimani Blood Bank, Iraq

INTRODUCTION

It has been suggested that blood donation reduces risks of developing cardiovascular diseases such as heart failure, atherosclerosis, and stroke. Although there are known benefits of blood donation, the inclination of people of the Kurdistan Region of Iraq to donate blood is not known. Therefore, the aim of this study was to determine demograpic and blood biochemical profiles of regular and first-time blood donors in the Sulaimani province of North Iraq.

METHODS

A cross-sectional study was conducted at the Sulaimani Blood Bank, during the period of April 1, 2016 to March 28, 2017, on convenient samples of 100 regular and 100 first-time blood donors. Donor particulars were obtained from blood bank records. The cholesterol, triglyceride, low-density lipoprotein, ferritin, vitamin D3, and uric acid concentrations of blood samples were determined.

RESULTS

The main reason for blood donation by regular blood donors was headache (45%), while for the first-timers it was to help relatives (31%). The low-density lipoprotein and ferritin concentrations were significantly (p=0.001) lower in the blood of regular donors than first-timers.

CONCLUSION

The study shows that regular blood donation is beneficial for the maintenance of health of donors.

Re-establishing safer medical-circumcision-integrated initiation ceremonies for HIV prevention in a rural setting in Papua New Guinea. A multi-method acceptability study

Background

Efforts to stem the spread of Human Immunodeficiency Virus (HIV) in Papua New Guinea (PNG) are hampered by multiple interrelated factors including limited health services, extreme diversities in culture and language and highly prevalent gender inequity, domestic violence and poverty. In the rural district of Yangoru-Saussia, a revival of previously ceased male initiation ceremonies (MICs) is being considered for a comprehensive approach to HIV prevention. In this study, we explore the local acceptability of this undertaking including replacing traditional penile cutting practices with medical male circumcision (MMC).

Methods

A multi-method study comprising three phases. Phase one, focus group discussions with male elders to explore locally appropriate approaches to HIV prevention; Phase two, interviews and a cross-sectional survey with community men and women to assess views on MICs that include MMC for HIV prevention; Phase three, interviews with cultural leaders and a cross sectional survey to assess the acceptability of replacing traditional penile bleeding with MMC.

Results

Cultural leaders expressed that re-establishing MICs was locally appropriate for HIV prevention given the focus on character building and cultural preservation. Most surveyed participants (81.5%) supported re-establishing MICs and 92.2% supported adapting MICs with MMC. Changes to penile bleeding emerged as a contentious and contested issue given its cultural significance in symbolizing initiates’ transition from childhood to adulthood. Participants were concerned about potential clash with modern education, introduced religious beliefs and limited government support in leadership and funding.

Conclusions

Most people in this study in Yangoru-Saussia support re-establishing MICs and replacing traditional penile bleeding with MMC. This culturally-sensitive alignment of MMC (and HIV prevention) with revived MICs responds to a national health priority in PNG and acts as an example of providing culturally-sensitive male circumcision for HIV prevention recommended by WHO/UNAIDS. However, the implementation of this undertaking will require considerable effort, especially when modern pursuits in education and religion must be factored and when there is expectation for local authorities to lead and provide funding.

The impact of multiple blood donations on the risk of cardiovascular diseases: Insight of lipid profile

OBJECTIVES

The reduction in blood viscosity and iron store were proposed to be connected to the reduction in the risk of cardiovascular disease (CVD) among multiple blood donors. Herein, we evaluated the modulation of serum lipids levels in accordance with donation events. Furthermore, atherogenic impacts on the risk of CVD were investigated.

MATERIALS AND METHODS

A total of 100 voluntarily male donors were included in the study. Fifty donors were multiple time donors (MTD) and 50 were single time donors (STD). Levels of serum lipids were determined and atherogenic indices including TG/HDL and CHO/HDL ratios were calculated. QRISK2 parameters were determined to evaluate the 10-years risk of developing CVD.

RESULTS

Among MTD, there were significantly higher serum levels of triglycerides (TG) and very low-density lipoproteins (VLDL) combined with significantly lower HDL level. These modulations were significantly correlated to the extent of donation. Both CHO/HDL and TG/HDL ratios were also significantly higher among MTD. However, only TG/HDL ratio was strongly correlated to the donation extent even when controlled for age, BMI and smoking status. Despite the significant difference in QRISK2 parameters between study groups, none of these parameters was correlated to the extent of donation when controlling for age, BMI and smoking status.

CONCLUSION

We demonstrate that multiple blood donation is associated with an unfavorable modulation of serum levels of lipids that is influenced by donation extent. This modulation is not associated with an increased risk of CVD but may weakly contribute in a higher risk for coronary heart disease (CHD).

The role of iron in the pathogenesis of atherosclerosis

Ferritin and increased iron stores first appeared on the list of cardiovascular risk factors more than 30 years ago and their causal role in the pathogenesis of atherosclerosis has been heavily discussed since the early 1990s. It seems that besides traditional factors such as hyperlipoproteinemia, hypertension, diabetes mellitus, obesity, physical inactivity, smoking and family history, high iron stores represent an additional parameter that could modify individual cardiovascular risk. The role of iron in the pathogenesis of atherosclerosis was originally primarily associated with its ability to catalyze the formation of highly reactive free oxygen radicals and the oxidation of atherogenic lipoproteins. Later, it became clear that the mechanism is more complex. Atherosclerosis is a chronic fibroproliferative inflammatory process and iron, through increased oxidation stress as well as directly, can control both native and adaptive immune responses. Within the arterial wall, iron affects all of the cell types that participate in the atherosclerotic process (monocytes/macrophages, endothelial cells, vascular smooth muscle cells and platelets). Most intracellular iron is bound in ferritin, whereas redox-active iron forms labile iron pool. Pro-inflammatory and anti-inflammatory macrophages within arterial plaque differ with regard to the amount of intracellular iron and most probably with regard to their labile iron pool. Yet, the relation between plasma ferritin and intracellular labile iron pool has not been fully clarified. Data from population studies document that the consumption of meat and lack of physical activity contribute to increased iron stores. Patients with hereditary hemochromatosis, despite extreme iron storage, do not show increased manifestation of atherosclerosis probably due to the low expression of hepcidin in macrophages.

Hemochromatosis and blood donation

The voluntary, unpaid, altruistic blood donor is a cornerstone of current transfusion medicine. The complexity of medical and ethical issues related to blood donation and hemochromatosis has led to a large number of studies related to the safety of the hemochromatosis donor and the quality of the blood components produced from these donations. The issue of accepting persons with HC as blood donors is diverting, both in Europe and worldwide and without joint guidelines. A questionnaire-based study was performed and mailed to all 25 blood bank leaders in Norway. Descriptive analysis was used to evaluate the data. Eight of 22 blood banks strictly followed national guidelines concerning persons with hemochromatosis. Other blood banks make local adjustments. 16 of 22 responding blood banks accept hemochromatosis donors and five do not, and one answered partly yes. The reasons the blood bank leaders supported the acceptance of hemochromatosis donors differ. Based on published papers and the present questionnaire, we believe that a clear definition of the "hemochromatosis donor" and guidelines with more detailed information on an acceptable donation regime would be important to overcome the weak points in blood donor eligibility criteria.

Donating blood on a regular basis appears to reduce blood pressure, but appearances can be deceiving

BACKGROUND

Previous studies have reported a relationship between blood donation and decreased risk for cardiovascular events, and it has been proposed that this may be due to a lowering of blood pressure among hypertensive individuals who donate on a regular basis.

STUDY DESIGN AND METHODS

With the use of a retrospective longitudinal analysis, predonation blood pressure readings were examined across consecutive whole blood donations for New York Blood Center donors. With blood pressure levels recorded at the first, second, third, and fourth donations, the sample was divided into three subgroups including high (≥140 mmHg), intermediate (>100 and <40 mmHg), and low (≤100 mmHg) systolic blood pressure (SBP). In addition, a computational approach was used to estimate regression to the mean effects for donors with high SBP or high diastolic blood pressure (DBP) at their first, second, or third donation.

RESULTS

Visual examination of SBP and DBP patterns across donations revealed that, on average, donors with extreme values at one donation had relatively normal values at the other donations. Further, comparison of computed expected versus observed blood pressure decreases supported the notion of a subsequent regression to the mean among donors with elevated SBP or DBP at Donation 1, 2, or 3.

CONCLUSION

Among individuals who are hypertensive at initial donation, reductions in blood pressure at subsequent donations appear to result from regression to the mean as opposed to a salutary physiologic process.

One more health benefit of blood donation: reduces acute-phase reactants, oxidants and increases antioxidant capacity

BACKGROUND

One of the most important problems in finding blood donors is the inadequacy of volunteer number. To overcome this problem, one of the solutions we suggest is innovating new health benefits of blood donation. The aim of the present study is to investigate the effects of blood donation on oxidative status markers and acute-phase reactants.

METHODS

A total of 96 healthy volunteers were recruited into the study. Blood samples were withdrawn 5 min before and 24 h after the blood donation. Serum nitric oxide, malondialdehyde levels, and activity of superoxide dismutase and myeloperoxidase were measured spectrophotometrically. Serum levels of high-sensitive C-reactive protein and pentraxin-3 as acute-phase reactants were measured by enzyme-linked immunosorbent assay kits.

RESULTS

We found statistically significant lower pentraxin-3 and high-sensitive C-reactive protein levels and higher superoxide dismutase activity and nitric oxide level 24 h after blood donation in serum of blood donor when compared with before blood donation.

CONCLUSIONS

These findings suggest that blood donation affected oxidative status and acute-phase reactants in donors. Blood donation removes oxidants and decreases oxidative stress by elevating antioxidant enzyme such as superoxide dismutase. This is one more health benefit or reason why we should donate blood. Further large-scale studies should evaluate this mechanism and compare the same effect of wet cupping therapy.

Iron and peripheral arterial disease: revisiting the iron hypothesis in a different light

The relationship between iron status and atherosclerosis has long been a topic of debate in the literature. Despite more than 25 years of research, there is no consensus regarding a causal relationship. To date, the vast majority of studies have focused on iron burden with respect to a hypothesized role in the onset and progression of coronary artery disease. However, the effect of iron in the coronary arterial system may differ mechanistically and therefore clinically from its effect in the peripheral arterial system. This review will summarize the biochemical, pathologic, animal, and clinical research data with respect to iron and atherosclerosis. This background will be expanded upon to provide insights into ongoing studies and paths for future investigations into the role of iron and peripheral arterial disease.

Blood removal therapy in hereditary hemochromatosis induces a stress response resulting in improved genome integrity

BACKGROUND

Hereditary hemochromatosis (HH) is a common disease of iron metabolism, manifesting with iron overload and affecting up to 1% of individuals of northern European descent. Untreated HH can result in irreversible damage of the liver and pancreas, potentially leading to cancer and diabetes. Therapy consists of normalizing iron stores by repeated blood donations (phlebotomy). Treated HH patients have normal survival rates and report less tiredness after phlebotomy; however, it is not understood why musculoskeletal symptoms may persist in spite of iron removal. We hypothesize that phlebotomy therapy does not simply reverse iron accumulation but has additional effects at the subcellular level. In particular, the systemic impact of phlebotomy on mitochondria and genome integrity is largely unknown.

STUDY DESIGN AND METHODS

The effects of phlebotomy therapy on mitochondrial iron proteins and genome integrity were investigated in peripheral blood mononuclear blood cells from HH patients.

RESULTS

After the reduction of systemic iron load in these patients with phlebotomy, we observed increased expression of mitochondrial superoxide dismutase, reduced iron sulfur assembly protein (Iscu1/2), and improved genome integrity.

CONCLUSION

We conclude that phlebotomy therapy in HH does not merely restore systemic iron homeostasis, but induces an "oxidative stress" defense response that manifests as improved genome integrity. These findings provide novel insights into an ancient therapy.

Regular blood donation may help in the management of hypertension: an observational study on 292 blood donors

BACKGROUND

Hypertension is one of the leading global risks for cardiovascular events worldwide. There is preliminary evidence that regular blood donation may be beneficial.

STUDY DESIGN AND METHODS

Unselected blood donors were included in this observational study. Blood pressure (BP) was measured before and after blood donation, with participants donating between one and four occasions in a 1-year study period.

RESULTS

In this study, 292 donors were enrolled. At baseline, 146 had elevated BP (> 140/90 mmHg). In hypertensives, after four blood donations, systolic and diastolic blood pressure (SBP and DBP, respectively) decreased from a mean of 155.9 ± 13.0 to 143.7 ± 15.0 mmHg and from 91.4 ± 9.2 to 84.5 ± 9.3 mmHg, respectively (each p < 0.001). There was a clear dose effect with decreasing BP by the increasing number of blood donations. After at least four blood donations, donors with Stage II hypertensive baseline values (≥ 160 mmHg SBP and/or ≥ 100 mmHg DBP) were found to have the most marked reduction in BP, with 17.1 mmHg (95% confidence interval [CI], -23.2 to -11.0; p < 0.0001) and 11.7 mmHg (95% CI, -17.1 to -6.1; p = 0.0006) for SBP and DBP, respectively. The decrease in BP was not significantly associated with changes of blood count or variables of iron metabolism.

CONCLUSIONS

Regular blood donation is associated with pronounced decreases of BP in hypertensives. This beneficial effect of blood donation may open a new door regarding community health care and cost reduction in the treatment of hypertension.

Regular blood donation improves endothelial function in adult males

OBJECTIVE

Endothelial dysfunction, secondary to systemic inflammation and oxidative stress, is known to play a major role in the development and progression of atherosclerosis. It is hypothesized that the lower incidence of coronary artery disease in the premenopausal period in females when compared with males is associated with regular menstrual blood loss. We investigated whether regular blood donation (BD) is associated with improved endothelial function in healthy adult males.

METHODS

Fifty young healthy male volunteers volunteers with a mean age of 30 ± 6 years without overt cardiovascular disease were enrolled to participate in serial consecutive BDs. Serum iron levels as oxidative stress parameters, flow-mediated dilatation (FMD) for endothelial function, 24-h mean diastolic blood pressure for peripheral vascular resistance identification, and high-sensitivity C-reactive protein (hs-CRP) levels as systemic inflammatory markers were evaluated before and after BD. This study used a prospective observational cohort design. Patients with cardiovascular and inflammatory diseases were excluded.

RESULTS

BD was found to improve FMD steadily and significantly when compared with the baseline (mean ± SD: 9.9% ± 3.8%, 10.44% ± 3.9%, 10.65% ± 3.9%, and 10.75 ± 3.9%, respectively, p=0.15, p=0.02, p=0.006 as compared with the baseline). A steady decrease was identified in hs-CRP levels after serial BDs, although this decrease was not statistically significant in the all phases (2.96 ± 3.3 mg/L, 2.26 ± 1.5 mg/L, and 2.12 ± 1.5 mg/L, respectively, p=0.829, p=0.558). The 24-h mean diastolic blood pressures were significantly lower in the chronic phase (77 ± 9 mm Hg, 75 ± 7 mm Hg, and 72 ± 8 mm Hg, respectively, p=0.50, p=0.003), whereas there was no significant change in iron levels in the acute and chronic phases (66 ± 32 mg/dL, 72 ± 43 mg/dL, and 68 ± 33 mg/dL, respectively, p=1.000, p=1.000).

CONCLUSION

The results of the study indicate that regular BD improves endothelial function.

Healthy donor effect and satisfaction with health: The role of selection effects related to blood donation behavior

The objective of this paper is to quantify selection effects related to blood donation behavior and their impact on donors' perceived health status. We rely on data from the 2009 and 2010 survey waves of the German socio-economic panel (N = 12,000), including information on health-related, demographic and psychographic factors as well as monetary donation behavior and volunteer work. We propose a propensity score matching approach to control for the healthy donor effect related to the health requirements for active blood donations. We estimate two separate models and quantify selection biases between (1) active and inactive blood donors and (2) active donors and non-donors. Our results reveal that active donors are more satisfied with their health status; after controlling for selection effects, however, the differences become non-significant, revealing selection biases of up to 82% compared with non-donors. These differences also exist between active and inactive donors, but the differences are less distinct. Our methodological approach reveals and quantifies selection biases attributable to the healthy donor effect. These biases are substantial enough to lead to erroneous statistical artifacts, implying that researchers should rigorously control for selection biases when comparing the health outcomes of different blood donor groups.

Changes in metabolic indices in response to whole blood donation in male subjects with normal glucose tolerance

OBJECTIVES

Previous studies have investigated the impact of venesection upon different metabolic indices in patients with various conditions (e.g., type 2 diabetes and iron overload). We aimed to investigate the changes on different metabolic indices including glycemic, iron, lipids and inflammatory markers at different time points after blood donation in male subjects with normal glucose tolerance.

DESIGN AND METHODS

42 male subjects were recruited to the study. Glucose tolerance was assessed by oral glucose tolerance test before (visit A) and after the blood donation (1day, visit B; 1week, visit C; 3weeks, visit D; and 3months, visit E). Fasting glucose, HbA1c, insulin, lipids, uric acid, C-reactive protein, iron stores and insulin resistance (HOMA-IR, ISI-gly) indices were measured. A repeated measures ANOVA was used for comparisons of quantitative variables between different visits.

RESULTS

All subjects had normal glucose tolerance according to WHO criteria. Fasting glucose, insulin and HOMA-IR were significantly higher (~2%, p<0.05; ~21%, p<0.01; and ~11%, p<0.05 respectively) at visit B following donation. At visit D, the mean±SE for HbA1c (5.28±0.06%) was significantly lower with a difference in percentage of ~-3% and p<0.05 compared to visit A (5.44±0.06%). Ferritin decreased significantly at visits B, C, D and E (~-8%, p<0.01, ~-24%, p<0.001, ~-39%, p<0.001 and ~-29%, p<0.01 respectively), when compared to visit A.

CONCLUSIONS

At different time points after blood donation, glycemic status and iron stores are affected significantly in male blood donors with normal glucose tolerance. The changes were particularly evident three weeks after donation. Hence, the interpretation of these parameters in male blood donors needs to take this into account, and the mechanisms resulting in these effects need to be clarified.

Iron and hepcidin as risk factors in atherosclerosis: what do the genes say?

Background

Previous reports suggested a role for iron and hepcidin in atherosclerosis. Here, we evaluated the causality of these associations from a genetic perspective via (i) a Mendelian randomization (MR) approach, (ii) study of association of atherosclerosis-related single nucleotide polymorphisms (SNPs) with iron and hepcidin, and (iii) estimation of genomic correlations between hepcidin, iron and atherosclerosis.

Results

Analyses were performed in a general population sample. Iron parameters (serum iron, serum ferritin, total iron-binding capacity and transferrin saturation), serum hepcidin and genome-wide SNP data were available for N = 1,819; non-invasive measurements of atherosclerosis (NIMA), i.e., presence of plaque, intima media thickness and ankle-brachial index (ABI), for N = 549. For the MR, we used 12 iron-related SNPs that were previously identified in a genome-wide association meta-analysis on iron status, and assessed associations of individual SNPs and quartiles of a multi-SNP score with NIMA. Quartile 4 versus quartile 1 of the multi-SNP score showed directionally consistent associations with the hypothesized direction of effect for all NIMA in women, indicating that increased body iron status is a risk factor for atherosclerosis in women. We observed no single SNP associations that fit the hypothesized directions of effect between iron and NIMA, except for rs651007, associated with decreased ferritin concentration and decreased atherosclerosis risk. Two of six NIMA-related SNPs showed association with the ratio hepcidin/ferritin, suggesting that an increased hepcidin/ferritin ratio increases atherosclerosis risk. Genomic correlations were close to zero, except for hepcidin and ferritin with ABI at rest [−0.27 (SE 0.34) and −0.22 (SE 0.35), respectively] and ABI after exercise [−0.29 (SE 0.34) and −0.30 (0.35), respectively]. The negative sign indicates an increased atherosclerosis risk with increased hepcidin and ferritin concentrations.

Conclusions

Our results suggest a potential causal role for hepcidin and ferritin in atherosclerosis, and may indicate that iron status is causally related to atherosclerosis in women.

Electronic supplementary material

The online version of this article (doi:10.1186/s12863-015-0246-4) contains supplementary material, which is available to authorized users.

Cyr JA. The systemic vascular resistance response: a cardiovascular response modulating blood viscosity with implications for primary hypertension and certain anemias

Without an active regulatory feedback loop, increased blood viscosity could lead to a vicious cycle of ischemia, increased erythropoiesis, further increases of blood viscosity, decreased tissue perfusion with worsened ischemia, further increases in red cell mass, etc. We suggest that an increase in blood viscosity is detected by mechanoreceptors in the left ventricle which upregulate expression of cardiac natriuretic peptides and soluble erythropoietin receptor. This response normalizes systemic vascular resistance and blood viscosity at the cost of producing ‘anemia of chronic disease or inflammation’ or ‘hemolytic anemia’ both of which are better described as states of compensated hyperviscosity. Besides its role in disease, this response is also active in the physiologic adaptation to chronic exercise. Malfunction of this response may cause primary hypertension.

Risk of illness, hospitalization and death in a cohort of blood donors in Italy

OBJECTIVE

The aim of this study was to determine whether blood donors (BDs), compared with non blood donors (nBDs), present significant differences in risk of illness, hospitalization and death.

METHODS

All subjects included in the database of the Association of Voluntary Italian Blood Donors of Ferrara entered the study. The analysis only included residents who donated at least once. For each BD, four age- and sex-matched non-donor controls were selected from the master archive of the Province of Ferrara. Then, all hospitalizations of BDs and controls from January 2005 to December 2010 were extracted from the hospital admission and discharge database of the region.

RESULTS

During the considered period, 26,140 hospital admissions in BDs and 98,685 in controls were recorded; 11,862 individual BDs and 43,138 nBDs. Compared with controls, BDs were characterized by older age, lower average number of admissions and diagnoses, Charlson comorbidity index score, shorter hospital length-of-stay (LOS), lower mortality rates and higher age at death. Age at death was significantly higher for BDs with longer duration and higher number of donations. In particular, blood donation was not related to an increased risk of malignancies. The main limitation of this study is potential selection bias (i.e. a healthy donor effect). Matching with the control population also has its limitations.

CONCLUSIONS

This study confirms that BDs have a lower risk of hospitalization, and, more specifically, do not have an increased risk of malignancies, leukemias, lymphomas and myeloma.

Atherogenesis and iron: from epidemiology to cellular level

Iron accumulates in human atherosclerotic lesions but whether it is a cause or simply a downstream consequence of the atheroma formation has been an open question for decades. According to the so called "iron hypothesis," iron is believed to be detrimental for the cardiovascular system, thus promoting atherosclerosis development and progression. Iron, in its catalytically active form, can participate in the generation of reactive oxygen species and induce lipid-peroxidation, triggering endothelial activation, smooth muscle cell proliferation and macrophage activation; all of these processes are considered to be proatherogenic. On the other hand, the observation that hemochromatotic patients, affected by life-long iron overload, do not show any increased incidence of atherosclerosis is perceived as the most convincing evidence against the "iron hypothesis." Epidemiological studies and data from animal models provided conflicting evidences about the role of iron in atherogenesis. Therefore, more careful studies are needed in which issues like the source and the compartmentalization of iron will be addressed. This review article summarizes what we have learnt about iron and atherosclerosis from epidemiological studies, animal models and cellular systems and highlights the rather contributory than innocent role of iron in atherogenesis.

Cancer Incidence and Mortality in a Cohort of US Blood Donors: A 20-Year Study

Blood donors are considered one of the healthiest populations. This study describes the epidemiology of cancer in a cohort of blood donors up to 20 years after blood donation. Records from donors who participated in the Retroviral Epidemiology Donor Study (REDS, 1991-2002) at Blood Centers of the Pacific (BCP), San Francisco, were linked to the California Cancer Registry (CCR, 1991-2010). Standardized incidence ratios (SIR) were estimated using standard US 2000 population, and survival analysis used to compare all-cause mortality among donors and a random sample of nondonors with cancer from CCR. Of 55,158 eligible allogeneic blood donors followed-up for 863,902 person-years, 4,236 (7.7%) primary malignant cancers were diagnosed. SIR in donors was 1.59 (95% CI = 1.54,1.64). Donors had significantly lower mortality (adjusted HR = 0.70, 95% CI = 0.66-0.74) compared with nondonor cancer patients, except for respiratory system cancers (adjusted HR = 0.93, 95% CI = 0.82-1.05). Elevated cancer incidence among blood donors may reflect higher diagnosis rates due to health seeking behavior and cancer screening in donors. A "healthy donor effect" on mortality following cancer diagnosis was demonstrated. This population-based database and sample repository of blood donors with long-term monitoring of cancer incidence provides the opportunity for future analyses of genetic and other biomarkers of cancer.