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Zhang J, Nie C, Zhang Y, Yang L, Du X, Liu L, Chen Y, Yang Q, Zhu X, Li Q. Analysis of mechanism, therapeutic strategies, and potential natural compounds against atherosclerosis by targeting iron overload-induced oxidative stress. Biomed Pharmacother 2024; 177:117112. [PMID: 39018869 DOI: 10.1016/j.biopha.2024.117112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/19/2024] Open
Abstract
Ferroptosis is a novel form of cell demise characterized primarily by the reduction of trivalent iron to divalent iron, leading to the release of reactive oxygen species (ROS) and consequent induction of intense oxidative stress. In atherosclerosis (AS), highly accumulated lipids are modified by ROS to promote the formation of lipid peroxides, further amplifying cellular oxidative stress damage to influence all stages of atherosclerotic development. Macrophages are regarded as pivotal executors in the progression of AS and the handling of iron, thus targeting macrophage iron metabolism holds significant guiding implications for exploring potential therapeutic strategies against AS. In this comprehensive review, we elucidate the potential interplay among iron overload, inflammation, and lipid dysregulation, summarizing the potential mechanisms underlying the suppression of AS by alleviating iron overload. Furthermore, the application of Traditional Chinese Medicine (TCM) is increasingly widespread. Based on extant research and the pharmacological foundations of active compounds of TCM, we propose alternative therapeutic agents for AS in the context of iron overload, aiming to diversify the therapeutic avenues.
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Affiliation(s)
- Jing Zhang
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China
| | - Chunxia Nie
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China
| | - Yang Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China
| | - Lina Yang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China
| | - Xinke Du
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China
| | - Li Liu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China
| | - Ying Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China
| | - Qing Yang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China
| | - Xiaoxin Zhu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China.
| | - Qi Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Science, Beijing 100700, China; State key laboratory for quality ensurance and sustainable use ofdao-di herbs, Beijing 100700, China.
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Zhang Y, Wang H, Jia R, Chen D, Li Z. Serum ferritin is associated with the presence of ischemic stroke among individuals with type 2 diabetes. Heliyon 2024; 10:e27898. [PMID: 38486737 PMCID: PMC10938112 DOI: 10.1016/j.heliyon.2024.e27898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024] Open
Abstract
Background Epidemiological evidence regarding the possible link between serum ferritin (SF) level and ischemic stroke risk among individuals with type 2 diabetes mellitus (T2DM) is sparse. Aim To evaluate the association between SF level in plasma and ischemic stroke risk among individuals with T2DM. Methods SF levels were measured in 210 T2DM patients with (n = 165) or without ischemic stroke (n = 45). Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results The SF level of T2DM patients with ischemic stroke was significantly higher than that of patients without ischemic stroke (P = 0.003). The multivariate logistic regression analyses revealed that each 1-SD increase in SF (OR: 1.92; 95%CI: 1.22, 3.03) was significantly associated with increased ischemic stroke risk among T2DM patients. In addition, interaction effect of SF and BMI on ischemic stroke risk were also observed (Pfor interaction = 0.037). Conclusions Higher levels of SF were independently associated with increased risk of ischemic stroke among individuals with T2DM.
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Affiliation(s)
- Youyou Zhang
- Department of Geriatric Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Hui Wang
- Department of Geriatric Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Ruirui Jia
- Department of Geriatric Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Dong Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xi'wu Road, Xi'an, 710004, Shaanxi, China
| | - Zhaoyang Li
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
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Nanri H, Hara M, Nishida Y, Shimanoe C, Iwasaka C, Higaki Y, Tanaka K. Association between green tea and coffee consumption and body iron storage in Japanese men and women: a cross-sectional study from the J-MICC Study Saga. Front Nutr 2023; 10:1249702. [PMID: 37637954 PMCID: PMC10449390 DOI: 10.3389/fnut.2023.1249702] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose This study examined the association between daily green tea and coffee consumption and body iron stores among Japanese middle-aged and older adults. Methods This cross-sectional study used data obtained from 2005 to 2007. A total of 10,435 participants were recruited for this study. The participants completed a validated, self-administered food frequency questionnaire on green tea and coffee consumption. A multivariate linear regression analysis was conducted to assess the relationship between green tea and coffee consumption and serum ferritin levels. Additionally, logistic regression analysis was performed to ascertain whether excessive consumption of these beverages was linked to iron deficiency. Results We observed that higher green tea and coffee consumption was associated with lower ferritin levels in men and postmenopausal women, even after adjusting for covariates (all P for trends <0.05). Among premenopausal women, we found an inverse association between green tea consumption and serum ferritin levels, while no significant association was observed for coffee consumption after adjusting for covariates (green tea, P for trend <0.05; coffee, P for trend = 0.08). Notably, the association between these beverages and iron deficiency was found only in postmenopausal women; the odds ratios (95% confidence intervals) for iron deficiency associated with almost None, <1 cup/day, 1-2 cups/day, and ≥ 3 cups/day were 1.00 (reference), 0.78 (0.26-2.49), 1.29 (0.49-3.39), and 1.59 (0.63-4.04) (P for trend = 0.05), respectively, for green tea and 1.00, 1.32 (0.64-2.73), 1.46 (0.68-3.13), and 2.20 (1.06-4.55) (P for trend <0.01), respectively, for coffee. Conclusion Higher green tea and coffee consumption was associated with lower serum ferritin levels in men and postmenopausal women. In premenopausal women, consumption of green tea, but not coffee, was associated with lower serum ferritin levels. However, postmenopausal women who ≥3 cups of coffee demonstrated a higher prevalence of iron deficiency compared to those who consumed almost none.
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Affiliation(s)
- Hinako Nanri
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health, and Nutrition, Osaka, Japan
- Laboratory of Gut Microbiome for Health, Microbial Research Center for Health and Medicine, National Institutes of Biomedical Innovation, Health, and Nutrition, Osaka, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuichiro Nishida
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | | | - Chiharu Iwasaka
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health, and Nutrition, Osaka, Japan
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yasuki Higaki
- Laboratory of Exercise Physiology, Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Marongiu F, Marongiu S, Ruberto MF, Faa G, Barcellona D. Trace Metals and The Hemostatic System. Clin Chim Acta 2023; 547:117458. [PMID: 37385467 DOI: 10.1016/j.cca.2023.117458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
In this narrative review we report the main relationships between trace metals and the hemostatic system since this aspect has seldom attracted the attention of the scientific community. A basic aspect to be considered is the importance of maintaining the fine control of all trace metals' levels since they have an important impact on the pathophysiology of the hemostatic system. It is worth noting that poor diet habits are responsible for most trace metal deficiencies, while pollution is responsible for dangerous exposure to them with a consequent negative impact on the general population. This appears of paramount importance in planning the implementation of food and nutrient support to ameliorate the hidden hunger and the quality of life of people especially in developing countries and limiting poisons both in the air and food. As it often happens, when damage to certain mechanisms takes a very long time to appear, no attention is paid to the importance of a systematic prevention to avoid late negative outcomes.
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Affiliation(s)
- F Marongiu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Haemostasis and Thrombosis Unit, Azienda Ospedaliero-Universitaria (A.O.U.), Cagliari, Cagliari, Italy; Fondazione Arianna, Anticoagulazione.it, Bologna, Italy
| | - S Marongiu
- Department of Medicine, Azienda Tutela della Salute Cagliari, Cagliari, Italy.
| | - M F Ruberto
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Haemostasis and Thrombosis Unit, Azienda Ospedaliero-Universitaria (A.O.U.), Cagliari, Cagliari, Italy
| | - G Faa
- Department of Medical Sciences and Public Health, Division of Pathology, Azienda Ospedaliero-Universitaria (A.O.U.), di Cagliari - University Hospital San Giovanni di Dio, University of Cagliari, Cagliari, Italy; Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - D Barcellona
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Haemostasis and Thrombosis Unit, Azienda Ospedaliero-Universitaria (A.O.U.), Cagliari, Cagliari, Italy; Fondazione Arianna, Anticoagulazione.it, Bologna, Italy
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Abstract
The cardiovascular system requires iron to maintain its high energy demands and metabolic activity. Iron plays a critical role in oxygen transport and storage, mitochondrial function, and enzyme activity. However, excess iron is also cardiotoxic due to its ability to catalyze the formation of reactive oxygen species and promote oxidative damage. While mammalian cells have several redundant iron import mechanisms, they are equipped with a single iron-exporting protein, which makes the cardiovascular system particularly sensitive to iron overload. As a result, iron levels are tightly regulated at many levels to maintain homeostasis. Iron dysregulation ranges from iron deficiency to iron overload and is seen in many types of cardiovascular disease, including heart failure, myocardial infarction, anthracycline-induced cardiotoxicity, and Friedreich's ataxia. Recently, the use of intravenous iron therapy has been advocated in patients with heart failure and certain criteria for iron deficiency. Here, we provide an overview of systemic and cellular iron homeostasis in the context of cardiovascular physiology, iron deficiency, and iron overload in cardiovascular disease, current therapeutic strategies, and future perspectives.
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Affiliation(s)
- Konrad Teodor Sawicki
- Feinberg Cardiovascular and Renal Research Institute, Northwestern University, Chicago, IL 60611
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Adam De Jesus
- Feinberg Cardiovascular and Renal Research Institute, Northwestern University, Chicago, IL 60611
| | - Hossein Ardehali
- Feinberg Cardiovascular and Renal Research Institute, Northwestern University, Chicago, IL 60611
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
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Carrilho P, Fidalgo P, Lima A, Bastos L, Soares E, Manso R, Santos A, Nobrega L. Post-mortem liver and bone marrow iron quantification in haemodialysis patients: A prospective cohort study. EBioMedicine 2022; 77:103921. [PMID: 35272260 PMCID: PMC8907683 DOI: 10.1016/j.ebiom.2022.103921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Magnetic resonance liver scans indicate that iron overload is common in haemodialysis (HD) patients. However, histological evidence is scarce. METHODS Liver biopsy and bone marrow aspirate were obtained in the first 24h post mortem from 21 adult HD patients. Biochemical liver iron content (LIC) was quantified by electrothermal atomization atomic absorption spectrophotometry. Tissue iron deposition was graded in the liver and bone marrow using Scheuer and Gale's criteria, respectively. FINDINGS Median LIC was 42.5 (22.9-69.7) μmol/g and the majority (n=11; 57%) had mild to moderate liver iron overload (LIC >36 μmol/g). Scheuer grade was 2 (1-3) and 13 (62%) of liver biopsies had increased (> 1) iron deposition. In the bone marrow, median Gale's grade was 3 (3-4) and 9 (45%) patients had increased (>3) iron content. Contrary to old autopsy studies, done in the pre-erythropoiesis-stimulating agents (ESAs) era, both liver and bone marrow were iron replete and showed a positive correlation (r=0.71, p<0.001). Ferritin proved to have a good diagnostic accuracy for liver iron overload (0.87 95% CI 0.71-1.00) with an optimal cut-off value of 422 ng/ml. Haemoglobin was negatively associated with both LIC (r= -0.46, p=0.04) and iron content in the bone marrow (p=0.04). Patients with increased LIC had higher resistance to ESAs (p=0.02), yet no association with previous IV iron therapy. INTERPRETATION In the majority of HD patients there was iron accumulation in both the liver and bone marrow that associated with anaemia severity and resistance to ESAs, suggesting a blocking mechanism of iron's utilization. FUNDING None.
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Affiliation(s)
- Patricia Carrilho
- Serviço de Nefrologia, Hospital Prof. Doutor Fernando da Fonseca, IC19, 2720-276, Amadora, Portugal.
| | - Pedro Fidalgo
- Serviço de Nefrologia, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal; Unidade de Cuidados Intensivos Polivalente, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005. Lisboa, Portugal
| | - Anna Lima
- Serviço de Nefrologia, Hospital Prof. Doutor Fernando da Fonseca, IC19, 2720-276, Amadora, Portugal
| | - Lourdes Bastos
- Faculdade de Farmácia Universidade do Porto, Rua Aníbal Cunha, 164, 4050-047, Porto, Portugal
| | - Elisa Soares
- Faculdade de Farmácia Universidade do Porto, Rua Aníbal Cunha, 164, 4050-047, Porto, Portugal
| | - Rita Manso
- Serviço de Anatomia Patológica, Hospital Prof. Fernando da Fonseca, IC19, 2720-276, Amadora, Portugal
| | - Alexandra Santos
- Serviço de Patologia Clínica, Hospital Prof. Fernando da Fonseca, IC19, 2720-276, Amadora, Portugal
| | - Lucinda Nobrega
- Serviço de Patologia Clínica, Hospital Prof. Fernando da Fonseca, IC19, 2720-276, Amadora, Portugal
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Carrilho P. Intravenous iron in heart failure and chronic kidney disease. Nefrologia 2021; 41:403-411. [PMID: 36165109 DOI: 10.1016/j.nefroe.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/25/2020] [Indexed: 06/16/2023] Open
Abstract
Intravenous iron therapy is increasingly being used worldwide to treat anemia in chronic kidney disease and more recently iron deficiency in heart failure. Promising results were obtained in randomized clinical trials in the latter, showing symptomatic and functional capacity improvement with intravenous iron therapy. Meanwhile, confirmation of clinical benefit in hard-endpoints such as mortality and hospitalization is expected in large clinical trials that are already taking place. In chronic kidney disease, concern about iron overload is being substituted by claims of direct cardiovascular benefit of iron supplementation, as suggested by preliminary studies in heart failure. We discuss the pitfalls of present studies and gaps in knowledge, stressing the known differences between iron metabolism in heart and renal failure. Systemic and cellular iron handling and the role of hepcidin are reviewed, as well as the role of iron in atherosclerosis, especially in view of its relevance to patients undergoing dialysis. We summarize the evidence available concerning iron overload, availability and toxicity in CKD, that should be taken into account before embracing aggressive intravenous iron supplementation.
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8
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Extracellular ferritin contributes to neuronal injury in an in vitro model of ischemic stroke. J Physiol Biochem 2021; 77:539-545. [PMID: 33829407 DOI: 10.1007/s13105-021-00810-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
Previous clinical and experimental studies have shown that neurological decline and poor functional outcome after acute ischemic stroke in humans are associated with high ferritin levels in serum and cerebrospinal fluid (CSF) within 24 h of ischemic stroke onset. The aim of the present study was to find out if and how high extracellular ferritin concentrations can increase the excitotoxicity effect in a neuronal cortical culture model of stroke. Extracellular ferritin (100 ng/ml) significantly increased the excitotoxic effect caused by excessive exogenous glutamate (50 μM and 100 μM) by leading to an increase in lipid peroxidation, a reduction in mitochondrial membrane potential, and a decrease in neuron viability. Extracellular apoferritin (100 ng/ml), the iron-free form of the protein, does not increase the excitotoxicity of glutamate, which proves that iron was responsible for the neurotoxic effect of the exogenous ferritin. We present evidence that extracellular ferritin iron exacerbates the neurotoxic effect induced by glutamate excitotoxicity and that the effect of ferritin iron is dependent of glutamate excitotoxicity. Our results support the idea that body iron overload is involved in the severity of the brain damage caused by stroke and reveal the need to control systemic iron homeostasis.
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Li Z, Xu Y, Huang Z, Wei Y, Hou J, Long T, Wang F, Cheng X, Duan Y, Chen X, Yuan H, Shen M, He M. Association of multiple metals with lipid markers against different exposure profiles: A population-based cross-sectional study in China. CHEMOSPHERE 2021; 264:128505. [PMID: 33068969 DOI: 10.1016/j.chemosphere.2020.128505] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
We sought to evaluate whether essential and toxic metals are cross-sectionally related to blood lipid levels using data among adults from Shimen (n = 564) and Huayuan (n = 637), two counties with different exposure profiles in Hunan province of China. Traditional and grouped weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) were performed to assess association between exposure to a mixture of 22 metals measured in urine or plasma, and lipid markers. Most of the exposure levels of metals were significantly higher in Shimen area than those in Huayuan area (all P-values < 0.001). Traditional WQS regression analyses revealed that the WQS index were both significantly associated with lipid markers in two areas, except for the HDL-C. Grouped WQS revealed that essential metals group showed significantly positive associations with lipid markers except for HDL-C in Huayuan area, while toxic metals group showed significantly negative associations except for HDL-C and LDL-C in Huayuan area. There were no significant joint effects, but potential non-linear relationships between metals mixture and TC or LDL-C levels were observed in BKMR analyses. Although consistent significantly associations of zinc and titanium with TG levels were found in both areas, the metals closely related to other lipid markers were varied by sites. Additionally, the BKMR analyses revealed an inverse U shaped association of iron with LDL-C levels and interaction effects of zinc and cadmium on LDL-C in Huayuan area. The relationship between metal exposure and blood lipid were not identical against different exposure profiles.
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Affiliation(s)
- Zhaoyang Li
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yali Xu
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhijun Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Yue Wei
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Tengfei Long
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fei Wang
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xu Cheng
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yanying Duan
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hong Yuan
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Minxue Shen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, China.
| | - Meian He
- Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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10
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Abstract
Intravenous iron therapy is increasingly being used worldwide to treat anemia in chronic kidney disease and more recently iron deficiency in heart failure. Promising results were obtained in randomized clinical trials in the latter, showing symptomatic and functional capacity improvement with intravenous iron therapy. Meanwhile, confirmation of clinical benefit in hard-endpoints such as mortality and hospitalization is expected in large clinical trials that are already taking place. In chronic kidney disease, concern about iron overload is being substituted by claims of direct cardiovascular benefit of iron supplementation, as suggested by preliminary studies in heart failure. We discuss the pitfalls of present studies and gaps in knowledge, stressing the known differences between iron metabolism in heart and renal failure. Systemic and cellular iron handling and the role of hepcidin are reviewed, as well as the role of iron in atherosclerosis, especially in view of its relevance to patients undergoing dialysis. We summarize the evidence available concerning iron overload, availability and toxicity in CKD, that should be taken into account before embracing aggressive intravenous iron supplementation.
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11
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Sciacqua A, Ventura E, Tripepi G, Cassano V, D'Arrigo G, Roumeliotis S, Maio R, Miceli S, Perticone M, Andreozzi F, Sesti G, Perticone F. Ferritin modifies the relationship between inflammation and arterial stiffness in hypertensive patients with different glucose tolerance. Cardiovasc Diabetol 2020; 19:123. [PMID: 32758229 PMCID: PMC7409693 DOI: 10.1186/s12933-020-01102-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background Ferritin, a crucial element for iron homeostasis, is associated with chronic diseases characterized by subclinical inflammation such as essential arterial hypertension and type 2 diabetes mellitus (T2DM), showing a prognostic value in different clinical settings. We investigated whether ferritin is associated with arterial stiffness (AS), an early indicator of atherosclerosis, and if it could act as effect modifier on the relationship between inflammation and AS in hypertensive patients with different glucose tolerance. Methods We enrolled 462 newly diagnosed untreated hypertensive (HT) patients. All subjects underwent an oral glucose tolerance test. Insulin sensitivity was assessed by MATSUDA index and ferritin levels were estimated by immunoradiometric assay. AS was defined by carotid-femoral pulse wave velocity (PWV). Results Out of 462 patients, 271 showed normal glucose tolerance (HT/NGT), 146 impaired glucose tolerance (HT/IGT) and 45 were diabetic (HT/T2DM). Iron levels significantly decreased and transferrin and ferritin significantly increased from the first to the third group. PWV values were significantly higher in HT/IGT and HT/T2DM patients. PWV was related directly with ferritin, high sensitivity C reactive protein (hs-CRP), transferrin, and inversely with MATSUDA index. Ferritin resulted the strongest determinant of PWV explaining a 14.9% of its variation; moreover it was a strong modifier of the relationship between hs-CRP and PWV. The estimated augmentation in PWV portended by a fixed increase in hs-CRP, was higher across increasing values of ferritin. Conclusion Ferritin represents an independent risk factor of arterial stiffness in our study population and a strong effect modifier on the relationship between inflammation and PWV. However, further studies are needed to fully elucidate the potential role of this biomarker in human atherosclerosis.
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Affiliation(s)
- Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy.
| | - Ettore Ventura
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Giovanni Tripepi
- Institute of Clinical Physiology (IFC-CNR), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy
| | - Velia Cassano
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Graziella D'Arrigo
- Institute of Clinical Physiology (IFC-CNR), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy
| | - Stefanos Roumeliotis
- Institute of Clinical Physiology (IFC-CNR), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy.,Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Raffale Maio
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Maria Perticone
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
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Wu W, Yuan J, Shen Y, Yu Y, Chen X, Zhang L, Huang K, Zhan J, Dong GP, Fu J. Iron overload is related to elevated blood glucose levels in obese children and aggravates high glucose-induced endothelial cell dysfunction in vitro. BMJ Open Diabetes Res Care 2020; 8:e001426. [PMID: 32675293 PMCID: PMC7368571 DOI: 10.1136/bmjdrc-2020-001426] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION This study was performed to investigate the role of iron overload in the early stage of hyperglycemia-induced vascular functional impairment. RESEARCH DESIGN AND METHODS A total of 196 obese children were enrolled, and data regarding ferritin levels, blood glucose levels, intima-media thickness of carotid arteries, liver function and fibrosis index, hemoglobin, blood pressure, blood lipids, and inflammation indicators were collected. Ferritin levels were compared with a control group, which consisted of 148 healthy non-obese children who were age-matched and gender-matched. Endothelial cells were cultured in high glucose medium and supplemented with ferric citrate with or without iron remover (deferoxamine), a reducing agent (N-acetyl-cysteine), or a nuclear factor-κB (NF-κB) inhibitor (BAY 11-7082). Apoptosis, oxidative stress, nitric oxide levels, and endothelin content were evaluated. DNA microarray analysis was performed to analyze the expression of genes in the NF-κB signaling pathway. RESULTS Obese children have significantly higher ferritin levels compared with the control group. Ferritin level was positively correlated with hemoglobin and was related to metabolic disorders, including impaired glucose tolerance, higher blood pressure, dyslipidemia, and impaired hepatic function. Endothelial cells treated with ferric citrate showed a significantly higher rate of apoptosis, higher levels of oxidative stress, and impaired vasomotor function under high glucose conditions. The above effects were rescued by treatment with an iron remover, reducing agent, or NF-κB inhibitor. Further, detection of phosphorylated-p65 distribution in cells confirmed activation of the NF-κB pathway. DNA microarrays and subsequent gene oncology enrichment analyses revealed the main processes activated in cells. CONCLUSION Increased ferritin levels are related to impaired glucose tolerance and other metabolic disorders in obese children. At the cellular level, iron overload aggravated the endothelial cell dysfunction caused by high glucose.
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Affiliation(s)
- Wei Wu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinna Yuan
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yu Shen
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yunxian Yu
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xuefeng Chen
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Zhang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ke Huang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianying Zhan
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guan-Ping Dong
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Junfen Fu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Cornelissen A, Guo L, Sakamoto A, Virmani R, Finn AV. New insights into the role of iron in inflammation and atherosclerosis. EBioMedicine 2019; 47:598-606. [PMID: 31416722 PMCID: PMC6796517 DOI: 10.1016/j.ebiom.2019.08.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/24/2022] Open
Abstract
Iron is fundamental for life-essential processes. However, it can also cause oxidative damage, which is thought to trigger numerous pathologies, including cardiovascular diseases. The role of iron in the pathogenesis of atherosclerosis is still not completely understood. Macrophages are both key players in the handling of iron throughout the body and in the onset, progression and destabilization of atherosclerotic plaques. Iron itself might impact atherosclerosis through its effects on macrophages. However, while targeting iron metabolism within macrophages may have some beneficial effects on preventing atherosclerotic plaque progression there may also be negative consequences. Thus, the prevailing view of iron being capable of accelerating the progression of coronary disease through lipid peroxidation may not fully take into account the multi-faceted role of iron in pathogenesis of atherosclerosis. In this review, we will summarize the current understanding of iron metabolism in the context of the complex interplay between iron, inflammation, and atherosclerosis.
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Affiliation(s)
- Anne Cornelissen
- CVPath Institute, Gaithersburg, MD, USA; University Hospital RWTH Aachen, Department of Cardiology, Aachen, Germany.
| | - Liang Guo
- CVPath Institute, Gaithersburg, MD, USA.
| | | | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD, USA; University of Maryland, School of Medicine, Baltimore, MD, USA.
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Gill D, Brewer CF, Monori G, Trégouët D, Franceschini N, Giambartolomei C, Tzoulaki I, Dehghan A. Effects of Genetically Determined Iron Status on Risk of Venous Thromboembolism and Carotid Atherosclerotic Disease: A Mendelian Randomization Study. J Am Heart Assoc 2019; 8:e012994. [PMID: 31310728 PMCID: PMC6761644 DOI: 10.1161/jaha.119.012994] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
Background Systemic iron status has been implicated in atherosclerosis and thrombosis. The aim of this study was to investigate the effect of genetically determined iron status on carotid intima-media thickness, carotid plaque, and venous thromboembolism using Mendelian randomization. Methods and Results Genetic instrumental variables for iron status were selected from a genome-wide meta-analysis of 48 972 subjects. Genetic association estimates for carotid intima-media thickness and carotid plaque were obtained using data from 71 128 and 48 434 participants, respectively, and estimates for venous thromboembolism were obtained using data from a study incorporating 7507 cases and 52 632 controls. Conventional 2-sample summary data Mendelian randomization was performed for the main analysis. Higher genetically determined iron status was associated with increased risk of venous thromboembolism. Odds ratios per SD increase in biomarker levels were 1.37 (95% CI 1.14-1.66) for serum iron, 1.25 (1.09-1.43) for transferrin saturation, 1.92 (1.28-2.88) for ferritin, and 0.76 (0.63-0.92) for serum transferrin (with higher transferrin levels representing lower iron status). In contrast, higher iron status was associated with lower risk of carotid plaque. Corresponding odds ratios were 0.85 (0.73-0.99) for serum iron and 0.89 (0.80-1.00) for transferrin saturation, with concordant trends for serum transferrin and ferritin that did not reach statistical significance. There was no Mendelian randomization evidence of an effect of iron status on carotid intima-media thickness. Conclusions These findings support previous work to suggest that higher genetically determined iron status is protective against some forms of atherosclerotic disease but increases the risk of thrombosis related to stasis of blood.
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Affiliation(s)
- Dipender Gill
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | | | - Grace Monori
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | | | - Nora Franceschini
- Department of EpidemiologyUNC Gillings Global School of Public HealthChapel HillNC
| | - Claudia Giambartolomei
- Department of Pathology and Laboratory MedicineUniversity of California, Los AngelesLos AngelesCA
| | | | - Ioanna Tzoulaki
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- MRC‐PHE Centre for EnvironmentSchool of Public HealthImperial College LondonLondonUnited Kingdom
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Abbas Dehghan
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- MRC‐PHE Centre for EnvironmentSchool of Public HealthImperial College LondonLondonUnited Kingdom
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15
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Ellidag HY, Eren E, Akdag M, Giray O, Kiraz K, Yilmaz N. The relationship between serum ferritin levels and serum lipids and HDL function with respect to age and gender. UKRAINIAN BIOCHEMICAL JOURNAL 2017; 88:76-86. [PMID: 29236376 DOI: 10.15407/ubj88.06.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Elevated serum ferritin (SFer) levels have been associated with chronic diseases such as coronary heart disease and diabetes mellitus type 2. The aim of this study was to examine the relationship between SFer levels and serum lipid parameters, and how this relation changes in terms of age and gender. Additionally, we investigated a possible relationship between SFer levels and high-density lipoprotein (HDL) function. SFer levels and lipid panel (total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C) and HDL-C) of 4205 people (3139 women, 1066 men) were examined retrospectively. Study population was classified according to age and gender. Separately, 100 subjects (52 women, 48 men) were randomly recruited to investigate the relation between SFer levels, and HDL dependent paraoxonase-1 (PON1) and arylesterase (ARE) activities. In all age groups, women’s SFer levels were found to be significantly lower and HDL-C levels significantly higher compared to men. In the 50-70 ages range, TC and LDL-C levels of women were found to be significantly higher than those of men (P < 0.01). SFer levels tended to increase with age in women. Correlation analyses revealed a negative correlation between levels of SFer and HDL-C, while positive correlations existed between levels of SFer, and TC, TG and LDL-C. There was no significant correlation between SFer levels and PON1 or ARE activities. The finding that increased SFer levels are accompanied by increased serum TC, TG and LDL-C levels may help us to explain the increased risk of metabolic disorders and cardiovascular disease in postmenopausal women.
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Egbuche O, Millard HR, Renelus B, Maihemuti A, Musani SK, Fox ER, Liu J, Taylor HA, Bidulescu A. Serum Ferritin Levels in Blacks Without Known Cardiovascular Disease (from the Jackson Heart Study). Am J Cardiol 2017; 120:1533-1540. [PMID: 28865891 DOI: 10.1016/j.amjcard.2017.07.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
Abstract
There has been conflicting results regarding the role of ferritin, a nonspecific marker of systemic inflammation, in the development of coronary heart disease (CHD). We aimed to evaluate the association of serum ferritin with incident CHD, incident stroke, and subclinical measurements of atherosclerosis among blacks. For our prospective study, we utilized data from the Jackson Heart Study. Eligible participants (n = 4,659) who were free from CHD were enrolled in 2000 to 2004. The participants' baseline serum ferritin levels were obtained, and they were followed up for an average of 8 years to identify incident CHD events and incident stroke. We used multivariate linear regression and Cox proportional hazard models to evaluate the association of serum ferritin with incident CHD events and incident stroke. The age-adjusted correlations between ferritin and specific study covariates, including carotid intima-media thickness, coronary artery calcium, and abdominal aortic calcium, were obtained. During an average of 8 years of follow-up, 161 incident CHD events and 117 incident stroke events were documented. There was no significant association between ferritin levels and incident CHD events (p = 0.54 in men and p = 0.31 in women) and incident stroke (p = 0.17 in men and p = 0.56 in women), or both considered together (p = 0.70 in men and p = 0.69 in women). Ferritin was significantly correlated with abdominal aortic calcium (r = 0.09, p <0.01) in women but not in men. In conclusion, a higher serum ferritin level was not associated with an increased risk of incident CHD events or incident stroke, and may not be an independent predictor of incident CHD or stroke in blacks.
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Affiliation(s)
- Obiora Egbuche
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia.
| | - Heather R Millard
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Bloomington, Bloomington, Indiana; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Benjamin Renelus
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Axiyan Maihemuti
- Department of Cardiology, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Ctr, Jackson, Mississippi
| | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Ctr, Jackson, Mississippi
| | - Jiankang Liu
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Herman A Taylor
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Bloomington, Bloomington, Indiana
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17
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Increased serum ferritin levels are independently associated with carotid atherosclerosis in women. Br J Nutr 2017; 117:1623-1630. [PMID: 28721838 DOI: 10.1017/s0007114517001544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Previous studies have supported the theory that there is a positive association between ferritin and carotid atherosclerosis in Western people. Diet plays an important role in determining serum ferritin concentration. Asian dietary patterns are different from Western dietary patterns, implying that there may be a difference in the association of ferritin with carotid atherosclerosis between Asian and Western people. However, few studies focus on the association between ferritin and carotid atherosclerosis among Asians. The aim of this study was to investigate how serum ferritin levels are associated with carotid atherosclerosis in an Asian adult population. A cross-sectional assessment was performed in 8302 adults in Tianjin, China. Carotid intima-media thickness (IMT) and plaques were assessed using ultrasonography, and serum ferritin was measured using the protein chip-chemiluminescence method. Multiple logistic regression analysis was used to examine the association between quartiles of serum ferritin concentration and carotid atherosclerosis. In the present study, the overall prevalence of IMT and carotid plaques in participants is 29·2 and 22·7 %, respectively. In women, after adjustments for potentially confounding factors, the OR of IMT and carotid plaques by increasing serum ferritin quartiles were 1·00, 1·39 (95 % CI 0·98-1·99), 1·39 (95 % CI 0·99-1·97), 1·81 (95 % CI 1·30-2·55) (P for trend<0·001) and 1·00, 1·24 (95 % CI 0·89-1·73), 1·18 (95 % CI 0·85-1·65), 1·59 (95 % CI 1·15-2·20) (P for trend<0·01), respectively. However, no association was found between serum ferritin and carotid atherosclerosis in men. The study demonstrated that increased serum ferritin levels are independently associated with IMT and carotid plaques in Asian women but not in Asian men.
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18
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Pisano G, Lombardi R, Fracanzani AL. Vascular Damage in Patients with Nonalcoholic Fatty Liver Disease: Possible Role of Iron and Ferritin. Int J Mol Sci 2016; 17:ijms17050675. [PMID: 27164079 PMCID: PMC4881501 DOI: 10.3390/ijms17050675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 02/06/2023] Open
Abstract
Non Alcoholic Fatty Liver Disease (NAFLD) is the most common chronic liver disease in Western countries. Recent data indicated that NAFLD is a risk factor by itself contributing to the development of cardiovascular disease independently of classical known risk factors. Hyperferritinemia and mild increased iron stores are frequently observed in patients with NAFLD and several mechanisms have been proposed to explain the role of iron, through oxidative stress and interaction with insulin metabolism, in the development of vascular damage. Moreover, iron depletion has been shown to decrease atherogenesis in experimental models and in humans. This review presents the recent evidence on epidemiology, pathogenesis, and the possible explanation of the role of iron and ferritin in the development of cardiovascular damage in patients with NAFLD, and discusses the possible interplay between metabolic disorders associated with NAFLD and iron in the development of cardiovascular disease.
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Affiliation(s)
- Giuseppina Pisano
- Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, Centre of the Study of Metabolic and Liver Diseases, Via Francesco Sforza 35, 20122 Milan, Italy.
| | - Rosa Lombardi
- Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, Centre of the Study of Metabolic and Liver Diseases, Via Francesco Sforza 35, 20122 Milan, Italy.
| | - Anna Ludovica Fracanzani
- Department of Pathophysiology and Transplantation, Ca' Granda IRCCS Foundation, Policlinico Hospital, University of Milan, Centre of the Study of Metabolic and Liver Diseases, Via Francesco Sforza 35, 20122 Milan, Italy.
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Tayal D, Goswami B, Tyagi S, Chaudhary M, Mallika V. Interaction between dyslipidaemia, oxidative stress and inflammatory response in patients with angiographically proven coronary artery disease. Cardiovasc J Afr 2016; 23:23-7. [PMID: 22331247 PMCID: PMC3721930 DOI: 10.5830/cvja-2010-092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 09/07/2010] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is emerging as the biggest killer of the 21st century. A number of theories have been postulated to explain the aetiology of atherosclerosis. The present study attempts to elucidate the interaction, if any, between inflammation, oxidative stress and dyslipidaemia in CAD. METHODS A total of 753 patients undergoing angiography were evaluated and 476 were included in the study. The parameters studied included complete lipid profile, and apolipoprotein B, ferritin and nitric oxide (NO) levels. Statistical analysis was carried out to determine the interrelationship between these parameters and the best predictor of CAD risk. Cut-off points were determined from the receiver operating characteristics curves, and the specificity, sensitivity, positive predictive value, negative predictive value, odds ratio and confidence intervals were calculated. RESULTS The levels of the parameters studied increased with the stenotic state and a positive correlation was observed between ferritin, NO and apolipoprotein B. NO emerged as the most reliable predictor of CAD, with an area under the curve of 0.992 and sensitivity and specificity of 97 and 98%, respectively. CONCLUSION Environmental and genetic risk factors for CAD interact in a highly complex manner to initiate the atherosclerotic process. These risk factors should be considered mutually inclusive, not exclusive when devising pharmacological interventions, as multi-factorial risk management is the cornerstone of CAD management.
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Affiliation(s)
- D Tayal
- Department of Biochemistry, GB Pant Hospital, New Delhi, India
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Prats-Puig A, Moreno M, Carreras-Badosa G, Bassols J, Ricart W, López-Bermejo A, Fernández-Real JM. Serum Ferritin Relates to Carotid Intima-Media Thickness in Offspring of Fathers With Higher Serum Ferritin Levels. Arterioscler Thromb Vasc Biol 2015; 36:174-80. [PMID: 26586658 DOI: 10.1161/atvbaha.115.306396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/09/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Body iron status has been linked to atherosclerosis in adults. The purposes of our study were to determine (1) the association between circulating ferritin levels and carotid intima-media thickness (cIMT) in a cohort of apparently healthy children and (2) the association between cIMT and parental ferritin levels. APPROACH AND RESULTS Circulating ferritin levels (microparticle enzyme immunoassay), metabolic parameters, and cIMT (ultrasonography) were analyzed cross-sectionally in a cohort of 692 healthy white children with a mean age of 8 ± 2 years (52% girls and 48% boys). In consecutive 123 children from the cross-sectional sample, the same serum assessments were also performed at baseline in their parents, and the cIMT was repeated after 3 years of follow-up in the children at a mean age of 11 ± 2 years (53% girls and 47% boys). Weak but significant positive associations were evident between children's circulating ferritin levels and cIMT (r=0.123; P=0.001) and with the change in cIMT 3 years later a tendency was also observed (r=0.185; P=0.048). In multiple regression analyses, circulating ferritin levels contributed independently to cIMT variance (β=0.090; P=0.026; R(2)=10%) and cIMT change variance (β=0.216; P=0.019; R(2)= 3.4%) after controlling for body mass index, high-sensitivity C-reactive protein, age, sex, and low-density lipoprotein-cholesterol levels. This association was, however, remarkably significant (β=0.509; P=0.001; R(2)= 20.4%) in children whose fathers had ferritin levels above the median value (122.5 ng/mL).The latter association remained significant after correction for multiple testing. Maternal's ferritin levels showed no interaction in this association. CONCLUSIONS These results suggest a paternal-specific effect on cIMT partially reflected by father's ferritin levels.
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Affiliation(s)
- Anna Prats-Puig
- From the Girona Institute for Biomedical Research, Girona, Spain (A.P.-P., M.M., G.C.-B., J.B., W.R., A.L.-B., J.M.F.-R.); Department of Physical Therapy, EUSES University School (A.P.-P.) and TransLab Research Group, Department of Medical Sciences, Faculty of Medicine (A.L.-B.), University of Girona, Girona, Spain; Pediatrics, Dr. JosepTrueta Hospital, Girona, Spain (A.P.-P., G.C.-B., J.B., A.L.-B.); and Department of Diabetes, Endocrinology, CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain (M.M., W.R., J.M.F.-R.)
| | - María Moreno
- From the Girona Institute for Biomedical Research, Girona, Spain (A.P.-P., M.M., G.C.-B., J.B., W.R., A.L.-B., J.M.F.-R.); Department of Physical Therapy, EUSES University School (A.P.-P.) and TransLab Research Group, Department of Medical Sciences, Faculty of Medicine (A.L.-B.), University of Girona, Girona, Spain; Pediatrics, Dr. JosepTrueta Hospital, Girona, Spain (A.P.-P., G.C.-B., J.B., A.L.-B.); and Department of Diabetes, Endocrinology, CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain (M.M., W.R., J.M.F.-R.)
| | - Gemma Carreras-Badosa
- From the Girona Institute for Biomedical Research, Girona, Spain (A.P.-P., M.M., G.C.-B., J.B., W.R., A.L.-B., J.M.F.-R.); Department of Physical Therapy, EUSES University School (A.P.-P.) and TransLab Research Group, Department of Medical Sciences, Faculty of Medicine (A.L.-B.), University of Girona, Girona, Spain; Pediatrics, Dr. JosepTrueta Hospital, Girona, Spain (A.P.-P., G.C.-B., J.B., A.L.-B.); and Department of Diabetes, Endocrinology, CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain (M.M., W.R., J.M.F.-R.)
| | - Judit Bassols
- From the Girona Institute for Biomedical Research, Girona, Spain (A.P.-P., M.M., G.C.-B., J.B., W.R., A.L.-B., J.M.F.-R.); Department of Physical Therapy, EUSES University School (A.P.-P.) and TransLab Research Group, Department of Medical Sciences, Faculty of Medicine (A.L.-B.), University of Girona, Girona, Spain; Pediatrics, Dr. JosepTrueta Hospital, Girona, Spain (A.P.-P., G.C.-B., J.B., A.L.-B.); and Department of Diabetes, Endocrinology, CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain (M.M., W.R., J.M.F.-R.)
| | - Wifredo Ricart
- From the Girona Institute for Biomedical Research, Girona, Spain (A.P.-P., M.M., G.C.-B., J.B., W.R., A.L.-B., J.M.F.-R.); Department of Physical Therapy, EUSES University School (A.P.-P.) and TransLab Research Group, Department of Medical Sciences, Faculty of Medicine (A.L.-B.), University of Girona, Girona, Spain; Pediatrics, Dr. JosepTrueta Hospital, Girona, Spain (A.P.-P., G.C.-B., J.B., A.L.-B.); and Department of Diabetes, Endocrinology, CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain (M.M., W.R., J.M.F.-R.)
| | - Abel López-Bermejo
- From the Girona Institute for Biomedical Research, Girona, Spain (A.P.-P., M.M., G.C.-B., J.B., W.R., A.L.-B., J.M.F.-R.); Department of Physical Therapy, EUSES University School (A.P.-P.) and TransLab Research Group, Department of Medical Sciences, Faculty of Medicine (A.L.-B.), University of Girona, Girona, Spain; Pediatrics, Dr. JosepTrueta Hospital, Girona, Spain (A.P.-P., G.C.-B., J.B., A.L.-B.); and Department of Diabetes, Endocrinology, CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain (M.M., W.R., J.M.F.-R.).
| | - José Manuel Fernández-Real
- From the Girona Institute for Biomedical Research, Girona, Spain (A.P.-P., M.M., G.C.-B., J.B., W.R., A.L.-B., J.M.F.-R.); Department of Physical Therapy, EUSES University School (A.P.-P.) and TransLab Research Group, Department of Medical Sciences, Faculty of Medicine (A.L.-B.), University of Girona, Girona, Spain; Pediatrics, Dr. JosepTrueta Hospital, Girona, Spain (A.P.-P., G.C.-B., J.B., A.L.-B.); and Department of Diabetes, Endocrinology, CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain (M.M., W.R., J.M.F.-R.).
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Lin KC, Tsai MY, Chi CL, Yu LK, Huang LH, Chen CA. Serum ferritin is associated with arterial stiffness in hemodialysis patients: results of a 3-year follow-up study. Int Urol Nephrol 2015; 47:1847-53. [PMID: 26329743 DOI: 10.1007/s11255-015-1090-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/14/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Iron may contribute to vascular injury through reactive oxygen species. Hemodialysis patients frequently receive iron supply for correction of anemia and are at a high risk of cardiovascular disease. We tested the relationship between iron status and change in arterial stiffness in hemodialysis patients. PATIENTS AND METHODS We measured iron status in 53 hemodialysis patients and studied the association with clinical, biochemical, and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) over 3 years. The blood pressure was controlled to below 140/90 mmHg by anti-hypertensive drugs. RESULTS Median and interquartile range of baseline baPWV, baPWV at 3 years, and ΔbaPWV (difference between 3-year baPWV and baseline baPWV) were following: 17.6 (14.8-18.9), 16.9 (15.3-19.9), and 0.2 (-1.2 to 2.7) m/s. At baseline, baPWV was positively correlated with age, serum ferritin, and systolic blood pressure in univariate analysis. However, in multivariate analysis, only age and serum ferritin remained the significant determinants of baseline baPWV. After 3 years, ΔbaPWV was negatively correlated with age and positively with 3-year averaged serum ferritin in univariate analysis. Then, in multivariate analysis, only 3-year averaged serum ferritin was the important determinant of ΔbaPWV. ΔbaPWV was significantly increased in patients with 3-year averaged serum ferritin >500 ng/mL compared to patients with 3-year averaged serum ferritin ≤500 ng/mL. CONCLUSIONS In hemodialysis patients, serum ferritin associates with the progressive arterial stiffness, especially when serum ferritin >500 ng/mL.
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Affiliation(s)
- Kao-Chang Lin
- Department of Biotechnology, Southern Taiwan University, Tainan, Taiwan.,Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Meng-Yi Tsai
- Department of Hematology and Oncology, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chun-Ling Chi
- Department of Family Medicine, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Lai-King Yu
- Division of Nephrology, Tainan Sinlau Hospital, No. 57, 1 Sec., Dongmen Rd., Tainan, Taiwan
| | - Li-Hsueh Huang
- Division of Nephrology, Tainan Sinlau Hospital, No. 57, 1 Sec., Dongmen Rd., Tainan, Taiwan
| | - Chien-An Chen
- Division of Nephrology, Tainan Sinlau Hospital, No. 57, 1 Sec., Dongmen Rd., Tainan, Taiwan.
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Zhou FL, Gao Y, Tian L, Yan FF, Chen T, Zhong L, Tian HM. Serum ferritin is associated with carotid atherosclerotic plaques but not intima-media Thickness in patients with abnormal glucose metabolism. Clin Chim Acta 2015; 450:190-5. [PMID: 26319885 DOI: 10.1016/j.cca.2015.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/06/2015] [Accepted: 08/25/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND We investigated the association between serum ferritin and carotid artery lesions in populations with abnormal glucose metabolism. METHODS We included 70 participants with abnormal glucose metabolism and 170 participants with normal glucose metabolism and measured their baseline serum ferritin levels. During follow-up carotid intima-media thickness and carotid plaque were evaluated. RESULTS Serum ferritin levels were higher in the participants with abnormal glucose metabolism (p<0.01). We further divided the patients with abnormal glucose metabolism into subgroups with and without intima-media proliferation, and found that ferritin was excluded from the final equation in the logistic regression. Furthermore, age, waist circumference, ferritin, 2h-PG, and total cholesterol were significantly different between the subgroups with and without carotid plaque. When the above data were included in a logistic regression model, the p values obtained for age, ferritin, and 2h-PG were 0.004, 0.032, and 0.011, respectively. CONCLUSIONS In the Chinese population, serum ferritin levels are significantly increased in patients with abnormal glucose metabolism. The carotid intima-media thickness showed no independent relationship with serum ferritin in patients with abnormal glucose metabolism. However, high serum ferritin is an important risk factor for carotid atherosclerosis in these patients.
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Affiliation(s)
- F L Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - Y Gao
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - L Tian
- Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - F F Yan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - T Chen
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - L Zhong
- First People's Hospital of Longquanyi District, Chengdu 610041, Sichuan, People's Republic of China
| | - H M Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China.
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Serum ferritin levels are associated with carotid atherosclerosis in Chinese postmenopausal women: the Shanghai Changfeng Study. Br J Nutr 2015; 114:1064-71. [DOI: 10.1017/s0007114515001944] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Postmenopausal women are at increased risk of CVD: the increased serum ferritin level may be involved in the pathogenesis. The aim of the present study is to investigate the relationship of ferritin and carotid atherosclerosis in postmenopausal women. A total of 1178 postmenopausal women (mean age, 60·8 years) were enrolled from the Changfeng Study. A standard interview, anthropometric measurements and laboratory analyses were performed for each participant. Bilateral CIMT (carotid intima–media thickness) were measured using ultrasonography, and the presence of carotid plaques was assessed. Serum ferritin was measured using electrochemiluminescence immunoassay. The results showed that serum ferritin was 181·9 (sd 65·8) ng/ml in the postmenopausal women. Multivariate, linear, stepwise regression analysis demonstrated that age (standardised β = 0·233, P< 0·001), alanine transaminase (standardised β = 0·194, P< 0·001), log homeostasis model assessment index for insulin resistance (standardised β = 0·181, P< 0·001), TAG (standardised β = 0·083, P= 0·003), Hb (standardised β = 0·080, P= 0·004) and PPG (2-h glucose levels following a 75-g oral glucose challenge) (standardised β = 0·079, P= 0·004) were independently associated with serum ferritin. Compared with the ferritin level of subjects in the first quartile, that in the fourth quartile had greater CIMT, and higher prevalence of carotid plaque. After adjusting for conventional CVD risk factors, Hb, leucocytes, log urine albumin:creatinine ratio and liver function, the ferritin level of postmenopausal women in the fourth quartile had a 1·587-fold increased risk of carotid plaques relative to those in the lowest quartile. In conclusion, these results suggest that serum ferritin is independently and positively associated with carotid atherosclerosis in postmenopausal women and that ferritin may be implicated in atherosclerosis.
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Seo SK, Yun BH, Chon SJ, Lee YJ, Han EJ, Park JH, Cho S, Choi YS, Lee BS. Association of serum ferritin levels with metabolic syndrome and subclinical coronary atherosclerosis in postmenopausal Korean women. Clin Chim Acta 2015; 438:62-6. [DOI: 10.1016/j.cca.2014.07.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/10/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics 2014; 6:748-73. [PMID: 24549403 DOI: 10.1039/c3mt00347g] [Citation(s) in RCA: 368] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
"Serum ferritin" presents a paradox, as the iron storage protein ferritin is not synthesised in serum yet is to be found there. Serum ferritin is also a well known inflammatory marker, but it is unclear whether serum ferritin reflects or causes inflammation, or whether it is involved in an inflammatory cycle. We argue here that serum ferritin arises from damaged cells, and is thus a marker of cellular damage. The protein in serum ferritin is considered benign, but it has lost (i.e. dumped) most of its normal complement of iron which when unliganded is highly toxic. The facts that serum ferritin levels can correlate with both disease and with body iron stores are thus expected on simple chemical kinetic grounds. Serum ferritin levels also correlate with other phenotypic readouts such as erythrocyte morphology. Overall, this systems approach serves to explain a number of apparent paradoxes of serum ferritin, including (i) why it correlates with biomarkers of cell damage, (ii) why it correlates with biomarkers of hydroxyl radical formation (and oxidative stress) and (iii) therefore why it correlates with the presence and/or severity of numerous diseases. This leads to suggestions for how one might exploit the corollaries of the recognition that serum ferritin levels mainly represent a consequence of cell stress and damage.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, 131, Princess St, Manchester M1 7DN, Lancs, UK.
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26
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Mascitelli L, Goldstein MR. Might intraplaque hemorrhage represent the proof-of-concept that iron plays a causal role in plaque vulnerability? J Cardiovasc Med (Hagerstown) 2014; 15:882-3. [PMID: 25353974 DOI: 10.2459/jcm.0b013e3283609455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Luca Mascitelli
- aComando Brigata Alpina 'Julia', Medical Service, Udine, Italy bNCH Healthcare Group, Naples, Florida, USA
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A case–control study on red meat consumption and risk of stroke among a group of Iranian adults. Public Health Nutr 2014; 18:1084-90. [DOI: 10.1017/s1368980014001165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveWe aimed to examine the association between red meat consumption and stroke in a group of Iranian adults.DesignA hospital-based case–control study.SettingThe study included stroke patients and hospital-based controls. Usual dietary intakes of participants were assessed by means of a validated 168-item semi-quantitative FFQ. Total red meat consumption was calculated by summing up the consumption of red, processed and visceral meats.SubjectsOne hundred and ninety-five cases were stroke patients hospitalized in the neurology ward and 195 controls were recruited from patients hospitalized in other wards with no history of cerebrovascular diseases or neurological disorders.ResultsParticipants with stroke were older, more likely to be male and less likely to be obese. Individuals in the highest tertile of red meat intake were 119 % more likely to have stroke (OR=2·19; 95 % CI 1·33, 3·60) compared with those in the lowest tertile. After controlling for age, sex and total energy intake, the association between red meat consumption and stroke was strengthened (OR=2·72; 95 % CI 1·53, 4·83). This association remained significant even after further controlling for physical activity and smoking as well as dietary intakes. Additional adjustments for BMI, diabetes, hypertension and hyperlipidaemia did not influence the association significantly (OR=2·51; 95 % CI 1·19, 5·09).ConclusionsConsumption of red meat was associated with greater odds of having stroke in a group of Iranian adults.
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López-Calderón C, Palacios R, Cobo A, Nuño E, Ruiz J, Márquez M, Santos J. Serum ferritin in HIV-positive patients is related to immune deficiency and inflammatory activity. Int J STD AIDS 2014; 26:393-7. [PMID: 24912540 DOI: 10.1177/0956462414539669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022]
Abstract
To analyse the prevalence of high ferritin levels in asymptomatic HIV patients and its related factors we conducted a cross-sectional study of a cohort of HIV outpatients in regular follow-up. Epidemiological, clinical, analytical and therapeutic data were collected. Patients completed a questionnaire about cardiovascular risk factors and underwent a physical examination and a 12-h fasting blood analysis. High ferritin levels were defined as a plasma ferritin level >200 µg/L in women and >300 µg/L in men. A total of 571 patients (78.1% men) were included. Median age was 43.2 years, HIV sexual transmission 68.5%, median CD4 count 474 cells/µL, 36.3% AIDS cases, 86.2% on antiretroviral therapy and 74.8% of them with undetectable viral load; 14.6% metabolic syndrome criteria, and mean cardiovascular risk at 10 years 6.67%. High ferritin levels prevalence was 11%, and related factors were a CD4 count <350 cells/µL (odds ratio, OR 2.37 [1.3-4.1], p = 0.003), ultrasensitive C-reactive protein >3 mg/L (OR 2.67 [1.5-4.7], p = 0.001) and chronic hepatitis C virus infection (OR 2.77 [1.5-4.9], p = 0.001). High ferritin levels are not uncommon in HIV patients, and they correlate with immunosuppression defined as CD4 count <350 cells/µL, higher ultrasensitive C-reactive protein and hepatitis C virus infection, and in contrast to the general population, they are not related to increased cardiovascular risk or metabolic syndrome.
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Affiliation(s)
| | - Rosario Palacios
- UGC Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain FIMABIS, Málaga, Spain
| | - Andrés Cobo
- UGC Análisis Clínicos, Hospital Virgen de la Victoria, Málaga, Spain
| | - Enrique Nuño
- UGC Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain FIMABIS, Málaga, Spain
| | - Josefa Ruiz
- UGC Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain FIMABIS, Málaga, Spain
| | - Manuel Márquez
- UGC Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain FIMABIS, Málaga, Spain
| | - Jesús Santos
- UGC Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain FIMABIS, Málaga, Spain
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Basuli D, Stevens RG, Torti FM, Torti SV. Epidemiological associations between iron and cardiovascular disease and diabetes. Front Pharmacol 2014; 5:117. [PMID: 24904420 PMCID: PMC4033158 DOI: 10.3389/fphar.2014.00117] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/30/2014] [Indexed: 12/11/2022] Open
Abstract
Disruptions in iron homeostasis are linked to a broad spectrum of chronic conditions including cardiovascular, malignant, metabolic, and neurodegenerative disease. Evidence supporting this contention derives from a variety of analytical approaches, ranging from molecular to population-based studies. This review focuses on key epidemiological studies that assess the relationship between body iron status and chronic diseases, with particular emphasis on atherosclerosis ,metabolic syndrome and diabetes. Multiple surrogates have been used to measure body iron status, including serum ferritin, transferrin saturation, serum iron, and dietary iron intake. The lack of a uniform and standardized means of assessing body iron status has limited the precision of epidemiological associations. Intervention studies using depletion of iron to alter risk have been conducted. Genetic and molecular techniques have helped to explicate the biochemistry of iron metabolism at the molecular level. Plausible explanations for how iron contributes to the pathogenesis of these chronic diseases are beginning to be elucidated. Most evidence supports the hypothesis that excess iron contributes to chronic disease by fostering excess production of free radicals. Overall, epidemiological studies, reinforced by basic science experiments, provide a strong line of evidence supporting the association between iron and elevated risk of cardiovascular disease and diabetes. In this narrative review we attempt to condense the information from existing literature on this topic.
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Affiliation(s)
- Debargha Basuli
- Molecular Biology and Biophysicis, University of Connecticut Health Center, Farmington CT, USA
| | - Richard G Stevens
- Division of Epidemiology and Biostatistics, Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington CT, USA
| | - Frank M Torti
- Internal Medicine, University of Connecticut Health Center, Farmington CT, USA
| | - Suzy V Torti
- Molecular Biology and Biophysicis, University of Connecticut Health Center, Farmington CT, USA
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Cash WJ, O'Neill S, O'Donnell ME, McCance DR, Young IS, McEneny J, McDougall NI, Callender ME. Endothelial function, antioxidant status and vascular compliance in newly diagnosed HFE C282Y homozygotes. Adv Med Sci 2014; 59:28-33. [PMID: 24797970 DOI: 10.1016/j.advms.2013.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/01/2013] [Indexed: 01/19/2023]
Abstract
PURPOSE This pilot study was aimed to establish techniques for assessing and observing trends in endothelial function, antioxidant status and vascular compliance in newly diagnosed HFE haemochromatosis during the first year of venesection. PATIENTS/METHODS Untreated newly diagnosed HFE haemochromatosis patients were tested for baseline liver function, iron indices, lipid profile, markers of endothelial function, anti-oxidant status and vascular compliance. Following baseline assessment, subjects attended at 6-weeks and at 3, 6, 9 and 12-months for follow-up studies. RESULTS Ten patients were recruited (M=8, F=2, mean age=51 years). Venesection significantly increased high density lipoproteins at 12-months (1.25 mmol/L vs. 1.37 mmol/L, p=0.01). However, venesection did not significantly affect lipid hydroperoxides, intracellular and vascular cell adhesion molecules or high sensitivity C-reactive protein (0.57 μmol/L vs. 0.51 μmol/L, p=0.45, 427.4 ng/ml vs. 307.22 ng/ml, p=0.54, 517.70 ng/ml vs. 377.50 ng/ml, p=0.51 and 290.75 μg/dL vs. 224.26 μg/dL, p=0.25). There was also no significant effect of venesection on anti-oxidant status or pulse wave velocity (9.65 m/s vs. 8.74 m/s, p=0.34). CONCLUSIONS Venesection significantly reduced high density lipoproteins but was not associated with significant changes in endothelial function, anti-oxidant status or vascular compliance. Larger studies using this established methodology are required to clarify this relationship further.
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Affiliation(s)
- William J Cash
- Department of Hepatology (Liver Unit), Royal Victoria Hospital, Belfast, UK.
| | - Stephen O'Neill
- Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - Mark E O'Donnell
- Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - David R McCance
- Department of Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Ian S Young
- Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, UK; Department of Medicine, Queen's University Belfast, Belfast, UK
| | - Jane McEneny
- Department of Medicine, Queen's University Belfast, Belfast, UK
| | - Neil I McDougall
- Department of Hepatology (Liver Unit), Royal Victoria Hospital, Belfast, UK
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Lapice E, Masulli M, Vaccaro O. Iron Deficiency and Cardiovascular Disease: An Updated Review of the Evidence. Curr Atheroscler Rep 2013; 15:358. [DOI: 10.1007/s11883-013-0358-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Muñoz-Bravo C, Gutiérrez-Bedmar M, Gómez-Aracena J, García-Rodríguez A, Navajas JFC. Iron: protector or risk factor for cardiovascular disease? Still controversial. Nutrients 2013; 5:2384-404. [PMID: 23857219 PMCID: PMC3738979 DOI: 10.3390/nu5072384] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/09/2013] [Accepted: 06/11/2013] [Indexed: 01/12/2023] Open
Abstract
Iron is the second most abundant metal in the Earth’s crust. Despite being present in trace amounts, it is an essential trace element for the human body, although it can also be toxic due to oxidative stress generation by the Fenton reaction, causing organic biomolecule oxidation. This process is the basis of numerous pathologies, including cardiovascular diseases (CVD). The relationship between iron and cardiovascular disease was proposed in 1981 by Jerome Sullivan. Since then, numerous epidemiological studies have been conducted to test this hypothesis. The aim of this review is to present the main findings of the chief epidemiological studies published during the last 32 years, since Sullivan formulated his iron hypothesis, suggesting that this element might act as a risk factor for cardiovascular disease. We have analyzed 55 studies, of which 27 supported the iron hypothesis, 20 found no evidence to support it and eight were contrary to the iron hypothesis. Our results suggest that there is not a high level of evidence which supports the hypothesis that the iron may be associated with CVD. Despite the large number of studies published to date, the role of iron in cardiovascular disease still generates a fair amount of debate, due to a marked disparity in results.
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Affiliation(s)
- Carlos Muñoz-Bravo
- Department of Preventive Medicine and Public Health, University of Málaga, Boulevard Louis Pasteur 32, Málaga 29071, Spain.
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Chakraborty B, Vishnoi G, Goswami B, Gowda SH, Chowdhury D, Agarwal S. Lipoprotein(a), ferritin, and albumin in acute phase reaction predicts severity and mortality of acute ischemic stroke in North Indian Patients. J Stroke Cerebrovasc Dis 2012; 22:e159-67. [PMID: 23253530 DOI: 10.1016/j.jstrokecerebrovasdis.2012.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 10/18/2012] [Accepted: 10/24/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Inflammation plays a crucial role in the pathogenesis and prognosis of stroke. We studied the behavior of lipoprotein(a) [Lp(a)], ferritin, and albumin as acute phase reactants and their roles in the severity and mortality of stroke. METHODS We recruited 100 consecutive patients with acute ischemic stroke and 120 controls. Blood samples were drawn on days 1 and 7 and at both 3 and 6 months. Stroke was classified using Trial of Org 10172 in Acute Stroke Treatment classification. Stroke severity was assessed using the National Institutes of Health Stroke Scale. Prognosis at 6 months was assessed using the modified Rankin Scale, and mortality was assessed using the Kaplan-Meier analysis. Serum levels of interleukin-6 (IL-6), Lp(a), ferritin, and albumin were measured using enzyme-linked immunosorbent assay, immunoturbidimetry, and chemiluminescence commercial kits, respectively. RESULTS Levels of IL-6, Lp(a), and ferritin were consistently higher among cases than controls (P < .0001). Serum Lp(a) levels peaked at day 7 after stroke and tapered thereafter. Albumin levels were lower than controls on admission day and increased subsequently. In our study, Lp(a) acted as an acute phase reactant while albumin acted as a negative acute phase reactant. There was no association between Trial of Org 10172 in Acute Stroke Treatment subtype and elevated serum levels of Lp(a), albumin, and ferritin. Lp(a) and ferritin were high in patients with severe stroke. Albumin was negatively correlated with stroke severity. Serum levels of Lp(a) ≥ 77 mg/dL, albumin ≤ 3.5 g/dL, and ferritin ≥ 370 ng/dL is associated with a significantly increased risk of having a poorer outcome in stroke. Serum levels of Lp(a) >77 mg/dL and albumin <3.5 g/dL were also associated with increased mortality. CONCLUSIONS High levels of Lp(a) and ferritin and low levels of albumin are associated with increased severity and poorer long term prognosis of stroke. Patients with admission levels of Lp(a) >77 mg/dL and albumin <3.5 g/dL had increased mortality.
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Canavesi E, Alfieri C, Pelusi S, Valenti L. Hepcidin and HFE protein: Iron metabolism as a target for the anemia of chronic kidney disease. World J Nephrol 2012; 1:166-76. [PMID: 24175256 PMCID: PMC3782218 DOI: 10.5527/wjn.v1.i6.166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 05/24/2012] [Accepted: 09/25/2012] [Indexed: 02/06/2023] Open
Abstract
The anemia of chronic kidney disease and hemodialysis is characterized by chronic inflammation and release of cytokines, resulting in the upregulation of the iron hormone hepcidin, also increased by iron therapy and reduced glomerular filtration, with consequent reduction in iron absorption, recycling, and availability to the erythron. This response proves advantageous in the short-term to restrain iron availability to pathogens, but ultimately leads to severe anemia, and impairs the response to erythropoietin (Epo) and iron. Homozygosity for the common C282Y and H63D HFE polymorphisms influence iron metabolism by hampering hepcidin release by hepatocytes in response to increased iron stores, thereby resulting in inadequate inhibition of the activity of Ferroportin-1, inappropriately high iron absorption and recycling, and iron overload. However, in hemodialysis patients, carriage of HFE mutations may confer an adaptive benefit by decreasing hepcidin release in response to iron infusion and inflammation, thereby improving iron availability to erythropoiesis, anemia control, the response to Epo, and possibly survival. Therefore, anti-hepcidin therapies may improve anemia management in hemodialysis. However, HFE mutations directly favor hemoglobinization independently of hepcidin, and reduce macrophages activation in response to inflammation, whereas hepcidin might also play a beneficial anti-inflammatory and anti-microbic action during sepsis, so that direct inhibition of HFE-mediated regulation of iron metabolism may represent a valuable alternative therapeutic target. Genetic studies may offer a valuable tool to test these hypotheses and guide the research of new therapies.
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Affiliation(s)
- Elena Canavesi
- Elena Canavesi, Serena Pelusi, Luca Valenti, Internal Medicine, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F Sforza 35, 20122 Milano, Italy
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Zhang W, Iso H, Ohira T, Date OC, Tanabe N, Kikuchi S, Tamakoshi A. Associations of dietary iron intake with mortality from cardiovascular disease: the JACC study. J Epidemiol 2012; 22:484-93. [PMID: 22986645 PMCID: PMC3798559 DOI: 10.2188/jea.je20120006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background We investigated the relationship between dietary iron intake and mortality from cardiovascular disease (CVD) in a population-based sample of Japanese adults. Methods The study cohort consisted of 58 615 healthy Japanese (23 083 men and 35 532 women), aged between 40 and 79 years, who had no history of stroke, coronary heart disease (CHD), or cancer at baseline. Dietary iron intake was assessed at baseline by a validated food frequency questionnaire administered between 1988 and 1990 as part of the Japan Collaborative Cohort (JACC) Study. Results We documented 2690 (1343 men and 1347 women) deaths from CVD: 1227 (607 men and 620 women) deaths from total stroke, 651 from ischemic stroke (355 men and 296 women), 459 (196 men and 263 women) from hemorrhagic stroke, and 557 (311 men and 246 women) from CHD. Dietary intake of total iron was positively associated with mortality from total and ischemic stroke and total CVD in men. The multivariable hazard ratio for the highest versus the lowest quintile of total iron intake was 1.43 (95% CI, 1.02–2.00; P for trend = 0.009) for total stroke and 1.27 (1.01–1.58; 0.023) for total CVD in men. Dietary total iron intake was not associated with mortality from other endpoints in men, and was not associated with any endpoints in women. Conclusions Dietary intake of total iron was positively associated with mortality from stroke and total CVD in Japanese men.
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Affiliation(s)
- Wen Zhang
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka University
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Bryant BJ, Yau YY, Arceo SM, Daniel-Johnson J, Hopkins JA, Leitman SF. Iron replacement therapy in the routine management of blood donors. Transfusion 2012; 52:1566-75. [PMID: 22211316 PMCID: PMC3690467 DOI: 10.1111/j.1537-2995.2011.03488.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Iron depletion or deficiency in blood donors frequently results in deferrals for low hemoglobin (Hb), yet blood centers remain reluctant to dispense iron replacement therapy to donors. STUDY DESIGN AND METHODS During a 39-month period, 1236 blood donors deferred for a Hb level of less than 12.5 g/dL and 400 nondeferred control donors underwent health history screening and laboratory testing (complete blood counts, iron studies). Iron depletion and deficiency were defined as a ferritin level of 9 to 19 and less than 9 µg/L in females and 18 to 29 and less than 18 µg/L in males. Deferred donors and iron-deficient control donors were given a 60-pack of 325-mg ferrous sulfate tablets and instructed to take one tablet daily. Another 60-pack was dispensed at all subsequent visits. RESULTS In the low-Hb group, 30 and 23% of females and 8 and 53% of males had iron depletion or deficiency, respectively, compared with 29 and 10% of females and 18 and 21% of males in the control group. Iron-depleted or -deficient donors taking iron showed normalization of iron-related laboratory parameters, even as they continued to donate. Compliance with oral iron was 68%. Adverse gastrointestinal effects occurred in 21% of donors. The study identified 13 donors with serious medical conditions, including eight with gastrointestinal bleeding. No donors had malignancies or hemochromatosis. CONCLUSION Iron depletion or deficiency was found in 53% of female and 61% of male low-Hb donors and in 39% of female and male control donors. Routine administration of iron replacement therapy is safe and effective and prevents the development of iron depletion and deficiency in blood donors.
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Affiliation(s)
- Barbara J Bryant
- Department of Transfusion Medicine, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, USA.
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Cho GJ, Shin JH, Yi KW, Park HT, Kim T, Hur JY, Kim SH. Serum ferritin levels are associated with metabolic syndrome in postmenopausal women but not in premenopausal women. Menopause 2012; 18:1120-4. [PMID: 21694651 DOI: 10.1097/gme.0b013e318217e172] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ferritin, a marker of total body iron stores, is known to be associated with the risk of having metabolic syndrome and has been demonstrated to increase after the onset of menopause. Postmenopause status is an important determinant of metabolic syndrome. The aim of this study was to perform a menopause status-specific analysis of the association between ferritin levels and metabolic syndrome. METHODS We conducted a cross-sectional study of 3,082 participants (1,691 premenopausal women and 1,391 postmenopausal women), all of whom were enrolled in the Korean National Health and Nutrition Examination Survey 2007. RESULTS Premenopausal and postmenopausal women with metabolic syndrome had higher ferritin levels than did those without metabolic syndrome. After adjustments for age; body mass index; alcohol intake; smoking history; exercise; hormone therapy use; hemoglobin, aspartate aminotransferase, and alanine aminotransferase levels; and intake of energy and iron, multivariate logistic regression analysis revealed that postmenopausal women with ferritin levels in the third tertile had an increased risk of having metabolic syndrome (odds ratio, 1.62; 95% CI, 1.04-2.81) compared with postmenopausal women with levels in the first quartile. No such association was detected in premenopausal women. CONCLUSIONS Increased ferritin levels may be a determinant for metabolic syndrome in postmenopausal women but not in premenopausal women.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Abstract
BACKGROUND Cardiovascular complications and vascular changes are common in patients with beta-thalassaemia major. The aim of this study is to investigate the common carotid artery intima-media thickness in children. METHODS The study population was consisted of 33 thalassaemic children (22 boys and 11 girls, with a median age of 8 years) and 30 healthy children for control (12 girls and 18 boys, with a median age of 8 years) who were matched for age and gender. Common carotid artery intima-media thickness of the children was measured. RESULTS The patients' age at diagnosis ranged from 0.25 to 2 years, with a median of 0.6 months. Their disease duration ranged from 4 to 13.75 years, with a median of 6.5 years. The patients' median common carotid artery intima-media thickness was significantly higher than controls - that is, 0.87 versus 0.74, with a p-value less than 0.005. The mean common carotid artery intima-media thickness value was positively correlated with disease duration (r = 0.535), with a p-value less than 0.01 and ferritin level (r = 0.501), with a p-value less than 0.01. CONCLUSION Owing to the nature of the disease, patients with beta-thalassaemia major should be considered to have an increased risk of early vascular alteration and atherosclerosis. For this reason, common carotid artery intima-media thickness measurement can be recommended as a non-invasive and early diagnostic method.
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Rajapurkar MM, Shah SV, Lele SS, Hegde UN, Lensing SY, Gohel K, Mukhopadhyay B, Gang S, Eigenbrodt ML. Association of catalytic iron with cardiovascular disease. Am J Cardiol 2012; 109:438-42. [PMID: 22071209 DOI: 10.1016/j.amjcard.2011.09.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 09/13/2011] [Accepted: 09/13/2011] [Indexed: 11/18/2022]
Abstract
The ability of iron to cycle reversibly between its ferrous and ferric oxidation states is essential for the biological functions of iron but may contribute to vascular injury through the generation of powerful oxidant species. We examined the association between chemical forms of iron that can participate in redox cycling, often referred to as "catalytic" or "labile" iron, and cardiovascular disease (CVD). In our cross-sectional study of 496 participants, 85 had CVD. Serum catalytic iron was measured using the bleomycin-detectable iron assay that detects biologically active iron. The odds of existing CVD for subjects in the upper third of catalytic iron were 10 times that of subjects with lower catalytic iron in unadjusted analyses. The association was decreased by 1/2 by age adjustment, but little additional attenuation occurred after adjusting for age, Framingham Risk Score, estimated glomerular filtration rate, hypertension status, high-density lipoprotein cholesterol, and systolic blood pressure, with the association remaining strong and significant (odds ratio 3.8, 95% confidence interval 1.4 to 10.1). In conclusion, we provide preliminary evidence for a strong detrimental association between high serum catalytic iron and CVD even after adjusting for several co-morbid conditions; however, broader prospective studies are needed to confirm these findings, which would support therapeutic trials to assess the beneficial effects of iron chelators on CVD.
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Affiliation(s)
- Mohan M Rajapurkar
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, India
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Syrovatka P, Kraml P, Hulikova K, Fialova L, Vejrazka M, Crkovska J, Potockova J, Andel M. Iron stores are associated with asymptomatic atherosclerosis in healthy men of primary prevention. Eur J Clin Invest 2011; 41:846-53. [PMID: 21281279 DOI: 10.1111/j.1365-2362.2011.02474.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of our study was to assess the impact of increased iron stores on the presence of asymptomatic atherosclerosis in a cohort of healthy men. We anticipated that higher iron stores would be associated with higher soluble cluster of differentiation 163 (sCD163) concentrations, elevated markers of oxidative stress, inflammation and higher common carotid intima-media thickness, independently of traditional risk factors of atherosclerosis. METHODS In this cross-sectional study that included 72 healthy men, we measured the ultrasonography of common carotid intima-media thickness (IACC), the ratio of plasma-circulating transferrin receptors concentration to plasma ferritin concentration, certain inflammatory and oxidative stress markers, insulin sensitivity, plasma lipids and markers of endothelial dysfunction. RESULTS The plasma-circulating transferrin receptor concentration to plasma ferritin concentration ratio (TfR/F) showed significant association with IACC (r=-0·310, P=0·008 vs. r=0·295, P=0·012). Multivariate analysis confirmed that the correlation of TfR/F with IACC is independent of traditional risk factors of atherosclerosis. The TfR/F ratio correlated with other indicators of atherosclerotic process fibrinogen (r=-0·292, P=0·013), von Willebrand factor (vWf; r=0·284, P=0·017), sCD163 (r=0·239, P=0·043) and IL-8 (r=0·233, P=0·049). In multivariate analysis, TfR/F independently correlated with haemoglobin (β=-0·220, P=0·047), fibrinogen (β=-0·290, P=0·009), IL-8 (β=0·227, P=0·039) and sCD163 (β=0·244, P=0·025); however, when vWf was added, significant independent correlation was seen only with fibrinogen (β=-0·301, P=0·007) and IL-8 (β=0·219, P=0·047). In addition, we demonstrated the independent correlation of sCD163 with vWf (β=0·240, P=0·040). CONCLUSIONS Our study showed a clear association of body iron stores expressed by the TfR/F ratio with asymptomatic carotid atherosclerosis. TfR/F further exhibited an independent positive correlation with fibrinogen and a negative correlation with sCD163 and IL-8.
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Affiliation(s)
- Petr Syrovatka
- Cardiocentre, Institute for Clinical and Experimental Medicine, Videnska 1958 ⁄ 9, Prague 4, CZ-140 21, Czech Republic.
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Valenti L, Swinkels DW, Burdick L, Dongiovanni P, Tjalsma H, Motta BM, Bertelli C, Fatta E, Bignamini D, Rametta R, Fargion S, Fracanzani AL. Serum ferritin levels are associated with vascular damage in patients with nonalcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2011; 21:568-575. [PMID: 20392616 DOI: 10.1016/j.numecd.2010.01.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 11/06/2009] [Accepted: 01/05/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Increased ferritin and body iron stores are frequently observed in nonalcoholic fatty liver disease (NAFLD), associated with heightened susceptibility to vascular damage. Conflicting data have been reported on the role of iron in atherosclerosis, with recent data suggesting that excess iron induces vascular damage by increasing levels of the hormone hepcidin, which would determine iron trapping into macrophages, oxidative stress, and promotion of transformation into foam cells. Aim of this study was to investigate the relationship between iron status and cardiovascular damage in NAFLD. METHODS AND RESULTS Vascular damage was evaluated by common carotid arteries intima-media thickness (CC-IMT) measurement and plaque detection by ecocolor-doppler ultrasonography in 506 patients with clinical and ultrasonographic diagnosis of NAFLD, hemochromatosis gene (HFE) mutations by restriction analysis in 342 patients. Serum hepcidin-25 was measured by time-of-flight mass spectrometry in 143 patients. At multivariate analysis CC-IMT was associated with systolic blood pressure, glucose, LDL cholesterol, abdominal circumference, age, and ferritin (p=0.048). Carotid plaques were independently associated with age, ferritin, glucose, and hypertension. Ferritin reflected iron stores and metabolic syndrome components, but not inflammation or liver damage. Hyperferritinemia was associated with increased vascular damage only in patients with HFE genotypes associated with hepcidin upregulation by iron stores (p<0.0001), and serum hepcidin-25 was independently associated with carotid plaques (p=0.05). CONCLUSION Ferritin levels, reflecting iron stores, are independent predictors of vascular damage in NAFLD. The mechanism may involve upregulation of hepcidin by increased iron stores in patients not carrying HFE mutations, and iron compartmentalization into macrophages.
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Affiliation(s)
- L Valenti
- Center for the Study of Metabolic and Liver Diseases, Department of Internal Medicine, Università degli Studi Milano, Internal Medicine 1B, Hospital Fondazione Policlinico MaRE IRCCS, Milano, Italy.
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Spilcke-Liss E, Friedrich N, Dörr M, Schminke U, Völzke H, Brabant G, Nauck M, Wallaschofski H. Serum insulin-like growth factor I and its binding protein 3 in their relation to intima-media thickness: results of the study of health in Pomerania (SHIP). Clin Endocrinol (Oxf) 2011; 75:70-5. [PMID: 21521279 DOI: 10.1111/j.1365-2265.2011.04010.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies detected associations between lower insulin-like growth factor I (IGF-I) levels and increased risk of congestive heart failure or ischaemic heart disease. The aim of the present study was to assess the association of IGF-I and its binding protein 3 (IGFBP-3) with the carotid intima-media thickness (IMT) as marker of asymptomatic cardiovascular disease. DESIGN AND POPULATION From the population-based Study of Health in Pomerania (SHIP), a total of 2286 participants aged 45 years or older with readable ultrasound of the carotid arteries were available for the present analyses. METHODS AND MEASUREMENTS Serum IGF-I and IGFBP-3 levels were categorized into three groups (low, moderate, high) according to the sex-specific 10th and 90th percentile. Analyses of variance (anova) and logistic regression analyses adjusted for age, waist circumference, diabetes, hypertension and creatinine clearance were performed. RESULTS After adjusting for confounding factors, IGF-I and the IGF-I/IGFBP-3 ratio were positively related to IMT in anova. Logistic regression analyses confirmed these findings and showed that high IGF-I levels, a high IGF-I/IGFBP-3 ratio and low IGFBP-3 levels were associated to higher odds of increased IMT. CONCLUSION In conclusion, high IGF-I or high IGF-I/IGFBP-3 ratio values and low IGFBP-3 levels are associated with increased IMT. Therefore, systemic levels of the IGF axis or alterations in the balance of its components are associated with subclinical atherosclerotic disease.
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Affiliation(s)
- Elisabeth Spilcke-Liss
- Institute of Clinical Chemistry and Laboratory MedicineDepartment of CardiologyDepartment of NeurologyInstitute for Community Medicine University of Greifswald, GermanyDepartment of Endocrinology, Christie Hospital, Manchester, UK
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Meroño T, Gómez L, Sorroche P, Boero L, Arbelbide J, Brites F, Brites F. High risk of cardiovascular disease in iron overload patients. Eur J Clin Invest 2011; 41:479-86. [PMID: 21128934 DOI: 10.1111/j.1365-2362.2010.02429.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Iron overload (IO) is defined as an increase in storage iron, regardless of the presence or absence of tissue damage. Whether increased iron stores are involved in the pathogenesis of cardiovascular disease remains controversial. OBJECTIVES To study insulin resistance markers, lipoprotein profile, activities of anti and prooxidant enzymes and cholesteryl ester transfer protein (CETP) in patients with IO. METHODS Twenty male patients with IO were compared with 20 sex- and age-matched controls. General biochemical parameters, lipoprotein profile, and activities of paraoxonase 1, employing two substrates, paraoxon (PON) and phenylacetate (ARE), lipoprotein-associated phospholipase A(2) (Lp-PLA(2) ) and CETP were determined. RESULTS IO patients showed higher levels of HOMA-IR and triglycerides [median (Q1-Q3)] [128 (93-193) vs. 79(51-91) mg dL(-1) , P < 0·0005] while lower high-density lipoprotein (HDL) cholesterol (mean ± SD) (41 ± 9 vs. 52 ± 10 mg dL(-1) , P < 0·0005) in comparison with controls. Moreover, the triglycerides/HDL-cholesterol [3·2 (2·0-5·1) vs. 1·5 (1·0-1·9), P < 0·0005] ratio and oxidized low-density lipoprotein levels [94 (64-103) vs. 68 (59-70) IU L(-1) , P < 0·05] were increased in the patient group. Although no difference was observed in ARE activity, PON activity was decreased in IO patients [246 (127-410) vs. 428 (263-516) nmol mL(-1) min(-1) , P < 0·05]. In addition, CETP and Lp-PLA(2) activities were also increased in the patients (189 ± 31 vs. 155 ± 36% ml(-1) h(-1) , P < 0·005; and 10·1 ± 2·9 vs. 8·2 ± 2·4 μmol mL(-1) h(-1) , P < 0·05, respectively). Associations between ferritin concentration and the alterations in lipid metabolism were also found. Multiple regression analyses identified HOMA-IR as independent predictor of CETP activity (B = 65·9, P < 0·0001, r(2) = 0·35), as well as ferritin concentration of Lp-PLA(2) activity (B = 3·7, P < 0·0001, r(2) = 0·40) after adjusting for confounding variables. CONCLUSIONS IO patients presented not only insulin resistance but also metabolic alterations that were related to elevated iron stores and are associated with high risk of cardiovascular disease.
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Affiliation(s)
- Tomás Meroño
- Tomàs Meroño, Department of Clinical Biochemistry, School of Pharmacy and Biochemistry, University of Buenos Aires, Argentina.
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Ruiz-Jaramillo MDLC, Guizar-Mendoza JM, Amador-Licona N, Gutierrez-Navarro MDJ, Hernandez-Gonzalez MA, Dubey-Ortega LA, Solorio-Meza SE. Iron overload as cardiovascular risk factor in children and adolescents with renal disease. Nephrol Dial Transplant 2011; 26:3268-73. [DOI: 10.1093/ndt/gfr044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Kim SD, Hwang JK, Park SC, Kim JI, Moon IS. Relationship of Serum Ferritin, Cholesterol, and Intimal Hyperplasia after Mechanical Injury to Carotid Artery in a Rat Model. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011. [DOI: 10.4174/jkss.2011.80.2.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sang Dong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Kye Hwang
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Il Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Sung Moon
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kell DB. Towards a unifying, systems biology understanding of large-scale cellular death and destruction caused by poorly liganded iron: Parkinson's, Huntington's, Alzheimer's, prions, bactericides, chemical toxicology and others as examples. Arch Toxicol 2010; 84:825-89. [PMID: 20967426 PMCID: PMC2988997 DOI: 10.1007/s00204-010-0577-x] [Citation(s) in RCA: 286] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 07/14/2010] [Indexed: 12/11/2022]
Abstract
Exposure to a variety of toxins and/or infectious agents leads to disease, degeneration and death, often characterised by circumstances in which cells or tissues do not merely die and cease to function but may be more or less entirely obliterated. It is then legitimate to ask the question as to whether, despite the many kinds of agent involved, there may be at least some unifying mechanisms of such cell death and destruction. I summarise the evidence that in a great many cases, one underlying mechanism, providing major stresses of this type, entails continuing and autocatalytic production (based on positive feedback mechanisms) of hydroxyl radicals via Fenton chemistry involving poorly liganded iron, leading to cell death via apoptosis (probably including via pathways induced by changes in the NF-κB system). While every pathway is in some sense connected to every other one, I highlight the literature evidence suggesting that the degenerative effects of many diseases and toxicological insults converge on iron dysregulation. This highlights specifically the role of iron metabolism, and the detailed speciation of iron, in chemical and other toxicology, and has significant implications for the use of iron chelating substances (probably in partnership with appropriate anti-oxidants) as nutritional or therapeutic agents in inhibiting both the progression of these mainly degenerative diseases and the sequelae of both chronic and acute toxin exposure. The complexity of biochemical networks, especially those involving autocatalytic behaviour and positive feedbacks, means that multiple interventions (e.g. of iron chelators plus antioxidants) are likely to prove most effective. A variety of systems biology approaches, that I summarise, can predict both the mechanisms involved in these cell death pathways and the optimal sites of action for nutritional or pharmacological interventions.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry and the Manchester Interdisciplinary Biocentre, The University of Manchester, Manchester M1 7DN, UK.
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Ahluwalia N, Genoux A, Ferrieres J, Perret B, Carayol M, Drouet L, Ruidavets JB. Iron status is associated with carotid atherosclerotic plaques in middle-aged adults. J Nutr 2010; 140:812-6. [PMID: 20181783 PMCID: PMC3140217 DOI: 10.3945/jn.109.110353] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Although the iron-heart disease hypothesis is prevalent, the epidemiological findings are incongruent. The relationship of serum ferritin with early cardiovascular disease (CVD), particularly atherosclerosis, has not been evaluated extensively, particularly with accounting for inflammation. We examined this association in a case-control study of 124 age- and sex-matched pairs embedded in the population-based random sample (MONICA survey) in Southwest France, taking into account inflammation status. Cases had >or=2 carotid atherosclerotic plaques and controls had none. Inflammation was assessed using several markers, including serum alpha-1 acid glycoprotein (AGP) and high sensitivity C-reactive protein. There was an interaction of inflammation with group (case/control) for serum ferritin. In adults without elevated AGP, serum ferritin was significantly greater in atherosclerotic cases than in adults in the control group. In models adjusted for CVD risk factors, the odds of atherosclerosis increased with the increase in serum ferritin in individuals without elevated AGP; for every 10-microg/L increase in serum ferritin, the risk for atherosclerosis increased by 3% (odds ratio [95% CI]: 1.03 [1.01-1.06]). In conclusion, carotid atherosclerosis was positively associated with serum ferritin in individuals free from subclinical inflammation based on AGP. Further prospective and/or experimental studies are needed to corroborate the observed association of iron status with atherosclerosis.
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Affiliation(s)
- Namanjeet Ahluwalia
- INSERM U558, Department of Epidemiology, Faculty of Medicine, CHU-Toulouse, France.
| | - Annelise Genoux
- INSERM U558, Department of Epidemiology, and Departments of Cardiology and Epidemiology, Faculty of Medicine, CHU-Toulouse 31073, France; INSERM U563, Department of Lipoproteins and Lipid Mediators, CHU-Toulouse 31059, France; Service d'angiohématologie biologique, thrombologie et hémostase, CHU-Lariboisière Paris, Faculté de médecine Paris VII 75475 Paris cedex 10, France
| | - Jean Ferrieres
- INSERM U558, Department of Epidemiology, and Departments of Cardiology and Epidemiology, Faculty of Medicine, CHU-Toulouse 31073, France; INSERM U563, Department of Lipoproteins and Lipid Mediators, CHU-Toulouse 31059, France; Service d'angiohématologie biologique, thrombologie et hémostase, CHU-Lariboisière Paris, Faculté de médecine Paris VII 75475 Paris cedex 10, France
| | - Bertrand Perret
- INSERM U558, Department of Epidemiology, and Departments of Cardiology and Epidemiology, Faculty of Medicine, CHU-Toulouse 31073, France; INSERM U563, Department of Lipoproteins and Lipid Mediators, CHU-Toulouse 31059, France; Service d'angiohématologie biologique, thrombologie et hémostase, CHU-Lariboisière Paris, Faculté de médecine Paris VII 75475 Paris cedex 10, France
| | - Marion Carayol
- INSERM U558, Department of Epidemiology, and Departments of Cardiology and Epidemiology, Faculty of Medicine, CHU-Toulouse 31073, France; INSERM U563, Department of Lipoproteins and Lipid Mediators, CHU-Toulouse 31059, France; Service d'angiohématologie biologique, thrombologie et hémostase, CHU-Lariboisière Paris, Faculté de médecine Paris VII 75475 Paris cedex 10, France
| | - Ludovic Drouet
- INSERM U558, Department of Epidemiology, and Departments of Cardiology and Epidemiology, Faculty of Medicine, CHU-Toulouse 31073, France; INSERM U563, Department of Lipoproteins and Lipid Mediators, CHU-Toulouse 31059, France; Service d'angiohématologie biologique, thrombologie et hémostase, CHU-Lariboisière Paris, Faculté de médecine Paris VII 75475 Paris cedex 10, France
| | - Jean-Bernard Ruidavets
- INSERM U558, Department of Epidemiology, and Departments of Cardiology and Epidemiology, Faculty of Medicine, CHU-Toulouse 31073, France; INSERM U563, Department of Lipoproteins and Lipid Mediators, CHU-Toulouse 31059, France; Service d'angiohématologie biologique, thrombologie et hémostase, CHU-Lariboisière Paris, Faculté de médecine Paris VII 75475 Paris cedex 10, France
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Lack of association between insulin-like growth factor-1 or insulin-like growth factor-binding protein-3 and left ventricular hypertrophy: results of the Study of Health in Pomerania. J Hypertens 2010; 28:856-64. [DOI: 10.1097/hjh.0b013e328336274a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mateo-Gallego R, Calmarza P, Jarauta E, Burillo E, Cenarro A, Civeira F. Serum ferritin is a major determinant of lipid phenotype in familial combined hyperlipidemia and familial hypertriglyceridemia. Metabolism 2010; 59:154-8. [PMID: 19913843 DOI: 10.1016/j.metabol.2009.06.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 06/22/2009] [Accepted: 06/29/2009] [Indexed: 11/18/2022]
Abstract
Familial combined hyperlipidemia (FCH) and familial hypertriglyceridemia (FHTG) share pathogenic mechanisms and a high interaction with components of the metabolic syndrome. The metabolic syndrome associates increased serum ferritin concentration and high cardiovascular risk. The objective was to describe the frequency of iron overload and the relationship between serum ferritin and the phenotype in patients with FCH and FHTG. The study was composed of 211 consecutive unrelated patients aged at least 18 years with primary hypertriglyceridemia, 149 with FCH, and 62 with FHTG. The prevalence of the metabolic syndrome and hyperferritinemia was very high in both hypertriglyceridemic groups (51.7% and 20.1% in FCH and 62.9% and 16.1% in FHTG, respectively), without significant statistical differences between them. Serum ferritin concentration did not show any significant association with the number of metabolic syndrome criteria. Subjects in the highest tertile of ferritin concentration (ferritin >200 mug/L) presented higher concentrations of triglycerides and liver enzymes than subjects in the first tertile of ferritin concentration (ferritin <90 mug/L). The highest positive correlation coefficient for triglycerides was found with ferritin in FCH and in FHTG subjects (R = 0.317 [P < .001] when combined). Ferritin was also the covariate that showed the highest independent association with triglycerides in FCH and FHTG. In contrast, ferritin was not associated with carotid intima-media thickness. In summary, serum ferritin is commonly increased in FCH and in FHTG, it is not related with the presence of metabolic syndrome, and it is highly correlated with liver enzymes.
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Affiliation(s)
- Rocio Mateo-Gallego
- Unidad de Lípidos and Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de la Salud, 50009 Zaragoza, Spain.
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