van der A Daphne L, Marx Joannes J M, Grobbee Diederick E, Kamphuis Marjolein H, Georgiou Niki A, van Kats-Renaud J Henny, Breuer William, Cabantchik Z Ioav, Roest Mark, Voorbij Hieronymus A M, van der Schouw Yvonne T
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Circulation. 2006 Apr 25;113(16):1942-9. doi: 10.1161/CIRCULATIONAHA.105.545350. Epub 2006 Apr 17.
Epidemiological studies aimed at correlating coronary heart disease (CHD) with serum ferritin levels have thus far yielded inconsistent results. We hypothesized that a labile iron component associated with non-transferrin-bound iron (NTBI) that appears in individuals with overt or cryptic iron overload might be more suitable for establishing correlations with CHD.
We investigated the relation of NTBI, serum iron, transferrin saturation, and serum ferritin with risk of CHD and acute myocardial infarction (AMI). The cohort used comprised a population-based sample of 11 471 postmenopausal women aged 49 to 70 years at enrollment in 1993 to 1997. During a median follow-up of 4.3 years (quartile limits Q1 to Q3: 3.3 to 5.4), 185 CHD events were identified, including 66 AMI events. We conducted a case-cohort study using all CHD cases and a random sample from the baseline cohort (n=1134). A weighted Cox proportional hazards model was used to estimate hazard ratios for tertiles of iron variables in relation to CHD and AMI. Adjusted hazard ratios of women in the highest NTBI tertile (range 0.38 to 3.51) compared with the lowest (range -2.06 to -0.32) were 0.84 (95% confidence interval 0.61 to 1.16) for CHD and 0.47 (95% confidence interval 0.31 to 0.71) for AMI. The results were similar for serum iron, transferrin saturation, and serum ferritin.
Our results show no excess risk of CHD or AMI within the highest NTBI tertile compared with the lowest but rather seem to demonstrate a decreased risk. Additional studies are warranted to confirm our findings.
旨在关联冠心病（CHD）与血清铁蛋白水平的流行病学研究至今得出了不一致的结果。我们推测，在明显或隐匿性铁过载个体中出现的与非转铁蛋白结合铁（NTBI）相关的不稳定铁成分可能更适合用于建立与冠心病的关联。
我们研究了NTBI、血清铁、转铁蛋白饱和度和血清铁蛋白与冠心病及急性心肌梗死（AMI）风险的关系。所使用的队列包括1993年至1997年招募的11471名年龄在49至70岁的绝经后女性，该样本基于人群。在中位随访4.3年（四分位数范围Q1至Q3：3.3至5.4年）期间，共识别出185例冠心病事件，包括66例AMI事件。我们使用所有冠心病病例和基线队列中的随机样本（n = 1134）进行了病例队列研究。采用加权Cox比例风险模型来估计铁变量三分位数与冠心病和AMI相关的风险比。与最低NTBI三分位数（范围为 -2.06至 -0.32）相比，最高NTBI三分位数（范围为0.38至3.51）的女性，其冠心病的调整后风险比为0.84（95%置信区间0.61至1.16），AMI的调整后风险比为0.47（95%置信区间0.31至0.71）。血清铁、转铁蛋白饱和度和血清铁蛋白的结果相似。
我们的结果显示，与最低NTBI三分位数相比，最高NTBI三分位数内的冠心病或AMI风险并无增加，反而似乎显示出风险降低。需要进一步研究来证实我们的发现。
