Sempos C T, Looker A C, Gillum R F, Makuc D M
National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782.
N Engl J Med. 1994 Apr 21;330(16):1119-24. doi: 10.1056/NEJM199404213301604.
Recent studies have suggested an association between higher body iron stores and the risk of coronary heart disease. To assess these findings, we examined the association between transferrin saturation and the risk of coronary heart disease, myocardial infarction, overall mortality, and mortality from cardiovascular causes in a large population.
We studied a total of 4518 men and women from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, using a multivariate Cox proportional-hazards model. Base-line data were collected from 1971 to 1974, with follow-up through 1987. Transferrin saturation (serum iron concentration divided by total iron-binding capacity) was used as a measure of the amount of circulating iron available to tissues.
The risk of coronary heart disease was not related to transferrin-saturation levels in white men or women. Estimates of the relative risk of coronary heart disease for the fifth quintile of transferrin saturation as compared with the first quintile were 0.72 (95 percent confidence interval, 0.51 to 1.00) for men and 0.85 (95 percent confidence interval, 0.60 to 1.21) for women. The results were similar for myocardial infarction. A significant inverse association with transferrin saturation was found for overall mortality and for mortality from cardiovascular causes in white men and women. Transferrin saturation was not associated with any of the clinical outcomes in blacks, possibly owing to the small sample.
Higher transferrin-saturation levels were not associated with an increased risk of coronary heart disease or myocardial infarction. On the contrary, the results indicate that there may be an inverse association of iron stores with overall mortality and with mortality from cardiovascular causes.
最近的研究表明，体内铁储存量较高与冠心病风险之间存在关联。为评估这些研究结果，我们在一大群人中研究了转铁蛋白饱和度与冠心病、心肌梗死、全因死亡率及心血管疾病死亡率之间的关联。
我们利用多变量Cox比例风险模型，对来自第一次全国健康与营养检查调查流行病学随访研究的4518名男性和女性进行了研究。基线数据于1971年至1974年收集，并随访至1987年。转铁蛋白饱和度（血清铁浓度除以总铁结合力）被用作衡量组织可利用的循环铁量的指标。
冠心病风险与白人男性或女性的转铁蛋白饱和度水平无关。与第一五分位数相比，转铁蛋白饱和度第五五分位数的男性冠心病相对风险估计值为0.72（95%置信区间为0.51至1.00），女性为0.85（95%置信区间为0.60至1.21）。心肌梗死的结果相似。在白人男性和女性中，发现全因死亡率及心血管疾病死亡率与转铁蛋白饱和度呈显著负相关。转铁蛋白饱和度与黑人的任何临床结局均无关联，可能是由于样本量较小。
较高的转铁蛋白饱和度水平与冠心病或心肌梗死风险增加无关。相反，结果表明铁储存量可能与全因死亡率及心血管疾病死亡率呈负相关。
