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Rebekah St. Godard

Dr. James Munoz
Anatomy and Physiology 2 (BIOL 3330)
September 27, 2014
Ali Pourmoghaddas, Hamid Sanei, Mohammad Garakyaraghi, Fatemeh
Esteki-Ghashghaei, Maryam Gharaati (2013). The relation between
body iron store and ferritin, and coronary artery disease. ARYA
Atheroscler 2014; Volume 10, Issue 1 (32-36). Oct. 4, 2013.
Cardiovascular Disease in Relation to Excessive Iron Storage
Cardiovascular disease (CVD) is a class of diseases involving the
arteries, veins, or capillaries of the heart. According to data base
research, CVD is the largest cause of mortality in the world (Lusis, 1).
Because of the dominating presence of CVD cases, numerous research
studies have been conducted to discover possible underlying risk
factors that increase the chances of having CVD. The purpose of this
study was to determine the relationship between excessive iron levels
and atherosclerosis. Atherosclerosis is a disease involving the
hardening of the arteries due to fatty plaque build-up on the inner
artery walls. When atherosclerosis begins to affect the arteries of the
heart, it is termed coronary artery disease (CAD). Common risk factors
for CVD, including CAD, are obesity, diabetes, smoking, high
cholesterol, high blood pressure, and tobacco usage. Researchers have
routed their research methods to study deeper factors that increase

the risk of CVD and CAD. This research study was aimed at
independent relationship between iron serum ferritin levels and
atherosclerosis. Other studies similar to this one have yielded a variety
of results supporting and negating the relationship between excessive
iron levels to cardiovascular disease. It is thought that increased iron
storage leads to increased risk of atherosclerosis. This study seeks to
analyze the connection of iron to cardiovascular disease, along with
the commonly known risk factors. This relationship was observed using
the serum ferritin levels as an indicator of the iron stored in the body
system (Ali Pourmoghaddas, et al, 33).
Materials and Methods
This study used four hundred and thirty two male individuals who
were deemed eligible to participate in this study. These individuals
were divided into two test groups: case study and control study. The
case study group included two hundred and twelve participants who
have coronary artery disease with a stenosis greater than or equal to
50%. The control study group included two-hundred and twenty
participants who had no coronary artery disease according to
angiography data. By grouping the participants based on whether or
not they have coronary artery disease, the experimental results can be
compared using excessive iron storage as a variable. This allows the
researchers to determine whether or not the results are due to
excessive iron ferritin levels. It is important to note that during the

selection process, individuals with a history of inflammatory diseases,
had recent surgery, or used iron supplements or vitamins were
excluded from the study.
Angiography tests were conducted on all the participants to
determine which individuals had coronary artery disease. An
angiogram allows for the blood flow of arteries and veins to be
visualized on an x-ray screen. This is pivotal in establishing the
presence of plaque on the walls of blood vessels, which if present, will
prevent efficient blood flow. Additionally, the systolic (heart
contraction) and diastolic (heart relaxation) blood pressures were
recorded and used as a determining factor of CVD. Blood samples from
both groups were obtained twelve to twenty four hours after fasting.
The blood samples were taken to measure the hematologic indexes,
fasting blood sugars, and serum lipids under standard laboratory
procedures. The serum levels from both groups were collected and
used to determine the serum iron and total iron binding capacity.
Serum iron is the amount of iron in the circulating blood that is
bound to a protein molecule called transferrin. Serum is the protein
rich liquid part of the plasma separated when red blood cells are
removed or destroyed. (Pichler et al, 1). Iron ferritin is the main storage
compound in the body. It is usually found in reticuloendothelial cells in
the liver, spleen and bone marrow. However, small amounts can be
found in the circulating plasma (Walters et al, 770). Total iron binding

capacity is a blood test that indicates whether too much or too little
iron is present in the circulating blood. This experiment determined
serum ferritin concentration by enzyme-linked immunoassay. Enzyme
linked immunoassay uses antibodies that change the color of a
substance for clear identification (Bishai and Galli, 648)
The results of this experiment were grouped into three tables.
The first grouping involved the comparison of common risks factors to
the tested iron levels in both the control group and case group. The
common risk factors included in the table were hypertension, diabetes
mellitus, hyperlipidemia, and smoking. The tested iron levels that were
compared and included in the results were serum ferritin, serum iron,
serum TIBC, and percent transferrin saturation. All the common risk
factors were significantly higher in the case group than the control
group. Therefore, the major differences between the case and control
study groups were seen in the common factors. However, the tested
iron levels varied in results. Only the serum ferritin had significantly
increased levels in the case group. Both serum iron and serum TIBC
had lower values in the case group than the control group. Lastly,
transferrin saturation was slightly higher in the case group than in the
control group. Regarding all these results, there were still significant
differences in serum ferritin and other cardiovascular risk factors that

led to the conclusion that increased iron ferritin levels increasing the
risk of cardiovascular disease.
The second grouping involved the effect of the number of
individual vessels that were damaged. The results showed that injury
to one, two or three vessels had no effect of iron serum levels. The
third grouping, based on the experimental results, shows the
confidence interval of serum ferritin levels. When serum ferritin levels
are equal to or greater than 200 ng/ml, the odds ratio (OD) increases
four fold. This inquires that with excessive amount of iron in the body
system, it greatly increases the risk for atherosclerosis.
Discussion and Conclusion:
Serum ferritin is important to the bodys production and
regulation of hemoglobin. It is also directly proportional to internal cell
concentrations, which make is an excellent iron indicator. Hemoglobin
is the pigment molecule responsible for carrying oxygen and carbon
dioxide on the red blood cells. This is why iron is critical to life.
However, in excess amounts, iron has been thought to cause certain
cardiovascular diseases. Excessive iron levels may be a result of
hemochromatosis, known as iron overload, which is a genetic disorder.
Increasing a person's iron interferes with the lining of the blood vessels
(endothelium) causing oxidative stress.
This research study showed that with increased serum ferritin,
the risk of cardiovascular disease increases. When comparing the basic

risk factors between the two test groups, case and control, it is obvious
that the case group had much higher percentages for the common risk
factors. Based on the data obtained by this experiment, coronary
artery disease was proportional to serum ferritin levels when the
common risk factors were included in the model. The risk of
atherosclerosis was an astonishing four times higher risk factor than
the control group or healthy individuals when the serum ferritin levels
were great than one hundred. Because this study was only performed
on male individuals, it limits the results to only the male population.
This makes the results specific only to men and not to the generalized
population. In conclusion, high iron storage indicated through serum
ferritin was directly and independently associated with the
cardiovascular disease, specifically coronary artery disease.

Reference Page

Pourmoghaddas, Ali, and Hamid Sanei, and Mohammad Garakyaraghi,

and Fatemeh

Esteki-Ghashghaej, and Maryam Gharaati. "The relation between
iron store
and ferritin, and coronary artery disease." ARYA
Atherosclerosis 10 (2014):
32-36. 4 Oct. 2013.
Aldons J. Lusis. "Atherosclerosis." National Institutes of Health. NIH
Public Access. 7
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Bishai, F. R., and R. Galli. "Enzyme-Linked Immunosorbent Assay for
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Antibodies to Influenza A and B and Parainfluenza Type 1 in Sera
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11 Sep.
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Pichler, Irene, et al. "Serum Iron Levels and the Risk of Parkinson
Disease: A
Mendelian Randomization Study." PLOS Medicine 10 (June 2013):
1-2. Online
Walters, G O, and F Miller, and M Worwood. "Serum feritin

concentration and iron
stores in normal subjects." J. Clinical Pathways 26 (1973): 770772. Sep.
2014. Online.