To the Editor.
—Drs Miller and Hutchins1 find no increased coronary artery disease (CAD) in a sample of autopsy subjects with hemochromatosis. The degree of CAD in a small, potentially nonrepresentative subset of patients identified at autopsy may underestimate the degree of CAD in hemochromatosis. If the 47 961 autopsy subjects were a random population sample, one in 200 (or about 240) cases of hereditary hemochromatosis would be expected, many more than the 33 cases found. The 47961 subjects may have actually included more than 240 unidentified hemochromatosis cases. Hemochromatosis is notorious for presenting with confusing signs and symptoms. Premortem diagnostic confusion in cases of hemochromatosis may have preferentially led to the decision to perform autopsy. Before concluding that there is no increase in coronary atherosclerosis in hemochromatosis, Miller and Hutchins should have carefully excluded the possibility that selection of cases for autopsy preferentially included cases of hemochromatosis with
Sullivan JL. Hemochromatosis and Coronary Artery Disease. JAMA. 1995;273(1):25-26. doi:10.1001/jama.1995.03520250039028