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January 4, 1995

Hemochromatosis and Coronary Artery Disease-Reply

Author Affiliations

University of Maryland Hospital
The Johns Hopkins Hospital Baltimore, Md

JAMA. 1995;273(1):26. doi:10.1001/jama.1995.03520250039029

In Reply.  —Dr Sullivan raises the possibility that the small number of autopsy cases (n=41) with iron overload states (eg, hemochromatosis and multiorgan hemosiderosis) included in our study underestimates the degree of CAD because of the lower prevalence found at autopsy compared with the population at large. Sullivan believes that because hemochromatosis may be difficult to diagnose clinically, more cases of this disorder should have been identified at autopsy.Fortunately, hemochromatosis and multiorgan hemosiderosis are easily diagnosed at autopsy, and diagnostic criteria have not changed during the past 100 years. Of the 47961 autopsies performed from May 1889 to October 1992, there were approximately 200 subjects with systemic iron deposition. After excluding subjects less than 18 years old, those with transfusion-related hemochromatosis, and those with hemosiderosis identified in one organ (often a nonspecific finding), 41 cases met our stringent entry criteria. Histologic reexamination and confirmation of iron deposition within parenchymal

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