Increased iron intake and accumulation of iron in the body may be considered to be important risk factors for atherosclerosis and ischemic heart disease.1 Until recently, iron was thought to be an environmental risk factor. However, 2 recent independent articles published in Circulation revealed that heterozygosity for hereditary hemochromatosis associated with the Cys282Tyr mutation of one HFE gene is associated with increased cardiovascular mortality in postmenopausal women2 and a higher incidence of acute myocardial infarction in men.3 Heterozygotes were previously considered to be perfectly healthy, since they have no iron overload. A combination of other risk factors in addition to hereditary hemochromatosis heterozygosity, in particular smoking and hypertension, enormously increased cardiovascular risk in women.2 Nevertheless, many subjects with the most awful combination of risk factors may escape an early fatal outcome and may even live long and healthy lives. This may simply be the result of good luck. However, one should also consider the possibility of environmental or genetic factors that may offer protection against the development of atherosclerosis and its complications.
Marx JJM, de Valk B. Iron and Ischemic Heart Disease in the African Setting—Reply. Arch Intern Med. 2000;160(2):241-242. doi: