Association between serum ferritin levels and significant coronary artery stenosis in asymptomatic Korean adults

Abstract

Objective: Iron hypothesis was first proposed in 1981 suggesting that body iron stores were positively related to coronary heart disease. However there have been conflicting results regarding association between serum ferritin and cardiovascular disease. Therefore, we aimed to evaluate association between ferritin and significant coronary artery stenosis (CAS) in asymptomatic Korean adults. Methods: Our population is composed of 1,511 (710 male and 801 female) subjects over 40 aged who took routine health check-ups including coronary computed tomography angiography(CTA) at Seoul National University Hospital Health Promotion Center. Significant CAS was defined as any more than a 50% diameter stenosis. In multivariate logistic analysis, we assessed association between serum ferritin levels and significant CAS adjusting for age, sex, body mass index, smoking status, hypertension, diabetes, hypercholesterolemia and chronic kidney disease. Additionally, we assessed interaction between ferritin and cardiovascular risk factors. Results: The prevalence of significant CAS was 5.4%. In univariate logistic regression analysis, the odds ratio (OR) for subjects with serum ferritin ≥ 300 ng/mL was 2.92 (95% confidence interval [CI] 1.38 – 6.18

p value = 0.005) compared with subjects with serum ferritin < 100 ng/mL. However, After adjusting for demographic, clinical, life style variables or C-reactive protein, ORs for subjects with serum ferritin ≥ 300 ng/mL was 2.31 (95% CI 1.02 – 5.23

p value = 0.045) in model 1, 2.11 (95% CI 0.92 – 4.84

p value = 0.096) in model 2 and 1.87 (0.80 – 4.35

p value = 0.147) in model 3 compared with subjects with serum ferritin < 100 ng/mL, respectively. In a subgroup analysis for interaction between ferritin and diabetes, smoking status, hypertension or hypercholesterolemia, there was a significant interaction only in smoking status. Conclusion: We conclude that association between elevated serum ferritin levels (≥ 300 ng/mL) and significant CAS is not significant in asymptomatic Korean. . However, significant association between ferritin levels more than 300 ng/mL and significant CAS compared with ferritin < 100 ng/mL was observed in non-diabetic subjects and current smoker. Further replicative studies are needed to elucidate this important association for specific population.