Serum ferritin and risk of myocardial infarction in the elderly: The Rotterdam Study

Background: Elevated body iron stores have been suggested to be a risk fact or for ischemic heart disease. Objective: We examined whether elevated serum ferritin concentrations, othe r indicators of iron status, and dietary iron affected the incidence of myo cardial infarction (MI) in an elderly population. Design: A nested, case-control study of 60 patients who had their first MI and 112 age- and sex-matched control subjects embedded in. the population-b ased cohort of the Rotterdam Study. Results: The age- and sex-adjusted risk of MI for subjects with serum ferri tin concentrations greater than or equal to 200 mu g/L was 1.82 (95% CI: 0. 90, 3.69; P = 0.096). The odds ratio (OR) was 1.26 (95% CI: 0.98, 1.64; P = 0.078) for the highest tertile of serum ferritin and was only slightly alt ered in a multivariate model. Risk of MI associated with the highest tertil e of ferritin was most evident in current or former smokers (OR: 1.68; 95% CI: 1.17, 2.47; P for trend = 0.008) and in subjects with hypercholesterole mia (OR: 1.43; 95% CI: 0.99, 2.11; P for trend = 0.056) or diabetes (OR: 2. 41; 95% CI: 1.12, 7.67; P for trend = 0.027). No association with risk of M I was observed for tertiles of serum iron, serum transferrin, or total diet ary iron. For dietary heme iron, risk of MI was significantly increased in a multivariate model in which dietary energy, fat, saturated fat, and chole sterol were adjusted for (OR: 4.01; 95% CI: 1.17, 15.87; P for trend = 0.03 1). Conclusion: In the presence of other risk factors, serum ferritin may adver sely affect ischemic heart disease risk in the elderly.