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Decreased iron stores are associated with cardiovascular disease in patients with type 2 diabetes both cross-sectionally and longitudinally

  • Milton Fabian Suárez-Ortegón
    Correspondence
    Corresponding author. Centre for Population Health Sciences, College of Medicine and Veterinary Medicine.University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
    Affiliations
    Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK

    Nutrition Group, Universidad Del Valle, Cali, Colombia
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  • Stela McLachlan
    Affiliations
    Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
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  • Anna H. Price
    Affiliations
    Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
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  • Mercé Fernández-Balsells
    Affiliations
    Department of Diabetes, Endocrinology and Nutrition, Institut D'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
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  • Josep Franch-Nadal
    Affiliations
    DAP-Catgroup, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari D’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain

    Primary Health Care Center Raval Sud, Gerència D’Àmbit D’Atenció Primària Barcelona Ciutat, Institut Català de La Salut, Barcelona, Spain

    Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain
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  • Manel Mata-Cases
    Affiliations
    DAP-Catgroup, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari D’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain

    Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain

    Primary Health Care La Mina (Sant Adrià de Besò), Gerència D’Àmbit D’Atenció Primària Barcelona Ciutat, Institut Català de La Salut, Barcelona, Spain
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  • Joan Barrot-de la Puente
    Affiliations
    DAP-Catgroup, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari D’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
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  • Xavier Mundet-Tudurí
    Affiliations
    DAP-Catgroup, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari D’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
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  • Didac Mauricio
    Affiliations
    Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain
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  • Wifredo Ricart
    Affiliations
    Department of Diabetes, Endocrinology and Nutrition, Institut D'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
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  • Sarah H. Wild
    Affiliations
    Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
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  • Mark W.J. Strachan
    Affiliations
    Metabolic Unit, Western General Hospital, Edinburgh, Scotland, UK
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  • Jackie F. Price
    Affiliations
    Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
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  • José-Manuel Fernández-Real
    Correspondence
    Corresponding author. Department of Diabetes, Endocrinology and Nutrition, Hospital of Girona “Dr JosepTrueta”, Carretera de França s/n, 17007, Girona, Spain.
    Affiliations
    Department of Diabetes, Endocrinology and Nutrition, Institut D'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
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      Highlights

      • Low iron status was associated with cardiovascular disease risk in patients with type 2 diabetes (T2D) in two studies.
      • The association was evident also in incident cases prospectively followed.
      • The pattern was consistent in populations at different cardiovascular risk.
      • Low iron status seems to be harmful for cardiovascular health in T2D and it may be a target for intervention.

      Abstract

      Background and aims

      The possible contribution of iron to cardiovascular complications of type 2 diabetes (T2D) has been scarcely investigated. We aimed to study whether serum ferritin is linked to prevalent/incident cardiovascular disease (CVD) in T2D.

      Methods

      The prevalence of coronary heart disease (CHD), cerebrovascular disease (CEVD) and CVD was evaluated in the SIDIAP study (n = 38,617) and prevalence and 7-year incidence were analysed in the Edinburgh Type 2 Diabetes Study (ET2DS) (n = 821). Logistic and Cox regressions were used to describe associations between serum ferritin and CVD adjusting for confounding variables.

      Results

      Increase of 1 SD unit in log-ferritin was associated with lower CVD prevalence in fully-adjusted models (ET2DS odds ratio (OR) 95% confidence interval (CI): 0.81 (0.68–0.96), p = 0.018; SIDIAP study: 0.91 (0.88–0.94), p < 0.001). In ET2DS, ferritin in the highest (vs. the lowest) quintile was associated with lower incidence of CVD (fully adjusted HR 95% CI: 0.46 (0.26–0.83), p = 0.010). This association persisted after removing subjects with CVD at baseline (n = 536) (HR 95% CI: 0.34 (0.14–0.81), p = 0.016).

      Conclusions

      Low iron status was associated with CVD risk in T2D. This pattern was consistent in populations at different cardiovascular risk. Low iron status seems to be harmful for cardiovascular health in T2D and it may be a target for intervention.

      Keywords

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