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To the Editor: The iron-heart hypothesis postulated a primary protective effect of iron depletion against ischemic heart disease.¹ The report of the Iron (Fe) and Atherosclerosis Study (FeAST) by Dr Zacharski and colleagues² had 2 key limitations as a general test of the idea: it was a trial of secondary prevention, and the iron-reduction protocol fell short of achieving full iron depletion.

Exploratory post hoc analyses suggested that reducing iron stores may improve outcomes for people with symptomatic but stable peripheral arterial disease if iron reduction is begun before age 60 years (unadjusted hazard ratio for the primary outcome, 0.47; 95% confidence interval, 0.24-0.90). The study findings would support a trial designed to test the original hypothesis using full iron depletion (defined as the absence of storage iron without significant iron-deficiency anemia), particularly among patients in this subgroup.

Zheng et al³ reported that frequent volunteer blood donors with a median . . . [Full Text of this Article]

Jerome L. Sullivan, MD, PhD
jlsullivan@pol.net
Department of Pathology, Immunology and Laboratory Medicine
University of Florida College of Medicine
Winter Park

Stuart D. Katz, MD
Yale University School of Medicine
New Haven, Conn

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