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Item #15
Blood
Letting Improves Vascular Reactivity In High-Ferritin Type 2 Diabetes
Iron
depletion by blood letting improves endothelium-independent
vasodilation in patients with type 2 diabetes who have high ferritin
levels.
"In
a recent study, iron chelation with deferoxamine led to improvement of
endothelial dysfunction in patients with coronary artery
disease," Dr. Jose Manuel Fernandez-Real and colleagues from the
University Hospital of Girona 'Dr. Josep Trueta,' Spain, note. The
team examined whether decreasing circulating iron stores might benefit
type 2 diabetic patients with increased serum ferritin concentration.
Twenty-eight
patients with serum ferritin levels above 200 ng/mL were randomly
assigned to iron depletion (group 1a) or to observation (group 1b).
Patients were matched for age, body mass index, pharmacological
treatment, and chronic diabetes complications. The iron-depletion
group underwent three extractions of 500mL of blood at 2-week
intervals.
The
researchers evaluated vascular reactivity at baseline, 4 and 12
months. There were no significant changes in endothelium-dependent
vasodilation in either group. On the other hand, glyceryl trinitrate-
induced vasodilation improved significantly after iron depletion (p =
0.006).
"These
changes occurred in parallel to decreases in transferrin saturation
index and HbA1c levels (-0.6%, p < 0.05) only in group 1a
patients," the investigators explain. "The best predictor of
the modifications in endothelium-independent vasodilation was the
change in HbA1c levels."
In
both groups, transferrin saturation index and nitrate-induced
vasodilation returned to baseline values at 12 months.
Dr.
Fernandez-Real and colleagues note that a number of strategies to
improve endothelial function and thereby delay atherogenesis are being
examined currently, but "whether blood letting should be
considered adjuvant therapy in high-ferritin type 2 diabetes requires
further study.
"Diabetes
Care 2002;25:2249-2255.
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