Published: 2017-01-17

Assessment of ferritin and its association with C - reactive protein and malondialdehyde in acute myocardial infarction

Vijaya Bhaskar M., Srilekha S., Saranya M., Balu Mahendran K., Madhulatha M.


Background: There is increasing evidence that moderately elevated body iron stores, below levels commonly found in genetic hemochromatosis, may be associated with adverse health outcomes. Ferritin status has been implicated in atherosclerotic cardiovascular disease and hypothesis is that high iron status is associated with increased oxidation of LDL. The main objective of study is to evaluate the ferritin status and its association with C - reactive protein, malondialdehyde and serum lipids in acute myocardial infarction patients compared with healthy volunteers.

Methods: Sixty seven acute myocardial infarction (AMI) patients in the age group of 30 to 50 years were selected for this study and 40 healthy age matched subjects were selected as control group. Diagnosis of AMI was made using guidelines of American College of Cardiology and European Society of Cardiology. The comprised group of 67 consecutive patients was divided based on the C - reactive protein (CRP) level into two groups (Group I <5 mg/L and Group II ≥5mg/L). Serum ferritin was assessed by ELISA method, C-reactive protein by turbilatex method and malondialdehyde (MDA) by Thiobarbituric Acid Reactive Substances (TBARS) method. Routine investigations were analysed by ERBA EM-360 fully automated analyzer.

Results: The mean serum ferritin level was significantly increased in AMI patient groups compared with controls. The group II patients showed significantly increased serum ferritin levels compared to group I. In both the groups ferritin levels positively correlated with CRP and malondialdehyde. In group II serum ferritin levels showed positive correlation with serum Cholesterol, TGL, LDL and negative correlation with and HDL.  In group I serum ferritin levels showed positive correlation with triglycerides and LDL and there was no statistical significant correlation with HDL and total cholesterol.

Conclusions: Iron, an essential dietary constituent is now considered as a pro oxidant. Higher levels of ferritin, seems to be a strong risk factor for AMI. Regular monitoring of serum ferritin level can be useful in reducing cardiovascular morbidity and mortality.



Acute myocardial infarction (AMI), Ferritin, Malondialdehyde (MDA)

Full Text:



Jennings RB, Murry CE, Steenbergen C, Jr. Reimer KA. Development of cell injury in sustained acute ischemia. Circulation. 1990;82(3):II2-II12.

Frangogiannis NG, Smith CW, Entman ML (2002). The inflammatory response in myocardial infarction. Cardiovasc Res. 53:31-47.

Gupta R, Gupta KD. Coronary heart disease in low socioeconomic status subjects in India: "an evolving epidemic". Indian Heart J. 2009;61(4):358-67.

Ahmed MS, Jadhav AB, Hassan A, Meng QH. Acute phase reactants as novel predictors of cardiovascular disease. ISRN Inflamm. 2012;953461:1-18.

Wigmore SJ, Fearon KCH, Maingay JP, Lai PB, Ross JA. Interleukin-8 can mediate acute-phase protein production by isolated human hepatocytes. Am J Physiol. 1997;273:720-6.

Fattori E, Cappeletti M, Costa P, Sellitto C, Cantoni L, Carelli M et al. Defective inf lammatory response in interleu- kin6-deficient mice. J Exp Med. 1994;180:1243-50.

Chen X, Scholl TO, Stein TP. Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: the Camden study. Diabetes Care. 2006;29(5):1077-82.

Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23(3):95-104.

Salonen JT, Nyyssonen K, Korpela H, Tuomilehto J, Seppanen R, Salonen R. High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. Circulation. 1992;86:803-11

Kiechl S, Willeit J, Egger G, Poewe W, Oberhollenzer F. Body iron stores and the risk of carotid atherosclerosis: prospective results from the Bruneck study. Circulation. 1997;96:3300-7.

11. Tuomainen TP, Punnonen K, Nyyssonen K, Salonen JT. Association between body iron stores and the risk of acute myocardial infarction in men. Circulation. 1998;97:1461-6.

Morrison HI, Semenciw RM, Mao Y, Wigle DT. Serum iron and risk of fatal acute myocardial infarction. Epidemiology. 1994;5:243-6.

Mahfouz MO, Hariprasad CH, Shaffie IA, Sadasivudu B. Serum malondialdehyde levels in myocardial infarction and chronic renal failure. IRCS Med Sci. 1986;14:1110-1.

Nahrendorf M, Pittet MJ, Swirski FK. Monocytes: protagonists of infarct inflammation and repair after myocardial infarction. Circulation. 2010;121:2437-45.

Hilgendorf I, Gerhardt LM, Tan TC, Winter C, Holderried TA, Chousterman BG et al. Ly-6C high monocytes depend on Nr4a1 to balance both inflammatory and reparative phases in the infarcted myocardium. CircRes. 2014;114(10):1611-22.

Kiechl S, Willeit J, Egger G, Poewe W, Oberhollenzer F. Body iron stores and the risk of carotid atherosclerosis: prospective results from the bruneck study. Circulation. 1997;96(10):3300-7.

Salonen JT, Nyyssonen K, Korpela H, Tuomilehto J, Seppanen R, Salonen R. High stored iron levels are associated with excess risk of myocardial infarction in Eastern Finnish men. Circulation. 1992;86(3):803-11.

Sung KC, Kang JH, Shin HS. Relationship of Cardiovascular Risk Factors and Serum Ferritin with C-reactive Protein. Archives of Medical Research. 2007;38(1):121-5.

Sano T, Tanaka A, Namba M, et al. C-reactive protein and lesion morphology in patients with acute myocardial infarction. Circulation. 2003;108:282-5.

Kukielka GL, Smith CW, Manning AM, et al. Induction of interleukin-6 synthesis in the myocardium: potential role in post reperfusion inflammatory injury. Circulation. 1995;92:1866 -75.

Auer J, Berent R, Lassnig E, Eber B. C-reactive protein and activity of coronary artery disease. Jpn Heart J. 2002;43:607-19.

Corti MC, Gaziano M, Hennekens CH. Iron status and risk of cardiovascular disease. Ann Epidemiol. 1997;7(1):62-8.

Sempos CT, Looker AC, Gillum RF. Iron and Heart disease. The epidemiological data. Nutr Rev 1996;54:73-4.

Ester bauer II, Phul GJ II, Jargons G. The role of lipid peroxidation and antioxidants in oxidative modification of LDL. J Free Radical Biological Med 1992;13:341-90.