Ferritin and Percent Transferrin Saturation Levels Predict Type 2 Diabetes Risk and Cardiovascular Disease Outcomes
2017
Introduction: Type 2 diabetes (T2D) and cardiovascular disease
(CVD) risk associate with ferritin and percent transferrin saturation (%TS)
levels. However, increased risk has been observed at levels considered
within the “normal range” for these markers.
Objective: To define normative ferritin and %TS levels associated with T2D
and CVD risk.
Methods: Six-monthly ferritin, %TS and hemoglobin levels from 1,277 iron
reduction clinical trial participants with CVD (peripheral arterial disease,
37% diabetic) permitted pair-wise analysis using Loess Locally Weighted
Smoothing plots. Curves showed continuous quantitative ferritin, hemoglobin
(reflecting physiologic iron requirements), and %TS (reflecting iron
transport and sequestration) levels over a wide range of values. Inflection
points in the curves were compared to ferritin and %TS levels indicating
increased T2D and CVD risk in epidemiologic and intervention studies.
Results: Increasing ferritin up to about 80 ng/mL and %TS up to about 25% TS
corresponded to increasing hemoglobin levels, and minimal T2D and CVD risk.
Displaced Loess trajectories reflected lower hemoglobin levels in diabetics
compared to non-diabetics. Ferritin levels up to about 100 ng/mL paralleled
proportionately increasing %TS levels up to about 55%TS corresponding to
further limitation of T2D and CVD risk. Ferritin levels over 100 ng/mL did
not associate with hemoglobin levels and coincided with increased T2D and
CVD risk.
Conclusions: Recognition of modified normal ranges for ferritin from about
15 ng/mL up to about 80-100 ng/mL and %TS from about 15% up to about 25-55%
may improve the value of iron biomarkers to assess and possibly lower T2D
and CVD risk.
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