Sex-Specific Association Between Iron Status and the Predicted 10-Year Risk for Atherosclerotic Cardiovascular Disease in Hypertensive Patients

Abstract

Serum ferritin (SF) and haemoglobin (Hb) are widely used in clinical practice to assess iron status. Studies exploring the relationship of SF and Hb with atherosclerotic cardiovascular disease (ASCVD) risk have yielded conflicting results, and some indicated sex specificity. Hypertensive patients have abnormal iron status. However, research on patients with hypertension is limited. We aim to investigate the sex-specific links of SF and Hb with the predicted 10-year ASCVD risk in hypertensive patients. This cross-sectional study included 718 hypertensive men and 708 hypertensive women. The predicted 10-year ASCVD risk was calculated based on the China-PAR equation. The dose–response curves were illustrated by fitting linear and quadratic models. In hypertensive men, the iron status fits for a quadratic model for ASCVD risk, showing a U-shape. After adjusting for potential confounding factors, the regression coefficients and 95% confidence intervals (95% CI) across tertile of SF were 0.0 (reference), − 0.99 (− 1.65, − 0.33) and − 0.22 (− 0.88, 0.44), and of Hb were 0.0 (reference), − 0.74 (− 1.41, − 0.08) and − 0.77 (− 1.46, − 0.08). In hypertensive women, iron status was linearly and positively associated with ASCVD risk. Per one unit increment of log-transformed SF as well as Hb was associated with a 1.22 (95% CI: 0.97, 1.48) and 0.04 (95% CI: 0.02, 0.07) increased in ASCVD risk score, respectively. A significant interaction between iron status and inflammation on ASCVD risk was observed in hypertensive women. SF and Hb showed a U-shape with ASCVD risk in hypertensive men; however, a positive linear relationship was observed in hypertensive women.

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