oa Cardiovascular Journal of Africa - Dietary iron overload as a cause of idiopathic cardiomyopathy in South- African blacks
Clinical experience in the former Ciskei suggests an association between dietary iron overload (DIO) and idiopathic cardiomyopathy (IC). A literature analysis suggests that a fundamental problem underlies autopsy studies on iron overload/heart disease, i.e. that two assumptions are false: (I) cardiac iron deposits must be demonstrated to prove toxicity; and (ii) the quantity of hepatic iron must correlate with heart disease. In the original studies on IC associated with DIO, the same assumptions led to the exclusion of iron toxicity. A mechanism of iron toxicity based on blood-borne free radical cardiac damage explains the false assumptions, accounts for the contradictory results in the literature and suggests that the exclusion of iron toxicity in IC was incorrect. This study demonstrates an ongoing association between IC and DIO in the Ciskei, and reports an ICIDIO patient whose cardiomyopathy improved following venesection. If blood-borne free radicals are in fact responsible for myocardial damage in iron-overloaded individuals, prognostic factors other than iron quantity per se may be important.
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