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Excess iron stores have been thought to increase risk for atherosclerotic disease through increased oxidative stress, but epidemiologic studies have been inconclusive.
Veterans Affairs investigators randomized 1277 patients with symptomatic but stable peripheral arterial disease (ankle-brachial index ≤0.85; mean age, 67; almost all men; 50% with comorbid coronary artery disease) to phlebotomy every 6 months or control. At baseline, mean ferritin level was 122 ng/mL. Phlebotomy was calculated to achieve trough levels of 25 ng/mL, and peak levels around 60 ng/mL just before the next phlebotomy. Pre-phlebotomy levels actually achieved in the study were 80 ng/mL in all subjects and 58 ng/mL in adherent subjects. After a mean follow-up of 4.5 yea…