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Open Access Commentary

Back to past leeches: repeated phlebotomies and cardiovascular risk

Melania Manco1* and Josè Manuel Fernandez-Real234

Author Affiliations

1 Bambino Gesù Children's Hospital and Research Institute, Research Unit for Multifactorial Disease. Piazza San Onofrio 4, 00165, Rome. Italy

2 University Hospital of Girona 'Dr Josep Trueta', Carretera de França s/n, 17007, Girona, Spain

3 Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomédica de Girona IdibGi, Girona, Spain

4 CIBER Fisiopatología de la Obesidad y Nutrición. Hospital of Girona 'Dr Josep Trueta', Carretera de França s/n, 17007, Girona, Spain

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BMC Medicine 2012, 10:53  doi:10.1186/1741-7015-10-53

Published: 30 May 2012


In patients with metabolic syndrome, body iron overload exacerbates insulin resistance, impairment of glucose metabolism, endothelium dysfunction and coronary artery responses. Conversely, iron depletion is effective to ameliorate glucose metabolism and dysfunctional endothelium. Most of its effectiveness seems to occur through the amelioration of systemic and hepatic insulin resistance.

In a study published by BMC Medicine, Michalsen et al. demonstrated a dramatic improvement of blood pressure, serum glucose and lipids after removing 550 to 800 ml of blood in subjects with metabolic syndrome. This effect was apparently independent of changes in insulin resistance, in contrast to previous cross-sectional and cohort studies investigating the association between iron overload, insulin resistance and cardiovascular disease.

Despite drawbacks in the study design, its findings may lead the way to investigations aimed at exploring iron-dependent regulatory mechanisms of vascular tone in healthy individuals and patients with metabolic disease, thus providing a rationale for novel preventive and therapeutic strategies to counteract hypertension.

Please see related article: webcite

blood pressure; insulin sensitivity; iron; metabolic syndrome; phlebotomy