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Open Access Highly Accessed Research article

Effects of phlebotomy-induced reduction of body iron stores on metabolic syndrome: results from a randomized clinical trial

Khosrow S Houschyar1, Rainer Lüdtke2, Gustav J Dobos1, Ulrich Kalus3, Martina Broecker-Preuss4, Thomas Rampp1, Benno Brinkhaus5 and Andreas Michalsen56*

Author Affiliations

1 Department of Internal Medicine, Kliniken Essen-Mitte, University Duisburg-Essen, Essen, Germany

2 Department of Biometry, Karl und Veronica Carstens-Foundation, Essen, Germany

3 Institute of Transfusion Medicine, Charité- University Medical Centre, Berlin, Germany

4 Department of Endocrinology and Division of Laboratory Research, University Hospital Essen, Essen, Germany

5 Institute of Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre, Berlin, Germany

6 Immanuel Hospital Berlin, Department of Internal and Integrative Medicine, Berlin, Germany, Königstrasse 63, 14109 Berlin, Germany

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BMC Medicine 2012, 10:54  doi:10.1186/1741-7015-10-54

Published: 30 May 2012

Abstract

Background

Metabolic syndrome (METS) is an increasingly prevalent but poorly understood clinical condition characterized by insulin resistance, glucose intolerance, dyslipidemia, hypertension, and obesity. Increased oxidative stress catalyzed by accumulation of iron in excess of physiologic requirements has been implicated in the pathogenesis of METS, but the relationships between cause and effect remain uncertain. We tested the hypothesis that phlebotomy-induced reduction of body iron stores would alter the clinical presentation of METS, using a randomized trial.

Methods

In a randomized, controlled, single-blind clinical trial, 64 patients with METS were randomly assigned to iron reduction by phlebotomy (n = 33) or to a control group (n = 31), which was offered phlebotomy at the end of the study (waiting-list design). The iron-reduction patients had 300 ml of blood removed at entry and between 250 and 500 ml removed after 4 weeks, depending on ferritin levels at study entry. Primary outcomes were change in systolic blood pressure (SBP) and insulin sensitivity as measured by Homeostatic Model Assessment (HOMA) index after 6 weeks. Secondary outcomes included HbA1c, plasma glucose, blood lipids, and heart rate (HR).

Results

SBP decreased from 148.5 ± 12.3 mmHg to 130.5 ± 11.8 mmHg in the phlebotomy group, and from 144.7 ± 14.4 mmHg to 143.8 ± 11.9 mmHg in the control group (difference -16.6 mmHg; 95% CI -20.7 to -12.5; P < 0.001). No significant effect on HOMA index was seen. With regard to secondary outcomes, blood glucose, HbA1c, low-density lipoprotein/high-density lipoprotein ratio, and HR were significantly decreased by phlebotomy. Changes in BP and HOMA index correlated with ferritin reduction.

Conclusions

In patients with METS, phlebotomy, with consecutive reduction of body iron stores, lowered BP and resulted in improvements in markers of cardiovascular risk and glycemic control. Blood donation may have beneficial effects for blood donors with METS.

Trial registration

ClinicalTrials.gov: NCT01328210

Please see related article: http://www.biomedcentral.com/1741-7015/10/53 webcite