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Kannel and Levy,¹ commenting on the Framingham findings, which showed that natural menopause, surgical menopause with simple hysterectomy, or surgical menopause with hysterectomy and oophorectomy were associated with similar increases in coronary heart disease (CHD), suggested that an intact uterus might have a role in the protection of premenopausal women. A plausible explanation of these findings might be related to the beneficial effect of iron depletion in menstruating women (ie, the iron hypothesis suggested by Sullivan² in 1981).

The decrease of stored tissue iron caused by recurrent bleeding might also explain the reduced risk of fatal ischemic heart disease seen in patients with hemophilia.³ Furthermore, serum ferritin, a good measurement of body iron stores, emerged as one of the strongest risk factors for progression of carotid atherosclerosis.^4-5 Thus, the iron hypothesis should be considered as an important mechanism of protection against CHD in premenopausal women.

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Correspondence: Dr Mascitelli, 34 Via . . . [Full Text of this Article]

Luca Mascitelli, MD; Francesca Pezzetta, MD

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