Iron versus cholesterol--perspectives on the iron and heart disease debate.

Focusing only on the limited question of whether stored iron is a valid heart disease risk factor inappropriately narrows the scope of the debate on the "iron hypothesis." Framing the debate in this way ignores the broad explanatory power of the hypothesis that iron depletion protects against ischemic heart disease. The iron hypothesis provides a conceptual tool for study of the mechanisms by which age and gender influence the development of ischemic heart disease. The assumption that age and gender exert unalterable effects has diverted attention from these strong risk factors, and has led to intense preoccupation with weaker risk factors such as cholesterol. The notion that cholesterol is of central importance has become a rigid and institutionalized point of view. Increased mortality from some cholesterol-lowering drugs is but one of the potential dangers of continued promotion of the flawed idea that heart disease is a function of the cholesterol concentration. The more serious risk is that alternative approaches to the problem of ischemic heart disease will be suppressed. Consideration of the relationship between the iron and cholesterol hypotheses provides important perspectives on the current debate on the role of iron in the development of ischemic heart disease.