In 1978, Jerome Sullivan was working as a resident physician in a Tampa, Fla., hospital when he began puzzling over a question that had stumped others before him:
why is heart disease so much rarer in women than in men before middle age? Many doctors maintained that estrogen, a hormone produced
in the ovaries that helps to regulate the menstrual cycle in women, somehow protected them from heart attacks before menopause. But Sullivan said that after he reviewed the available medical literature, he became convinced that other factors were at work. Instead, he speculated that high levels of iron stored in the body contribute to heart disease, because menstruating women have considerably less iron stored in their bodies than men do. Sullivan said that he tried to publish his conclusions, but two of the leading medical publications turned him down. Finally, in 1981, the British medical journal Lancet published his article “Iron and the sex difference in heart disease risk”—with little result.
“It was met with a deafening silence,”
Sullivan said. “A lot of people must have felt I was nuts.”
But last week, Sullivan’s theories gained new stature when Circulation, the respected journal of the American Heart Association, published the results of a major new study. The Circulation article described a Finnish study involving 1,931 men and showed a statistical correlation between the levels of iron in their bodies and the incidence of heart attack. The study’s authors concluded that iron levels in the body created a risk of heart attacks that was second only to smoking in terms of seriousness. The article cited Sullivan and summarized
his work. Declared Sullivan, who now is a pathologist at the Veterans Affairs Medical Center in Charleston, S.C.: “I feel in a sense vindicated. I am very happy to see that they took my theory seriously enough to study it.” Proven: Still, the 47-year-old Sullivan says that more research has to be done before his theory can be accepted as proven. First, he said, other studies must substantiate the findings of the Finnish survey. As well, he said, additional large-scale studies must be carried out to determine whether lowering iron levels in the body reduces the incidence of heart disease. In the meantime, Sullivan said that research has shown that there are reasonable steps that people can take to help lower the iron content in their bodies—and, perhaps, reduce the risk of heart attack. Sullivan said that most adult men and postmenopausal women, who suffer from heart disease at the same rate as men,
should consider donating blood several times a year. As well, Sullivan said that people should not routinely take iron supplements, even those who have most of the many different types of anemia. “Only iron-deficient anemia is helped by iron supplements," he said. “That needs to be evaluated by your doctor.” Sullivan has pursued his cause with a singleminded intensity. Bom in Dothan, Ala., he graduated in 1976 with a PhD in cell biology from Florida State University in Tallahassee. In 1978, he graduated as a medical doctor from the University of Florida in Gainesville. Then he joined the University of South Florida College of Medicine in Tampa, first as a resident, and then as a faculty member.
While he was working in Tampa, Sullivan said, he concluded that he was on the right track when he discovered studies that showed that young women who have had partial hysterectomies, in which the uterus but not the
Skepticism: Despite facing skepticism, Sullivan said that he pursued his theory about iron because it seemed to explain so many medical findings. In many Third World nations, said Sullivan, men tend to have fewer heart problems than men of the same age in industrialized countries. The reason, Sullivan said, may be that in less developed countries many people carry intestinal parasites that rob the body of blood, preventing iron buildup.
ovaries were removed, suffer from heart disease at the same rate as older women who have had natural menopause. Sullivan said that the finding indicated that estrogen from the ovaries did not, as many experts had believed, protect women from heart attack. On the other hand, Sullivan said, the studies pointed to a key role for the uterus which, by shedding blood each month in women who are not pregnant, reduces iron levels.
Though he may now have been vindicated, Sullivan acknowledged that he would have liked to have carried out more original research of his own. But he said that he was never able to obtain sufficient funding. The only support he has received, he said, is from the Department of Veterans Affairs, for whom he has worked since 1984. As part of his work as a laboratory pathologist studying diseased tissue, in particular bone marrow, he has been able sometimes to examine the
role that iron plays. He and his wife, Laura, who is also a pathologist, have four children ranging in age from six months to nine years. Sullivan also has a 26-year-old daughter from a previous marriage. His work, and helping to bring up five children, has left him little spare time. But any extra time he has, he said, he spends “thinking about iron.” Added Sullivan: “It’s my recreation. I learn something new every week.” The publication of the Finnish study likely will mean that Sullivan will have company exploring the mysterious properties of iron.
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