Genetic predisposition to hereditary
hemochromatosis (HH) is associated with primary
hypertriglyceridemia (HTG). If
iron overload influences the development of HTG, the management of these patients could be different. However, the
metabolic syndrome in primary HTG is frequent; and it could partially confuse the association. The objective was to determine whether periodic
bloodletting could decrease
triglyceride concentrations in subjects with HH and
iron overload. We retrospectively studied 155 genetically defined HH patients (C282Y homozygotes and compound heterozygotes C282Y/H63D) with
iron overload and under periodic therapeutic phlebotomy.
Hypertriglyceridemia (
triglycerides ≥150 mg/dL) was present in 49 subjects at baseline (31.6%). Phlebotomies significantly decreased
triglycerides, especially in subjects with basal HTG (from 287 mg/dL at baseline to 133 mg/dL after phlebotomies, P < .001).
Blood glucose and total
cholesterol did not change with phlebotomies. The
triglyceride-lowering effect was obtained until
ferritin concentration decreased to less than 200 μg/L and
transferrin saturation to less than 40%. The
triglyceride-lowering effect was obtained for
glucose levels both less than and greater than 100 mg/dL. In summary, HH subjects frequently have HTG that improves after therapeutic phlebotomy, independently of basal
blood glucose. Our results suggest that therapeutic phlebotomy could be a useful therapeutic approach in patients with HTG and
iron overload.