Background-Previous studies have suggested a positive association of coronary heart disease risk and both serum ferritin concentrations and C282Y heterozygosity. Relationships between serum lipids, C282Y homozygosity, and serum ferritin have not been well established. Methods and Results-The Hemochromatosis and Iron Overload Screening study screened 101 168 participants in primary care from 5 field centers in the United States and Canada with serum ferritin, transferrin saturation, and HFE genotyping for C282Y and H63D mutations. Serum lipids were measured in a subset of 176 C282Y homozygotes (63 male, 113 female whites) without a prior diagnosis of, family history, or treatment for hemochromatosis and a matched sample of participants with normal transferrin saturation and serum ferritin without C282Y or H63D mutations (wild-type, 123 male, 189 female whites). The proportion of subjects who reported using prescription cholesterol-lowering medications was Ϸ3 times higher in HFE wild-type subjects than C282Y homozygotes among men (22% versus 7%; Pϭ0.02) and, in women, 2 times higher (16% versus 8%; Pϭ0.07). After excluding subjects taking cholesterol medications, C282Y homozygotes had significantly lower mean total and low-density lipoprotein cholesterol concentrations than wild-type subjects, with larger genotypic differences for low-density lipoprotein in men (Ϫ0.62 mmol/L; 95% CI, Ϫ0.93 to Ϫ0.33) than in women (Ϫ0.28 mmol/L; 95%, CI Ϫ0.52 to Ϫ0.08). Conclusions-Total mean serum cholesterol and low-density lipoprotein levels were lower in C282Y homozygotes than in HFE wild-type participants. Further studies are required to determine whether this is related to iron overload, HFE alleles, or other factors on C282Y-positive chromosome 6p haplotypes. (Circ Cardiovasc Genet. 2009;2:34-37.)Key Words: hemochromatosis Ⅲ iron overload Ⅲ iron H emochromatosis associated with homozygosity for the C282Y mutation of the HFE gene is the most common genetic disorder in white populations with a prevalence of Ϸ1 in 200 to 300 in white persons of northern European descent. 1 It has been suggested that there may be a biological advantage to persons carrying mutations of the HFE gene. 2 Population studies of elderly subjects have demonstrated no difference in the frequency of HFE mutations compared to younger subjects, suggesting minimal effects of these mutations on longevity. 3,4 There have been conflicting reports of the association of iron, serum ferritin (SF), and HFE mutations with coronary heart disease (CHD). [5][6][7][8][9][10][11][12][13] Most studies have reported on associations with C282Y heterozygotes, a group which is very unlikely to have significant iron overload. 1 A previous carefully designed population-based study reported lower total cholesterol and low-density lipoprotein (LDL) cholesterol in 48 C282Y homozygotes compared with HFE wild-type subjects. 14 In the current study, the relationship between serum lipids, SF, and transferrin saturation (TS) in C282Y homozygotes is reported in a subset of participants ...