We assessed the relation of serum iron, dietary iron, and the use of iron supplements to the risk of fatal acute myocardial infarction in the Nutrition Canada Survey cohort. We found an association between serum iron and risk of fatal acute myocardial infarction, with rate ratios for males and females in the highest category of serum iron (> or = 175 micrograms per dl) of 2.18 [95% confidence intervals (CI) = 1.01-4.74] and 5.53 (95% CI = 1.69-18.12), respectively. We found no important association between risk of fatal acute myocardial infarction and either dietary iron or iron supplement use among the 9,920 participants included in this study.