Iron deficiency in middle age is linked to

By on October 6, 2021 0

Sophia Antipolis, October 6, 2021: About 10% of new cases of coronary artery disease occurring in a middle-aged decade could be prevented by preventing iron deficiency, suggests a study published today in ESC heart failure, a journal of the European Society of Cardiology (ESC).1

“This was an observational study and we cannot conclude that iron deficiency causes heart disease,” said study author Dr Benedikt Schrage of the University Center for Cardiology and Medicine. blood supply from Hamburg, Germany. “However, there is a growing body of evidence for a link and these findings form the basis for further research to confirm the findings.”

Previous studies have shown that in patients with cardiovascular diseases such as heart failure, iron deficiency was linked to worse outcomes, including hospitalizations and death. Intravenous iron therapy improved symptoms, functional capacity and quality of life in heart failure and iron deficiency patients enrolled in the FAIR-HF trial.2 Based on these results, the FAIR-HF 2 trial is investigating the impact of intravenous iron supplementation on the risk of death in patients with heart failure.

The present study aimed to examine whether the association between iron deficiency and outcome was also observed in the general population.

The study involved 12,164 people from three European population-based cohorts. The median age was 59 and 55% were female. During the baseline study visit, cardiovascular risk factors and co-morbidities such as smoking, obesity, diabetes, and cholesterol were assessed through an in-depth clinical assessment including blood samples.

Participants were classified as iron deficient or not according to two definitions: 1) absolute iron deficiency, which includes only stored iron (ferritin); and 2) functional iron deficiency, which includes stored iron (ferritin) and circulating iron for use by the body (transferrin).

Dr Schrage explained, “Absolute iron deficiency is the traditional way to assess iron status, but it lacks circulating iron. The functional definition is more precise because it includes both measures and includes those that have enough reserves but not enough circulation for the body to function properly.

Participants were followed for incidents of coronary heart disease and stroke, deaths from cardiovascular disease and deaths from all causes. Researchers analyzed the association between iron deficiency and coronary heart disease, stroke, cardiovascular mortality and all-cause mortality after adjustments for age, sex, smoking, cholesterol, blood pressure , diabetes, body mass index and inflammation. Participants with a baseline history of coronary artery disease or stroke were excluded from analyzes for incidental disease.

At baseline, 60% of participants had absolute iron deficiency and 64% had functional iron deficiency. During a median follow-up of 13.3 years, there were 2,212 deaths (18.2%). Of these, a total of 573 people (4.7%) died of a cardiovascular cause. The incidence of coronary heart disease and stroke was diagnosed in 1,033 (8.5%) and 766 (6.3%) participants, respectively.

Functional iron deficiency was associated with a 24% increased risk of coronary heart disease, 26% increased risk of cardiovascular mortality, and 12% increased risk of all-cause mortality compared to no functional deficiency. hell. Absolute iron deficiency was associated with a 20% increased risk of coronary heart disease compared to no absolute iron deficiency, but was not related to mortality. There was no association between iron status and stroke.

The researchers calculated the population attributable fraction, which estimates the proportion of events in 10 years that would have been avoided if all individuals had been at risk of being iron-free to begin with. Models were adjusted for age, gender, smoking, cholesterol, blood pressure, diabetes, body mass index, and inflammation. Over a 10-year period, 5.4% of all deaths, 11.7% of cardiovascular deaths, and 10.7% of new coronary heart disease diagnoses were due to functional iron deficiency.

“This analysis suggests that if iron deficiency had been absent at baseline, about 5% of deaths, 12% of cardiovascular deaths and 11% of new diagnoses of coronary heart disease would not have occurred within the next decade,” he said. said Dr Schrage.

“The study showed that iron deficiency was very prevalent in this middle-aged population, with almost two-thirds having functional iron deficiency,” said Dr Schrage. “These people were more likely to develop heart disease and were also more likely to die within the next 13 years.”

Dr Schrage noted that future studies should examine these associations in younger, non-European cohorts. He said: “If the relationships are confirmed, the next step would be a randomized trial investigating the effect of treating iron deficiency in the general population.”

ENDS

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Funding: Please see the paper.

Disclosures: Please see the paper.

Remarks

The references

1Schrage B, Rübsamen N, Ojeda FM, et al. Association of iron deficiency with incident cardiovascular disease and mortality in the general population. ESC heart failure. 2021. doi: 10.1002 / ehf2.13589.

2Anker SD, Comin Colet J, Filippatos G, et al. Ferric carboxylaltosis in patients with heart failure and iron deficiency. N Engl J Med. 2009; 361: 2436-2448.

About the European Society of Cardiology

The European Society of Cardiology brings together healthcare professionals from over 150 countries, working to advance cardiovascular medicine and help people live longer and healthier lives.

About ESC heart failure

ESC heart failure is the open access journal of the Heart failure association (HFA) of CES.




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