Iron deficiency and cardiovascular disease

Savarese, G., von Haehling, S., Butler, J., Cleland, J. G.F. , Ponikowski, P. and Anker, S. D. (2023) Iron deficiency and cardiovascular disease. European Heart Journal, 44(1), pp. 14-27. (doi: 10.1093/eurheartj/ehac569) (PMID:36282723) (PMCID:PMC9805408)

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Iron deficiency (ID) is common in patients with cardiovascular disease. Up to 60% of patients with coronary artery disease, and an even higher proportion of those with heart failure (HF) or pulmonary hypertension have ID; the evidence for cerebrovascular disease, aortic stenosis and atrial fibrillation is less robust. The prevalence of ID increases with the severity of cardiac and renal dysfunction and is probably more common amongst women. Insufficient dietary iron, reduced iron absorption due to increases in hepcidin secondary to the low-grade inflammation associated with atherosclerosis and congestion or reduced gastric acidity, and increased blood loss due to anti-thrombotic therapy or gastro-intestinal or renal disease may all cause ID. For older people in the general population and patients with HF with reduced ejection fraction (HFrEF), both anaemia and ID are associated with a poor prognosis; each may confer independent risk. There is growing evidence that ID is an important therapeutic target for patients with HFrEF, even if they do not have anaemia. Whether this is also true for other HF phenotypes or patients with cardiovascular disease in general is currently unknown. Randomized trials showed that intravenous ferric carboxymaltose improved symptoms, health-related quality of life and exercise capacity and reduced hospitalizations for worsening HF in patients with HFrEF and mildly reduced ejection fraction (<50%). Since ID is easy to treat and is effective for patients with HFrEF, such patients should be investigated for possible ID. This recommendation may extend to other populations in the light of evidence from future trials.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Savarese, G., von Haehling, S., Butler, J., Cleland, J. G.F., Ponikowski, P., and Anker, S. D.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN (Online):1522-9645
Published Online:25 October 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in European Heart Journal 44(1): 14-27
Publisher Policy:Reproduced under a Creative Commons license

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