Iron deficiency and supplementation in heart failure

Lakhal-Littleton, S. and Cleland, J. G. F. (2024) Iron deficiency and supplementation in heart failure. Nature Reviews Cardiology, (doi: 10.1038/s41569-024-00988-1) (PMID:38326440) (Early Online Publication)

Abstract

Non-anaemic iron deficiency (NAID) is a strategic target in cardiovascular medicine because of its association with a range of adverse effects in various conditions. Endeavours to tackle NAID in heart failure have yielded mixed results, exposing knowledge gaps in how best to define ‘iron deficiency’ and the handling of iron therapies by the body. To address these gaps, we harness the latest understanding of the mechanisms of iron homeostasis outside the erythron and integrate clinical and preclinical lines of evidence. The emerging picture is that current definitions of iron deficiency do not assimilate the multiple influences at play in patients with heart failure and, consequently, fail to identify those with a truly unmet need for iron. Additionally, current iron supplementation therapies benefit only certain patients with heart failure, reflecting differences in the nature of the unmet need for iron and the modifying effects of anaemia and inflammation on the handling of iron therapies by the body. Building on these insights, we identify untapped opportunities in the management of NAID, including the refinement of current approaches and the development of novel strategies. Lessons learned from NAID in cardiovascular disease could ultimately translate into benefits for patients with other chronic conditions such as chronic kidney disease, chronic obstructive pulmonary disease and cancer.

• Item Type: Articles
• Additional Information: S L-L is funded by MR/V009567/1/ from the Medical Research Council, United Kingdom and HSR00031, British Heart Foundation, United Kingdom.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Lakhal-Littleton, S., and Cleland, J. G. F.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Nature Reviews Cardiology
• Publisher: Nature Research
• ISSN: 1759-5002
• ISSN (Online): 1759-5010
• Published Online: 07 February 2024
• Copyright Holders: Copyright © Springer Nature Limited 2024
• First Published: First published in Nature Reviews Cardiology 2024
• Publisher Policy: Reproduced in accordance with the publisher copyright policy