Iron deficiency and cardiovascular disease

Abstract

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.

Circulating Levels of Ferritin, RDW, PTLs as Predictive Biomarkers of Postoperative Atrial Fibrillation Risk after Cardiac Surgery in Extracorporeal Circulation

“…They can evidence not only an iron deficiency status accompanied by clinical symptoms (i.e., fatigue, which is not specific and often confused with the symptoms of primary diseases), but they can also provide information about the clinical status of a patient, an individual, related to degree of systemic inflammation. the status of iron deficiency is recurrent in patients with chronic inflammatory diseases (such as chronic cardiovascular diseases [12][13][14], i.e., coronaropathies, valvopathies, and ascending aorta aneurysms, affecting the patients of our study), that significantly correlates with their severity. Iron deficiency is mediated by high systemic levels of cytokines, which evocate a parallel increase of hepcidin concentrations.…”

“…The serum concentration of ferritin is usually augmented in cases with a systemic inflammatory body condition likely related to diverse chronic inflammatory diseases, even if there is still not a scientific and clinical consensus on a threshold value to be used in chronic inflammatory conditions [14]. However, international guidelines define the iron deficiency condition when the serum ferritin values are <100 µg/L related or not to a transferrin saturation <20% and suggest to attention the condition of iron depletion.…”

Circulating Levels of Ferritin, RDW, PTLs as Predictive Biomarkers of Postoperative Atrial Fibrillation Risk after Cardiac Surgery in Extracorporeal Circulation

“…The development of iron deficiency, even if functional, exacerbates underlying chronic diseases, alters erythropoiesis, and represents an independent factor of morbidity and mortality. In daily practice, the the iron body status is evaluated by detecting ferritin concentrations, because it reflects the iron body storage and transferrin saturation, which reproduces the transport of iron [ 28 , 29 , 30 ]. The serum concentration of ferritin is usually augmented in cases with a systemic inflammatory body condition likely related to diverse chronic inflammatory diseases, even if there is still not a scientific and clinical consensus on a threshold value to be used in chronic inflammatory conditions [ 28 , 29 , 30 ].…”

“…In daily practice, the the iron body status is evaluated by detecting ferritin concentrations, because it reflects the iron body storage and transferrin saturation, which reproduces the transport of iron [ 28 , 29 , 30 ]. The serum concentration of ferritin is usually augmented in cases with a systemic inflammatory body condition likely related to diverse chronic inflammatory diseases, even if there is still not a scientific and clinical consensus on a threshold value to be used in chronic inflammatory conditions [ 28 , 29 , 30 ]. However, international guidelines define the iron deficiency condition as when serum ferritin values are <100 μg/L, either related or not to a transferrin saturation <20% and suggest that attention should be paid to the condition of iron depletion.…”

“…However, international guidelines define the iron deficiency condition as when serum ferritin values are <100 μg/L, either related or not to a transferrin saturation <20% and suggest that attention should be paid to the condition of iron depletion. In addition, it has been reported that high serum ferritin levels correlate with the aging process [ 28 , 29 , 30 ]. Accordingly, we detected that the patients of group 1 were older and with a worse clinical history than the patients of group 0, and with the highest levels of ferritin, which suggested in the complex a severer inflammatory status and clinical conditions than the components of group 0.…”