Oral iron supplementation in patients with heart failure: a systematic review and meta‐analysis

Song, Zhiping; Tang, Mingyang; Tang, Gang; Fu, Guoqi; Ou, Dengke; Yao, Fengyou; Hou, Xingzhi; Zhang, Denghong

doi:10.1002/ehf2.14020

Cited by 7 publications

(6 citation statements)

References 47 publications

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“…Indeed, the beneficial effects of treating iron deficiency in HF have been highlighted by several meta‐analyses that demonstrated that intravenous iron infusion in patients with HF reduces the composite risk of first hospitalization for HF and cardiovascular mortality as well as the risk of first and recurrent hospitalizations for HF, with no or negligible effect on all‐cause mortality or cardiovascular mortality alone 40,41 . Another recent meta‐analysis has shown that oral iron supplementation can increase serum iron levels in patients with HF and ID or mild anaemia but does not improve transferrin saturation and the distance covered in the 6‐minute walking test 42 . In addition, oral iron supplementation is relatively safe.…”

Section: Treatmentmentioning

confidence: 99%

Editors' highlight picks from 2023 in ESC heart failure

Bäck,

von Haehling,

Papp

et al. 2024

ESC Heart Failure

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Heart failure is a devastating syndrome affecting an increasingly high number of patients worldwide. Its aetiology and pathogenesis are complex with the involvement of factors ranging from the genetic material through valvular dysfunctions to numerous organs beyond the entire cardiovascular system. Based on continuous efforts of the heart failure scientific community we have witnessed major advances in many related disciplines during the last year. For example, epidemiological aspects—paving the road for improved risk prevention—have been thoroughly analysed for various geographical regions. Additionally, evidence‐based approaches now allow the introduction of novel guideline recommended medical therapies (i.e. sodium‐glucose transporter 2 inhibitors, and iron supplementation) while basic and translational research aim to explore additional molecular targets for future heart failure diagnostics and medications. All above aspects are addressed in this article, where a selection of articles published in the ESC Heart Failure journal in 2023 are highlighted. The editors are confident that the scientific contributions of ESC Heart Failure effectively served a highly relevant area of cardiovascular research last year.

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Section: Treatmentmentioning

confidence: 99%

Editors' highlight picks from 2023 in ESC heart failure

Bäck,

von Haehling,

Papp

et al. 2024

ESC Heart Failure

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“…A statistical study has shown that iron supplementation can reduce the hospitalization rate of patients with HF, enhance heart function, and improve quality of life [ 129 ]. Oral iron supplements commonly used include ferrous salts (such as ferrous sulfate) and dextran iron, lactoferrin, and ferritin complex, etc.…”

Section: Treatment Strategiesmentioning

confidence: 99%

Research advances on molecular mechanism and natural product therapy of iron metabolism in heart failure

Zhang,

Luo,

et al. 2024

Eur J Med Res

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The progression of heart failure (HF) is complex and involves multiple regulatory pathways. Iron ions play a crucial supportive role as a cofactor for important proteins such as hemoglobin, myoglobin, oxidative respiratory chain, and DNA synthetase, in the myocardial energy metabolism process. In recent years, numerous studies have shown that HF is associated with iron dysmetabolism, and deficiencies in iron and overload of iron can both lead to the development of various myocarditis diseases, which ultimately progress to HF. Iron toxicity and iron metabolism may be key targets for the diagnosis, treatment, and prevention of HF. Some iron chelators (such as desferrioxamine), antioxidants (such as ascorbate), Fer-1, and molecules that regulate iron levels (such as lactoferrin) have been shown to be effective in treating HF and protecting the myocardium in multiple studies. Additionally, certain natural compounds can play a significant role by mediating the imbalance of iron-related signaling pathways and expression levels. Therefore, this review not only summarizes the basic processes of iron metabolism in the body and the mechanisms by which they play a role in HF, with the aim of providing new clues and considerations for the treatment of HF, but also summarizes recent studies on natural chemical components that involve ferroptosis and its role in HF pathology, as well as the mechanisms by which naturally occurring products regulate ferroptosis in HF, with the aim of providing reference information for the development of new ferroptosis inhibitors and lead compounds for the treatment of HF in the future.

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“… 1 , 98–106 Elevated levels of hepcidin explain why—following oral iron supplementation—patients with heart failure do not show an improvement in exercise capacity, 107–109 and only a minority (those without systemic inflammation and preserved gastrointestinal absorption 110 ) show changes in TSAT or serum ferritin. 107 , 109 , 111 Furthermore, higher serum ferritin levels (which are closely related to skeletal muscle ferritin but inversely related to skeletal muscle TfR1 91 , 112 ) cause intracellular sequestration and further depletion of cytosolic Fe 2+ . Therefore, in patients with heart failure, modest hypoferraemia—insufficient to cause anaemia—may trigger a disproportionate depletion of intracellular iron within skeletal myocytes, 113 especially when inflammation or immobilization (acting in concert) have already drained the cytosolic iron pool.…”

Section: Type 2 Iron-deficient Heart Failure: Heart Failure-related I...mentioning

confidence: 99%

Identification of three mechanistic pathways for iron-deficient heart failure

Packer,

Anker,

Butler

et al. 2024

European Heart Journal

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Current understanding of iron-deficient heart failure is based on blood tests that are thought to reflect systemic iron stores, but the available evidence suggests greater complexity. The entry and egress of circulating iron is controlled by erythroblasts, which (in severe iron deficiency) will sacrifice erythropoiesis to supply iron to other organs, e.g. the heart. Marked hypoferraemia (typically with anaemia) can drive the depletion of cardiomyocyte iron, impairing contractile performance and explaining why a transferrin saturation < ≈15%–16% predicts the ability of intravenous iron to reduce the risk of major heart failure events in long-term trials (Type 1 iron-deficient heart failure). However, heart failure may be accompanied by intracellular iron depletion within skeletal muscle and cardiomyocytes, which is disproportionate to the findings of systemic iron biomarkers. Inflammation- and deconditioning-mediated skeletal muscle dysfunction—a primary cause of dyspnoea and exercise intolerance in patients with heart failure—is accompanied by intracellular skeletal myocyte iron depletion, which can be exacerbated by even mild hypoferraemia, explaining why symptoms and functional capacity improve following intravenous iron, regardless of baseline haemoglobin or changes in haemoglobin (Type 2 iron-deficient heart failure). Additionally, patients with advanced heart failure show myocardial iron depletion due to both diminished entry into and enhanced egress of iron from the myocardium; the changes in iron proteins in the cardiomyocytes of these patients are opposite to those expected from systemic iron deficiency. Nevertheless, iron supplementation can prevent ventricular remodelling and cardiomyopathy produced by experimental injury in the absence of systemic iron deficiency (Type 3 iron-deficient heart failure). These observations, taken collectively, support the possibility of three different mechanistic pathways for the development of iron-deficient heart failure: one that is driven through systemic iron depletion and impaired erythropoiesis and two that are characterized by disproportionate depletion of intracellular iron in skeletal and cardiac muscle. These mechanisms are not mutually exclusive, and all pathways may be operative at the same time or may occur sequentially in the same patients.

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Oral iron supplementation in patients with heart failure: a systematic review and meta‐analysis

Cited by 7 publications

References 47 publications

Editors' highlight picks from 2023 in ESC heart failure

Editors' highlight picks from 2023 in ESC heart failure

Research advances on molecular mechanism and natural product therapy of iron metabolism in heart failure

Identification of three mechanistic pathways for iron-deficient heart failure

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