Wednesday , March 29 2023

Iron deficiency increases the risk of heart disease in middle-aged medical practice


Iron deficiency heart disease?

Many cases of middle-aged coronary artery disease appear to be related to iron deficiency. According to a recent study, not only the absolute iron deficiency but also the so-called functional iron deficiency play a decisive role. Preventing iron deficiency can therefore significantly reduce the risk of coronary artery disease.

A recent study with the participation of researchers from Helmholtz Zentrum München and the University Heart and Vascular Center UKE Hamburg aims to investigate whether there is a link between iron deficiency and treatment results in cardiovascular disease. The results can be read in the English-language journal of the European Society of Cardiology (ESC) “ESC Heart Failure”.

Does iron deficiency change heart disease?

“This study is an observational study and we can not conclude that iron deficiency causes heart disease,” explains research author Dr. Benedikt Schrage in a press release from the European Society of Cardiology. However, there is growing evidence that there is a connection.

Previous studies have shown that iron deficiency in people with cardiovascular disease (such as heartbeat) was linked to poorer outcomes, including hospital stay and death, the researchers said.

Benefits of intravenous iron treatment

Treatment with intravenous iron improved symptoms, function, and quality of life in people with heart failure and iron deficiency who participated in the FAIR-HF study. Based on these results, the FAIR-HF-2 study examines the effects of intravenous iron supplementation on the risk of death in people with heart attack. The experts analyzed whether the link between iron deficiency and treatment outcomes can also be observed in the general population.

Current cardiovascular risk factors determined

The current study included a total of 12,164 people with an average age of 59 years and 55 percent of the participants were women. An initial attempt identified cardiovascular risk factors and comorbidities such as smoking, obesity, diabetes and high cholesterol through an in-depth clinical examination, including blood samples, the team said.

Participants were then classified as iron-poor or non-iron-poor based on two definitions. One definition was absolute iron deficiency, in which only the stored iron (ferritin) is taken into account. The second definition was functional iron deficiency, which takes into account the stored iron (ferritin) and the iron that circulates for use by the body (transferrin), the experts explain.

“Absolute iron deficiency is the traditional method for assessing iron status, but it does not take into account circulating iron. The functional definition is more accurate because it includes metrics as well as those that have sufficient supplies but do not have enough iron in the bloodstream for the body to function properly, ”explains Dr. Skean.

Participants were then medically checked for the occurrence of coronary artery disease and stroke, death from cardiovascular disease and death from all causes.

Which people were excluded from the study?

The team analyzed the association between iron deficiency and the incidence of coronary artery disease, stroke, cardiovascular mortality, and all causes of mortality after adjusting for age, sex, smoking, cholesterol, blood pressure, diabetes, body mass index, and inflammation. If the participants already had coronary artery disease or stroke at the beginning of the study, these were excluded from the analysis of previous diseases.

At the start of the study, 60 percent of the participants had an absolute iron deficiency and 64 percent had a functional iron deficiency. During an average follow-up period of 13.3 years, there were 2,212 (18.2 percent) deaths. Of these, a total of 573 people (4.7 percent) died from a cardiovascular cause. Coronary artery disease and stroke were diagnosed in 1,033 (8.5 percent) and 766 (6.3 percent) participants, respectively.

Increased risk due to functional iron deficiency

According to the researchers, functional iron deficiency was associated with a 24 percent higher risk of coronary artery disease, a 26 percent higher risk of cardiovascular mortality and a twelve percent higher risk of all-cause mortality compared to people without functional iron deficiency.

No association between iron status and strokes

Absolute iron deficiency was associated with a 20 percent increased risk of coronary artery disease compared with no absolute iron deficiency, but was not related to mortality. There was no association between iron status and stroke incidence, the team reports.

5.4 percent of all deaths due to functional iron deficiency

The experts finally calculated that an estimated 5.4 percent of all deaths, 11.7 percent of cardiovascular deaths, and 10.7 percent of new diagnoses of coronary artery disease within a decade were related to functional iron deficiency.

This analysis suggests that about five percent of deaths, twelve percent of cardiovascular deaths, and eleven percent of new diagnoses of coronary artery disease in the following decades would not have occurred if there had been no iron deficiency. at the start of the study, ‘said Dr. Skean.

Iron deficiency of middle age is common

The study shows that iron deficiency was widely studied in the middle-aged population, with almost two-thirds showing functional iron deficiency. People affected by iron deficiency had a higher risk of developing heart disease and dying within the next 13 years, the doctor continues. In the future, further studies will examine the established relationships in younger and non-European cohorts. (as)

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Author and source information

This text meets the requirements of specialist medical literature, medical guidelines and current studies and is supervised by medical professionals.


  • Benedikt Schrage, Nicole Rübsamen, Francisco M. Ojeda, Barbara Thorand, Annette Peters, et al .: Association of iron deficiency with incident cardiovascular disease and mortality in the general population; in: ESC Heart Failure (published 05.10.2021), ESC Heart Failure
  • European Society of Cardiology: Iron deficiency in middle age has been linked to higher risk of developing heart disease (published 06.10.2021), ESC

Important NOTE:
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not replace a visit to the doctor.

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