Monday , May 16 2022

Iron deficiency appears to increase heart disease risk in middle age – medical practice


Iron Deficiency Heart Disease?

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

A recent study involving researchers from Helmholtz Zentrum München and UKE University of Hamburg’s Cardiovascular Center aimed to investigate whether there is a link between iron deficiency and treatment outcomes in cardiovascular diseases. The results can be read in the English journal “ESC Heart Failure” of the European Society of Cardiology (ESC).

Does iron deficiency cause heart disease?

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

Previous research has shown that iron deficiency in people with cardiovascular disease (such as heart failure) is linked to worse outcomes, including hospital stays and death, the researchers said.

Benefits of intravenous iron therapy

Intravenous iron therapy 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 investigates the effects of intravenous iron supplementation on the risk of death in people with heart failure. The experts analyzed whether the link between iron deficiency and treatment outcomes was also seen in the general population.

Existing cardiovascular risk factors identified

A total of 12,164 people with a mean age of 59 were included in the current study, and 55 percent of the participants were women. At the first visit, the team identified cardiovascular risk factors and comorbidities such as smoking, obesity, diabetes, and high cholesterol through a comprehensive clinical examination, including blood samples.

Participants were then classified as iron-poor or non-iron-poor according to two definitions. One definition was absolute iron deficiency, in which only stored iron (ferritin) was considered. The second definition, according to experts, was functional iron deficiency, which takes into account stored iron (ferritin) and circulating iron for use in the body (transferrin).

“Absolute iron deficiency is the traditional method of assessing iron status, but it does not take into account circulating iron. The functional definition is more precise because it includes both metrics and captures those who have sufficient supply but not enough iron in the bloodstream for the body to function properly,” explains Dr. Tilt.

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

Which individuals 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-cause mortality, after adjusting for age, sex, smoking, cholesterol, blood pressure, diabetes, body mass index, and inflammation. If participants had already had coronary artery disease or stroke at the start of the study, they were excluded from the analysis of previous diseases.

At the start of the study, 60 percent of the participants had absolute iron deficiency and 64 percent had functional iron deficiency. There were 2,212 (18.2 percent) deaths during a median follow-up of 13.3 years. Of these, a total of 573 (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 death, and a twelve percent higher risk of all-cause death compared to people without functional iron deficiency.

No association between iron status and stroke

Absolute iron deficiency was associated with a 20 percent increased risk of coronary artery disease compared with no absolute iron deficiency, but was not associated with death. The team reported no association between iron status and stroke incidence.

5.4 percent of all deaths from functional iron deficiency

Experts finally calculated that an estimated 5.4 percent of all deaths, 11.7 percent of cardiovascular deaths, and 10.7 percent of new coronary artery disease diagnoses over the decade were associated with functional iron deficiency.

“This analysis shows that about five percent of deaths, twelve percent of cardiovascular deaths, and eleven percent of new coronary artery disease diagnoses would not have occurred in the next decade if it were not for iron deficiency at the start of the study.” said Dr. Slope.

Middle-aged iron deficiency is common

The research shows that iron deficiency is common in the middle-aged population studied, with nearly two-thirds showing functional iron deficiency. The doctor says people affected by iron deficiency have a higher risk of developing heart disease and dying within the next 13 years. In the future, more research will be conducted to explore established relationships in younger, non-European cohorts. (aspect)

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Author and source information

This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.


  • Benedikt Schrage, Nicole Rübsamen, Francisco M. Ojeda, Barbara Thorand, Annette Peters, et al.: Association of cardiovascular diseases and mortality and iron deficiency in the general population; in: ESC Heart Failure (veröffentlicht 05.10.2021), ESC Heart Failure
  • European Society of Cardiology: Iron deficiency in middle age is linked to a higher risk of developing heart disease (veröffentlicht 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. It cannot replace a doctor’s visit.

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