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Iron deficiency: Prevalence and relation to cardiovascular biomarkers in heart failure outpatients
Morten Schou1, Helle Bosselmann2, Freja Gaborit1
1Department of Cardiology, Herlev University Hospital, DK-2730 Herlev, Denmark.
Insights
Iron deficiency (ID) is common in heart failure (HF) patients, affecting 45% of those in outpatient clinics. While not linked to most cardiovascular biomarkers, ID showed an association with inflammation marker hs-CRP.
Area of Science:
- Cardiology
- Internal Medicine
- Biochemistry
Background:
- Iron deficiency (ID) and cardiovascular biomarkers are linked to poor outcomes in heart failure (HF).
- The relationship between ID and cardiovascular biomarkers in HF is not well understood.
- ID prevalence in outpatient HF clinics may be underestimated.
Purpose of the Study:
- To determine the prevalence of ID in an outpatient HF clinic.
- To investigate the association between ID and elevated plasma concentrations of specific cardiovascular biomarkers associated with poor prognosis.
Main Methods:
- Prospective study of 149 patients with systolic HF in an outpatient clinic.
- ID defined by ferritin and transferrin saturation levels.
- Analysis of five cardiovascular biomarkers in frozen plasma samples.
Main Results:
- The prevalence of ID was 45% (95% CI: 37-53%).
- ID was not associated with troponin I, NT-proBNP, MR-proANP, chromogranin A, or copeptin.
- ID was associated with higher plasma concentrations of high-sensitivity C-reactive protein (hs-CRP) (OR: 2.03, 95% CI: 1.02-4.02, P=0.043).
Conclusions:
- Iron deficiency is highly prevalent in outpatient HF settings.
- ID is not associated with most cardiovascular biomarkers, except for inflammation (hs-CRP), in systolic HF.
- Further research is needed to elucidate iron metabolism in elderly HF patients.
Background:
Both iron deficiency (ID) and cardiovascular biomarkers are associated with a poor outcome in heart failure (HF). The relationship between different cardiovascular biomarkers and ID is unknown, and the true prevalence of ID in an outpatient HF clinic is probably overlooked.
Objectives:
To identify the prevalence of ID in a HF clinic and evaluate whether ID is associated with increased plasma concentrations of different cardiovascular biomarkers that carry a poor prognosis.
Methods:
We prospectively included 149 patients with systolic HF referred to an outpatients HF clinic. ID was defined as ferritin<100 μg/L or ferritin 100-300 μg/L and Tranferin-saturation<0.20. Five different cardiovascular biomarkers were analyzed on frozen plasma.
Results:
The patients had a median age of 70 (Interquartile range: 64-75) years, 25% were females, 29% were in functional class III-IV and LVEF was 32 (27-39) %. The prevalence of ID was 45% (95%-confidence interval (CI): 37-53%). In multivariate analyses, ID was not associated with plasma concentrations of troponin I, NT-proBNP, MR-proANP, chromogranin A or copeptin (P>0.05 for all) but with plasma concentrations of hs-CRP (odds ratio: 2.03, 95%-CI: 1.02-4.02, P=0.043).
Conclusion:
ID is frequent in an outpatient HF clinic. ID is not associated with cardiovascular biomarkers after adjustment for traditional confounders. Inflammation, but not neurohormonal activation is associated with ID in systolic HF. Further studies are needed to understand iron metabolism in elderly HF patients.
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