Plasma Ferritin Levels, Incident Heart Failure, and Cardiac Structure and Function: The ARIC Study

Area of Science:

• Cardiology
• Internal Medicine
• Nutritional Science

Background:

• Iron deficiency is prevalent and treatable, yet its role in heart failure (HF) development is not fully understood.
• Understanding the link between iron status and cardiac dysfunction is crucial for public health and therapeutic strategies.

Purpose of the Study:

• To investigate the association between plasma ferritin levels and the incidence of heart failure (HF) in older adults.
• To examine the relationship between ferritin and specific HF phenotypes (HFpEF, HFrEF) and cardiac function.

Main Methods:

• Analysis of data from the Atherosclerosis Risk In Communities (ARIC) study, including 3,472 participants without prior HF or anemia.
• Utilized Cox proportional hazards and linear regression models to assess associations between plasma ferritin and incident HF, HF phenotypes, and echocardiographic measures.

Main Results:

• Lower plasma ferritin levels were significantly associated with an increased risk of overall incident HF (HR: 1.20) and incident HF with preserved ejection fraction (HFpEF) (HR: 1.28).
• No significant association was found between lower ferritin and incident HF with reduced ejection fraction (HFrEF).
• Lower ferritin correlated with higher E/e' ratio and pulmonary artery systolic pressure, indicating increased left ventricular filling pressures.

Conclusions:

• In older adults without pre-existing HF or anemia, reduced plasma ferritin is a risk factor for developing heart failure, especially HFpEF.
• Lower iron stores are linked to elevated left ventricular filling pressures, suggesting a role in diastolic dysfunction.