Iron metabolism biomarkers and mortality risk in U.S. patients with congestive heart failure: NHANES 1999-2018
Chunyan Li1, Fushu Zhou2, Jing Wu3
1Department of Cardiology, Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China.
Insights
Three iron metabolism biomarkers predict mortality in congestive heart failure (CHF) patients. Derived ratios of these biomarkers show even stronger predictive capability for all-cause mortality.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Public Health
Background:
- Iron deficiency is a significant public health issue.
- Congestive heart failure (CHF) patients face increased mortality risks.
- Understanding iron metabolism's role in CHF mortality is crucial.
Purpose of the Study:
- To evaluate four iron metabolism biomarkers for predicting mortality in US CHF patients.
- To assess predictive capability for both all-cause and cardiovascular disease-specific mortality.
Main Methods:
- Analysis of 1905 US CHF patients from NHANES (1999-2018).
- Weighted analyses for nationally representative estimates.
- Assessed associations between iron biomarkers and mortality outcomes.
Main Results:
- Increased iron and transferrin saturation were linked to decreased all-cause mortality.
- Elevated transferrin receptor levels correlated with increased all-cause mortality.
- Derived ratios (TRI, TRTS) demonstrated stronger prediction for all-cause mortality; iron and TRTS predicted cardiovascular mortality.
Conclusions:
- Three iron metabolism biomarkers are independently associated with all-cause mortality in CHF patients.
- Two novel biomarker ratios (TRI, TRTS) offer enhanced predictive power for mortality.
- These findings highlight the importance of iron status in CHF management.
Background And Aims:
Iron deficiency is a major public health concern. We aimed to assess the predictive capability of 4 iron metabolism biomarkers for all-cause and cardiovascular disease-specific mortality in U.S. patients with congestive heart failure (CHF).
Methods And Results:
1904 CHF patients aged ≥20 years were enrolled from NHANES, 1999-2000 to 2017-2018. All analyses were weighted to provide nationally representative estimates. Among 1905 CHF patients, mean age was 71 years, and 1024 (53.8%), 459 (24.1%), 206 (10.8%), and 216 (11.3%) were Non-Hispanic Black, Non-Hispanic White, Hispanic-Mexican American, and Hispanic-Other Hispanic, respectively. During follow-ups, 1080 deaths occurred. Median follow-up time was 5.08 years. Per-unit increase in natural-logarithmic-transformed iron and transferrin saturation decreased all-cause mortality risk separately by 33.0% (adjusted hazard ratio: 0.670, 95% confidence interval: 0.563 to 0.797, P < 0.001) and 32.6% (0.674, 0.495 to 0.917, 0.013), and per-unit increase in transferrin receptor increased mortality risk by 33.7% (1.337, 1.104 to 1.618, 0.004). Two derivates from 3 significant iron biomarkers were generated - transferrin receptor to natural-logarithmic-transformed iron ratio (TRI) and transferrin receptor to natural-logarithmic-transformed transferrin saturation ratio (TRTS), which were significantly associated with all-cause mortality, with per-unit increase corresponding to 2.692- and 1.655-fold increased all-cause mortality risk (P: 0.003 and 0.023). Only iron and TRTS were associated with the significant risk of cardiovascular disease-specific mortality (P: 0.004 and 0.017).
Conclusions:
Our findings identified 3 iron metabolism biomarkers that were individually, significantly, and independently associated with all-cause mortality in patients with CHF, and importantly 2 derivates generated exhibited stronger predictive capability.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:17Pathophysiology of Heart Failure
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...