Iron and cardiovascular health: A review

Area of Science:

• Cardiology
• Biochemistry
• Pharmacology

Background:

• Iron is vital for cardiovascular functions, including energy production and cardiomyocyte contractility.
• Iron deficiency (ID) significantly impairs cardiac function, worsening outcomes in heart failure (HF) patients.
• Understanding iron homeostasis and ID pathophysiology is crucial for managing HF.

Purpose of the Study:

• To review iron homeostasis, ID pathophysiology, and its role in heart failure.
• To analyze therapeutic strategies, focusing on iron supplementation in ID and HF patients.
• To compare clinical trial outcomes of iron repletion therapies.

Main Methods:

• Review of existing literature and clinical trials on iron deficiency and heart failure.
• Analysis of data from randomized trials and meta-analyses, including AFFIRM-AHF, IRONMAN, and HEART-FID.
• Focus on intravenous (IV) iron therapies, specifically ferric carboxymaltose and ferric derisomaltose.

Main Results:

• IV iron therapy shows efficacy in reducing hospitalizations and improving quality of life for patients with Heart Failure with reduced ejection fraction (HFrEF), NYHA II-III.
• Studies like Ferinject Assessment, AFFIRM-AHF, IRONMAN, and HEART-FID support the benefits of IV iron supplementation.
• No significant improvement in survival or mortality was observed during acute exacerbations or outpatient management.

Conclusions:

• Intravenous iron supplementation is a promising therapeutic option for improving quality of life and reducing hospitalizations in specific heart failure populations.
• Further research is warranted to investigate the full spectrum of IV iron benefits across all HF types and its interactions with other HF treatments.
• Optimal use of iron repletion in heart failure management requires continued investigation.