[Iron deficiency in cardiovascular disease]

Area of Science:

• Cardiology
• Hematology
• Nutritional Science

Context:

• Iron deficiency is the most common nutritional deficiency globally.
• Emerging evidence links iron deficiency to cardiovascular diseases, including heart failure, aortic valve stenosis, atrial fibrillation, and pulmonary hypertension.
• Intravenous iron administration is an accessible treatment option.

Purpose:

• To review clinical comorbidities, diagnostic challenges, and treatment options for iron deficiency in cardiovascular diseases.
• To summarize current research on iron deficiency and substitution in various cardiovascular conditions.

Summary:

• Diagnostic criteria for iron deficiency in cardiovascular diseases are not standardized. European Society of Cardiology guidelines suggest ferritin <100 ng/ml or ferritin 100-299 ng/ml with transferrin saturation (TSAT) <20%.
• Some advocate TSAT alone for diagnosing iron deficiency in heart failure.
• Iron substitution in heart failure generally improves physical capacity and reduces hospitalizations, though non-responders exist, and reasons are unclear. Data on other cardiovascular conditions are limited.

Impact:

• Iron substitution offers a key strategy to enhance physical capacity in heart failure patients.
• Accurate identification of patients who will benefit from iron substitution is critical for effective treatment in cardiovascular disease.