Nutritional Landscape of Iron in Cardiovascular Disease

Both iron deficiency and iron overload are highly prevalent worldwide, along with cardiovascular disease (CVD) and associated risk factors; moreover, iron imbalance and CVD can occur simultaneously. Iron plays important roles in hematopoiesis, the composition and function of various enzymes, and a wide range of physiological and biochemical reactions. Here, we summarize our current knowledge regarding the association between altered iron homeostasis and various forms of CVD, including atherosclerosis, heart failure, pulmonary arterial hypertension, and myocardial infarction. In addition, we outline the latest data from observational and interventional studies regarding the effects of iron deficiency and iron overload on CVD. The pathogenicity between CVD and both iron deficiency and iron overload has been revealed, thanks to several decades of research, and we discuss whether data obtained from randomized controlled trials regarding iron deficiency and/or overload can be exploited to improve cardiovascular outcome. Although both iron deficiency and iron overload can be harmful to the heart, whether iron-targeted therapies can improve outcome in CVD remains an open question that warrants future study. The emergence of ferrology as a distinct discipline focused on ecosystemic iron regulatory networks offers promising avenues for advancing cardiovascular care. We believe that targeted maintenance of iron homeostasis may catalyze paradigm-shifting approaches in CVD management, potentially unveiling novel therapeutic strategies that address previously unrecognized pathophysiological mechanisms.