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Advances in iron deficiency and iron-related arrhythmias and cardiovascular diseases
1Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea.
Insights
Iron deficiency (ID) is a common, treatable condition in cardiovascular disease patients, especially those with heart failure (HF). Treating ID with iron supplements can improve HF symptoms and reduce hospitalizations.
Area of Science:
- Cardiology
- Nutritional Science
- Internal Medicine
Background:
- Iron deficiency (ID) is prevalent in cardiovascular disease (CVD) patients, affecting up to 60% with coronary artery disease and higher rates in heart failure (HF) or pulmonary hypertension.
- ID prevalence correlates with cardiac and renal dysfunction severity, disproportionately affecting women.
- Causes of ID include blood loss from therapies or comorbidities, poor dietary intake, and reduced iron absorption due to inflammation or low gastric acidity.
Purpose of the Study:
- To explore the association between iron deficiency (ID), anemia, and arrhythmias like atrial fibrillation (AF) in cardiovascular disease (CVD) patients.
- To highlight the therapeutic potential of addressing ID in heart failure with reduced ejection fraction (HFrEF), even without anemia.
- To discuss the role of micronutrient deficiencies, including selenium, in CVD outcomes.
Main Methods:
- Review of existing literature on iron deficiency (ID) and its impact on cardiovascular disease (CVD) patients.
- Analysis of the association between ID, anemia, and arrhythmias, particularly atrial fibrillation (AF).
- Evaluation of the efficacy of iron supplementation in heart failure with reduced ejection fraction (HFrEF).
Main Results:
- Iron deficiency (ID) is common in cardiovascular disease (CVD), increasing with cardiac and renal dysfunction.
- Intravenous ferric carboxymaltose improved symptoms, quality of life, exercise capacity, and reduced hospitalizations in HFrEF patients.
- Both anemia and ID are linked to adverse clinical outcomes in CVD, potentially acting as independent risk factors.
Conclusions:
- Iron deficiency (ID) is a significant, treatable factor in heart failure with reduced ejection fraction (HFrEF) and should be investigated.
- Optimizing micronutrient status, including iron and selenium, may improve outcomes in at-risk cardiovascular populations.
- Further interventional studies are needed to establish causality and guide treatment recommendations for micronutrient deficiencies in CVD.
Abstract:
Iron deficiency (ID) is common in patients with cardiovascular disease. Up to 60% of patients with coronary artery disease and even higher percentages of patients with heart failure (HF) or pulmonary hypertension have ID. However, the evidence for an association between ID including anemia and arrhythmias, particularly atrial fibrillation (AF) is less clear. The prevalence of ID increases with the severity of cardiac and renal dysfunction and would be more common in women. Increased blood loss due to antithrombotic therapy or gastrointestinal or renal disease and insufficient dietary iron intake, reduced iron absorption secondary to low-grade inflammation associated with congestion or reduced gastric acidity may cause ID. Both anemia and ID are associated with poor clinical outcomes, each may confer risk factors independently. There is growing evidence that ID is an important therapeutic target in patients with HF with reduced ejection fraction (HFrEF), even in the absence of anemia. Intravenous ferric carboxymaltose improved symptoms, ID-related quality of life, and exercise capacity and reduced hospitalizations for worsening HF in patients with HFrEF even mildly reduced EF (<50%). ID is easy to treat and effective in patients with HFrEF. These patients should be investigated for possible ID. Malnutrition has also been linked to cardiovascular disease. Both selenium and iron deficiencies have been associated with worse clinical outcomes in patients with HF. And selenium deficiency was associated with new-onset AF in nonsmoking participants. Interventional studies investigating the effects of optimizing the micronutrient status in at-risk populations are needed to assess causality, especially in those with ID. These recommendations may be extended to those populations based on evidence from future clinical trials.
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