Iron deficiency and cardiovascular disease.

Iron deficiency (ID) is common in patients with cardiovascular disease. Up to 60% of patients with coronary artery disease, and an even higher proportion of those with heart failure (HF) or pulmonary hypertension have ID; the evidence for cerebrovascular disease, aortic stenosis and atrial fibrillation is less robust. The prevalence of ID increases with the severity of cardiac and renal dysfunction and is probably more common amongst women. Insufficient dietary iron, reduced iron absorption due to increases in hepcidin secondary to the low-grade inflammation associated with atherosclerosis and congestion or reduced gastric acidity, and increased blood loss due to anti-thrombotic therapy or gastro-intestinal or renal disease may all cause ID. For older people in the general population and patients with HF with reduced ejection fraction (HFrEF), both anaemia and ID are associated with a poor prognosis; each may confer independent risk. There is growing evidence that ID is an important therapeutic target for patients with HFrEF, even if they do not have anaemia. Whether this is also true for other HF phenotypes or patients with cardiovascular disease in general is currently unknown. Randomized trials showed that intravenous ferric carboxymaltose improved symptoms, health-related quality of life and exercise capacity and reduced hospitalizations for worsening HF in patients with HFrEF and mildly reduced ejection fraction (<50%). Since ID is easy to treat and is effective for patients with HFrEF, such patients should be investigated for possible ID. This recommendation may extend to other populations in the light of evidence from future trials.

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© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

Déclaration de conflit d'intérêts

Conflict of interest: G.S. reports grants and personal fees from Vifor and AstraZeneca, grants and non-financial support from Boehringer Ingelheim; personal fees from Società Prodotti Antibiotici, Roche, Servier, GENESIS, Cytokinetics, and Medtronic; grants from Novartis, Boston Scientific, PHARMACOSMOS, Merck, and Bayer, outside the submitted work. J.B. reports consulting fees from Abbott, Adrenomed, Amgen, Applied Therapeutics, Array, Astra Zeneca, Bayer, Boehringer Ingelheim, CVRx, G3 Pharma, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Sequana Medical, and Vifor; and honoraria from Novartis, Boehringer Ingelheim-Lilly, Astra Zeneca, Janssen. P.P. has received personal fees from Boehringer Ingelheim, Servier, Novartis, Berlin-Chemie, Bayer, Renal Guard Solutions, Pfizer, Respicardia, Cardiorentis, AstraZeneca, and Cibiem; has received grants, personal fees, and fees to his institution from Impulse Dynamics; and has received fees to his institution from Vifor, Corvia, AstraZeneca, and Revamp Medical. J.G.F.C. reports grants and speaker honoraria from Amgen, Medtronic, and Novartis. S.D.A. has received research support from Vifor International and Abbott Vascular and fees for consultancy and/or speaking from AstraZeneca, Bayer, Boehringer Ingelheim, Respicardia, Impulse Dynamics, Janssen, Novartis, Servier, and Vifor International. S.v.H. reports research support from Amgen, Boehringer Ingelheim, IMI, and the German Centre for Cardiovascular Research (DZHK).