Journal
ESC HEART FAILURE
Volume 8, Issue 6, Pages 4584-4592Publisher
WILEY PERIODICALS, INC
DOI: 10.1002/ehf2.13589
Keywords
Iron deficiency; Risk factor; General population; Cardiovascular; Mortality
Categories
Funding
- European Union [HEALTH-F2-2011-278913]
- European Commission [HEALTH-F4-2007-2014113, HEALTH-F32010-242244]
- Finnish Foundation for Cardiovascular Research
- Norrbotten and Vasterbotten County Councils
- Swedish Research Council
- Swedish Environmental Protection Agency
- Umea University
- Swedish Heart-Lung Foundation [20140799, 20120631, 20100635]
- County Council of Vasterbotten (ALF) [VLL548791]
- University of Tromso
- Research Council of Norway
- National Screening Services
- Northern Norway Regional Health Authority
- Norwegian Council on Cardiovascular Diseases
- Norwegian EXTRA Foundation
- Helmholtz Zentrum Munchen -German Research Center for Environmental Health - German Federal Ministry of Education and Research (BMBF)
- State of Bavaria
- Projekt DEAL
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In a study involving 12,164 individuals from three European population-based cohorts, it was found that absolute iron deficiency (AID) and functional iron deficiency (FID) were highly prevalent in the general population and were associated with increased risks of incident coronary heart disease, cardiovascular death, and all-cause mortality, with FID having the highest impact on these events.
Aims Although absolute (AID) and functional iron deficiency (FID) are known risk factors for patients with cardiovascular (CV) disease, their relevance for the general population is unknown. The aim was to assess the association between AID/FID with incident CV disease and mortality in the general population. Methods and results In 12 164 individuals from three European population-based cohorts, AID was defined as ferritin < 100 mu g/L or as ferritin < 30 mu g/L (severe AID), and FID was defined as ferritin < 100 mu g/L or ferritin 100-299 mu g/L and transferrin saturation < 20%. The association between iron deficiency and incident coronary heart disease (CHD), CV mortality, and all-cause mortality was evaluated by Cox regression models. Population attributable fraction (PAF) was estimated. Median age was 59 (45-68) years; 45.2% were male. AID, severe AID, and FID were prevalent in 60.0%, 16.4%, and 64.3% of individuals. AID was associated with CHD [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.04-1.39, P = 0.01], but not with mortality. Severe AID was associated with all-cause mortality (HR 1.28, 95% CI 1.12-1.46, P < 0.01), but not with CV mortality/CHD. FID was associated with CHD (HR 1.24, 95% CI 1.07-1.43, P < 0.01), CV mortality (HR 1.26, 95% CI 1.03-1.54, P = 0.03), and all-cause mortality (HR 1.12, 95% CI 1.01-1.24, P = 0.03). Overall, 5.4% of all deaths, 11.7% of all CV deaths, and 10.7% of CHD were attributable to FID. Conclusions In the general population, FID was highly prevalent, was associated with incident CHD, CV death, and all-cause death, and had the highest PAF for these events, whereas AID was only associated with CHD and severe AID only with all-cause mortality. This indicates that FID is a relevant risk factor for CV diseases in the general population.
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