Silvestre Odilson M, Gonçalves Alexandra, Nadruz Wilson, Claggett Brian, Couper David, Eckfeldt John H, Pankow James S, Anker Stefan D, Solomon Scott D
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
University of Porto Medical School, Porto, Portugal.
Eur J Heart Fail. 2017 Mar;19(3):340-347. doi: 10.1002/ejhf.701. Epub 2016 Dec 14.
Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community-based cohort.
We examined 1063 participants who were free of heart failure from the Atherosclerosis Risk in Communities (ARIC) Study in whom ferritin serum levels were measured at baseline (1987-1989). The participants (mean age 52.7 ± 5.5 years, 62% women), were categorized in low (<30 ng/mL; n = 153), normal (30-200 ng/mL in women and 30-300 ng/mL in men; n = 663), and high (>200 ng/mL in women and >300 ng/mL in men; n = 247) ferritin levels. Multivariable Cox proportional hazards models were used to evaluate the relationship between ferritin and incident HF. After 21 ± 4.6 years of follow-up, HF occurred in 144 (13.5%) participants. When compared with participants with normal ferritin levels, participants with low ferritin levels had a higher risk of HF [hazard ratio (HR) = 2.24, 95% confidence interval (CI) 1.15-4.35; P = 0.02] as did those with high ferritin levels (HR = 1.81, 95% CI 1.01-3.25; P = 0.04), after adjusting for potential confounders. Notably, low ferritin levels remained associated with incident HF even after excluding subjects with anaemia (HR = 2.28, 95% CI 1.11-4.68; P = 0.03).
Derangements in iron metabolism, either low or high ferritin serum levels, were associated with higher risk of incident HF in a general population, even without concurrent anaemia. These findings suggest that iron imbalance might play a role in the development of HF.
严重铁过载与心脏损伤相关，而缺铁与心力衰竭（HF）患者的不良预后有关。本研究调查了铁状态标志物铁蛋白与社区队列中HF发病率之间的关系。
我们对社区动脉粥样硬化风险（ARIC）研究中1063名无心力衰竭的参与者进行了检查，在基线时（1987 - 1989年）测量了他们的血清铁蛋白水平。参与者（平均年龄52.7±5.5岁，62%为女性）被分为铁蛋白水平低（<30 ng/mL；n = 153）、正常（女性30 - 200 ng/mL，男性30 - 300 ng/mL；n = 663）和高（女性>200 ng/mL，男性>300 ng/mL；n = 247）三组。采用多变量Cox比例风险模型评估铁蛋白与新发HF之间的关系。经过21±4.6年的随访，144名（13.5%）参与者发生了HF。与铁蛋白水平正常的参与者相比，铁蛋白水平低的参与者发生HF的风险更高[风险比（HR）= 2.24，95%置信区间（CI）1.15 - 4.35；P = 0.02]，铁蛋白水平高的参与者也是如此（HR = 1.81，95%CI 1.01 - 3.25；P = 0.04），在调整潜在混杂因素后。值得注意的是，即使排除贫血患者，低铁蛋白水平仍与新发HF相关（HR = 2.28，95%CI 1.11 - 4.68；P = 0.03）。
铁代谢紊乱，无论是血清铁蛋白水平低还是高，在一般人群中都与新发HF的较高风险相关，即使没有同时存在贫血。这些发现表明铁失衡可能在HF的发生发展中起作用。
