Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
Nat Rev Cardiol. 2024 Jul;21(7):463-486. doi: 10.1038/s41569-024-00988-1. Epub 2024 Feb 7.
Non-anaemic iron deficiency (NAID) is a strategic target in cardiovascular medicine because of its association with a range of adverse effects in various conditions. Endeavours to tackle NAID in heart failure have yielded mixed results, exposing knowledge gaps in how best to define 'iron deficiency' and the handling of iron therapies by the body. To address these gaps, we harness the latest understanding of the mechanisms of iron homeostasis outside the erythron and integrate clinical and preclinical lines of evidence. The emerging picture is that current definitions of iron deficiency do not assimilate the multiple influences at play in patients with heart failure and, consequently, fail to identify those with a truly unmet need for iron. Additionally, current iron supplementation therapies benefit only certain patients with heart failure, reflecting differences in the nature of the unmet need for iron and the modifying effects of anaemia and inflammation on the handling of iron therapies by the body. Building on these insights, we identify untapped opportunities in the management of NAID, including the refinement of current approaches and the development of novel strategies. Lessons learned from NAID in cardiovascular disease could ultimately translate into benefits for patients with other chronic conditions such as chronic kidney disease, chronic obstructive pulmonary disease and cancer.
非缺铁性贫血（NAID）是心血管医学的一个重要目标，因为它与各种情况下的一系列不良影响有关。在心力衰竭中努力解决 NAID 的问题得到了混合的结果，暴露出了在如何最好地定义“缺铁”以及身体处理铁疗法方面的知识空白。为了解决这些空白，我们利用了对红细胞外铁稳态机制的最新理解，并整合了临床和临床前证据。新出现的情况是，当前的缺铁定义没有整合心力衰竭患者中起作用的多种影响，因此未能确定那些真正需要补铁的患者。此外，目前的铁补充疗法仅对某些心力衰竭患者有益，这反映了缺铁的性质以及贫血和炎症对身体处理铁疗法的调节作用的差异。在此基础上，我们确定了管理 NAID 的未开发机会，包括改进当前的方法和开发新的策略。从心血管疾病中的 NAID 中吸取的经验教训最终可能会使患有其他慢性疾病（如慢性肾脏病、慢性阻塞性肺疾病和癌症）的患者受益。
