Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Nephrology Section, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
ESC Heart Fail. 2024 Jun;11(3):1435-1442. doi: 10.1002/ehf2.14724. Epub 2024 Feb 26.
Among persons with prevalent heart failure (HF), iron deficiency has been linked to HF admissions, and intravenous iron replacement improves HF outcomes. Recent studies in persons with chronic kidney disease (CKD) demonstrate that iron deficiency is associated with incident HF. This study aimed to determine the relationship of iron status with incident HF in community-dwelling older adults irrespective of their kidney function.
In this case-cohort study, 1,006 Cardiovascular Health Study participants (785 from the random sub-cohort [including 193 HF cases] and 221 additional HF cases [N = 414 total HF cases]) aged ≥ 65 years without HF (41% with CKD), we used weighted Cox models to evaluate associations of iron status with incident HF. Participants were categorized based on quartiles of transferrin saturation and ferritin as "iron replete" (27.3%), "functional iron deficiency" (7.7%), "iron deficiency" (11.8%), "mixed iron deficiency" (5.6%), "high iron" (9.3%) and "non-classified" (38.1%), consistent with prior studies.
Compared to older persons who were iron replete, those with iron deficiency were at higher risk of incident HF (HR 1.47; 1.02-2.11) in models adjusting for demographics, HF risk factors, and estimated glomerular filtration rate. Other iron categories did not associate with incident HF. The relationship of iron deficiency with incident HF did not differ by CKD status (interaction P value 0.2).
Among community-dwelling elders, iron deficiency is independently associated with incident HF, an association that was similar irrespective of CKD status. Our findings support conduct of clinical trials of iron replacement for prevention of HF in older adults with iron deficiency.
在普遍存在心力衰竭（HF）的人群中，铁缺乏与 HF 入院有关，静脉铁替代治疗可改善 HF 结局。最近在慢性肾脏病（CKD）患者中的研究表明，铁缺乏与 HF 的发生有关。本研究旨在确定无论其肾功能如何，铁状态与社区居住的老年人群中 HF 发生的关系。
在这项病例队列研究中，纳入了 1006 名心血管健康研究参与者（785 名来自随机亚队列[包括 193 例 HF 病例]和 221 例额外的 HF 病例[总 HF 病例 414 例]），年龄≥65 岁且无 HF（41%有 CKD），我们使用加权 Cox 模型评估铁状态与 HF 发生的关系。根据转铁蛋白饱和度和铁蛋白的四分位数，参与者被分为“铁充足”（27.3%）、“功能性铁缺乏”（7.7%）、“铁缺乏”（11.8%）、“混合性铁缺乏”（5.6%）、“高铁”（9.3%）和“未分类”（38.1%），这与之前的研究一致。
与铁充足的老年人相比，铁缺乏的老年人发生 HF 的风险更高（调整人口统计学、HF 危险因素和估计肾小球滤过率后的 HR 为 1.47；1.02-2.11）。其他铁分类与 HF 发生无关。铁缺乏与 HF 发生的关系与 CKD 状态无关（交互 P 值为 0.2）。
在社区居住的老年人中，铁缺乏与 HF 的发生独立相关，与 CKD 状态无关。我们的研究结果支持对铁缺乏的老年人群进行铁替代治疗以预防 HF 的临床试验。
