Wang Qinhong, Han Wenqiang, Wang Tianyu, Deng Haonan, Zhong Jingquan
National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China; Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, Shandong, 266035, China.
Nutr Metab Cardiovasc Dis. 2025 Jan;35(1):103759. doi: 10.1016/j.numecd.2024.09.029. Epub 2024 Oct 3.
Iron deficiency (ID) leads to a significant global health burden, but research on the impact of ID on the prognosis of stroke patients is rare. We aim to investigate the impact of ID on the all-cause mortality of both the stroke and non-stroke individuals.
This retrospective cohort study used data from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2002. The follow-up period for the participants extended until December 31, 2019. Overall, 7239 participants were enrolled, out of which 200 had a history of stroke. There was no difference in the prevalence of ID (ferritin <100 ng/mL or serum ferritin concentration 100-299 ng/mL with transferrin saturation (TSAT) < 20 %) between stroke and non-stroke individuals (68 % vs 65 %, P = 0.5) even after propensity score matching (68 % vs 63 %, P = 0.5). In stroke survivors, ID was found to be associated with a higher risk of all-cause mortality over a 5-year period (HR: 4.16, 95 % CI: 1.54-11.3, P = 0.005). Additionally, there was no link between ID and all-cause mortality in individuals without stroke. Moreover, we did not observe a significant association between dietary iron, total folate, and ID in stroke patients.
Stroke survivors with low serum ferritin levels have an increased risk of 5-year all-cause mortality. Health care providers should consider screening for ID among individuals with a history of stroke. Future clinical trials examining the effects of iron therapy on patients with stroke and coexisting ID are warranted.
缺铁（ID）给全球带来了重大的健康负担，但关于ID对中风患者预后影响的研究却很少。我们旨在调查ID对中风患者和非中风患者全因死亡率的影响。
这项回顾性队列研究使用了1999年至2002年进行的美国国家健康与营养检查调查（NHANES）的数据。参与者的随访期延长至2019年12月31日。总体而言，共纳入7239名参与者，其中200人有中风病史。中风患者和非中风患者之间的ID患病率（铁蛋白<100 ng/mL或血清铁蛋白浓度为100 - 299 ng/mL且转铁蛋白饱和度（TSAT）<20%）没有差异（68%对65%，P = 0.5），即使在倾向得分匹配后也是如此（68%对63%，P = 0.5）。在中风幸存者中，发现ID与5年内全因死亡风险较高相关（HR：4.16，95%CI：1.54 - 11.3，P = 0.005）。此外，在没有中风的个体中，ID与全因死亡率之间没有关联。而且，我们在中风患者中未观察到膳食铁、总叶酸与ID之间存在显著关联。
血清铁蛋白水平低的中风幸存者5年内全因死亡风险增加。医疗保健提供者应考虑对有中风病史的个体进行ID筛查。未来有必要进行临床试验，研究铁疗法对中风合并ID患者的影响。
