Association of iron deficiency with incident cardiovascular diseases and mortality in the general population
Abstract 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...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13589 |
| _version_ | 1811255309587447808 |
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| author | Benedikt Schrage Nicole Rübsamen Francisco M. Ojeda Barbara Thorand Annette Peters Wolfgang Koenig Stefan Söderberg Maja Söderberg Ellisiv B. Mathiesen Inger Njølstad Frank Kee Allan Linneberg Kari Kuulasmaa Palosaari Tarja Veikko Salomaa Stefan Blankenberg Tanja Zeller Mahir Karakas |
| author_facet | Benedikt Schrage Nicole Rübsamen Francisco M. Ojeda Barbara Thorand Annette Peters Wolfgang Koenig Stefan Söderberg Maja Söderberg Ellisiv B. Mathiesen Inger Njølstad Frank Kee Allan Linneberg Kari Kuulasmaa Palosaari Tarja Veikko Salomaa Stefan Blankenberg Tanja Zeller Mahir Karakas |
| author_sort | Benedikt Schrage |
| collection | DOAJ |
| description | Abstract 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 μg/L or as ferritin < 30 μg/L (severe AID), and FID was defined as ferritin < 100 μg/L or ferritin 100–299 μg/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. |
| first_indexed | 2024-04-12T17:22:47Z |
| format | Article |
| id | doaj.art-afaff974ebd747afbbe5cd0498ff4856 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-12T17:22:47Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-afaff974ebd747afbbe5cd0498ff48562022-12-22T03:23:26ZengWileyESC Heart Failure2055-58222021-12-01864584459210.1002/ehf2.13589Association of iron deficiency with incident cardiovascular diseases and mortality in the general populationBenedikt Schrage0Nicole Rübsamen1Francisco M. Ojeda2Barbara Thorand3Annette Peters4Wolfgang Koenig5Stefan Söderberg6Maja Söderberg7Ellisiv B. Mathiesen8Inger Njølstad9Frank Kee10Allan Linneberg11Kari Kuulasmaa12Palosaari Tarja13Veikko Salomaa14Stefan Blankenberg15Tanja Zeller16Mahir Karakas17Department of Cardiology University Heart and Vascular Center Hamburg Hamburg GermanyDepartment of Cardiology University Heart and Vascular Center Hamburg Hamburg GermanyDepartment of Cardiology University Heart and Vascular Center Hamburg Hamburg GermanyInstitute of Epidemiology Helmholtz Zentrum München ‐ German Research Center for Environmental Health (GmbH) Neuherberg GermanyInstitute of Epidemiology Helmholtz Zentrum München ‐ German Research Center for Environmental Health (GmbH) Neuherberg GermanyDZHK (German Center for Cardiovascular Research), partner site Munich Munich GermanyDepartment of Public Health and Clinical Medicine, and Heart Centre Umeå University Umeå SwedenDepartment of Public Health and Clinical Medicine, and Heart Centre Umeå University Umeå SwedenDepartment of Community Medicine University of Tromsø The Arctic University of Norway Tromsø NorwayDepartment of Community Medicine University of Tromsø The Arctic University of Norway Tromsø NorwayCentre for Public Health Queens University of Belfast Belfast UKDepartment of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen DenmarkNational Institute for Health and Welfare Helsinki FinlandNational Institute for Health and Welfare Helsinki FinlandNational Institute for Health and Welfare Helsinki FinlandDepartment of Cardiology University Heart and Vascular Center Hamburg Hamburg GermanyDepartment of Cardiology University Heart and Vascular Center Hamburg Hamburg GermanyDepartment of Cardiology University Heart and Vascular Center Hamburg Hamburg GermanyAbstract 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 μg/L or as ferritin < 30 μg/L (severe AID), and FID was defined as ferritin < 100 μg/L or ferritin 100–299 μg/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.https://doi.org/10.1002/ehf2.13589Iron deficiencyRisk factorGeneral populationCardiovascularMortality |
| spellingShingle | Benedikt Schrage Nicole Rübsamen Francisco M. Ojeda Barbara Thorand Annette Peters Wolfgang Koenig Stefan Söderberg Maja Söderberg Ellisiv B. Mathiesen Inger Njølstad Frank Kee Allan Linneberg Kari Kuulasmaa Palosaari Tarja Veikko Salomaa Stefan Blankenberg Tanja Zeller Mahir Karakas Association of iron deficiency with incident cardiovascular diseases and mortality in the general population ESC Heart Failure Iron deficiency Risk factor General population Cardiovascular Mortality |
| title | Association of iron deficiency with incident cardiovascular diseases and mortality in the general population |
| title_full | Association of iron deficiency with incident cardiovascular diseases and mortality in the general population |
| title_fullStr | Association of iron deficiency with incident cardiovascular diseases and mortality in the general population |
| title_full_unstemmed | Association of iron deficiency with incident cardiovascular diseases and mortality in the general population |
| title_short | Association of iron deficiency with incident cardiovascular diseases and mortality in the general population |
| title_sort | association of iron deficiency with incident cardiovascular diseases and mortality in the general population |
| topic | Iron deficiency Risk factor General population Cardiovascular Mortality |
| url | https://doi.org/10.1002/ehf2.13589 |
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