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.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | ESC heart failure |
| Vol/bind | 8 |
| Udgave nummer | 6 |
| Sider (fra-til) | 4584-4592 |
| ISSN | 2055-5822 |
| DOI | |
| Status | Udgivet - 2021 |
Bibliografisk note
Funding Information:The BiomarCaRE Project was funded by the European Union Seventh Framework Programme (FP7/2007‐2013) under grant agreement no. HEALTH‐F2‐2011‐278913. The MORGAM collaboration was funded by the European Commission Seventh Framework Programme, references FP7/2007‐2013 (HEALTH‐F4‐2007‐2014113, ENGAGE; HEALTH‐F3‐2010‐242244, CHANCES). V.S. has been supported by the Finnish Foundation for Cardiovascular Research.
Funding Information:
The KORA study was initiated and financed by the Helmholtz Zentrum München – German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. Furthermore, KORA research was supported within the Munich Center of Health Sciences (MC‐Health), Ludwig‐Maximilians‐Universität, as part of LMUinnovativ. Open Access funding enabled and organized by Projekt DEAL.
Funding Information:
The Northern Sweden MONICA project was supported by Norrbotten and Västerbotten County Councils, with substantial contributions from the Swedish Research Council, the Swedish Environmental Protection Agency, and the Umeå University. Dr Söderberg has been supported by the Swedish Heart–Lung Foundation (grant nos 20140799, 20120631, 20100635), the County Council of Västerbotten (ALF, VLL‐548791), and the Umeå University.
Funding Information:
S.B.: None related to the current work. Outside: Research funding from Abbott Diagnostics, Bayer, SIEMENS, Singulex, and Thermo Fisher; speakers fee from Abbott, Abbott Diagnostics, Astra Zeneca, Bayer, AMGEN, Medtronic, Pfizer, Roche, SIEMENS Diagnostics, SIEMENS, and Thermo Fisher; and honoraria as a member of Advisory Boards and for consulting for Bayer, Novartis, and Thermo Fisher.
Funding Information:
T.Z.: None related to the current work. Outside: Research funding from the German Centre of Cardiovascular Research (grant number 81Z1710101) and by the European Research Area Network (ERA‐Net) (PREMED‐CAD) (grant no. FKZ01KL1807).
Funding Information:
W.K.: None related to the current work. Outside: Personal fees for consulting from AstraZeneca, Novartis, DalCor, Kowa, and Amgen and grants and non‐financial support from Roche Diagnostics, Beckmann, Singulex, and Abbott.
Funding Information:
B.S.: None related to the current work. Outside: Funding by the German Research Foundation and by the Else Kröner‐Fresenius‐Stiftung and speakers fee by AstraZeneca and Abiomed.
Funding Information:
The Tromsø study is mainly funded by the University of Tromsø, with substantial contributions from the Research Council of Norway, the National Screening Services, the Northern Norway Regional Health Authority, the Norwegian Council on Cardiovascular Diseases, and the Norwegian EXTRA Foundation for Health and Rehabilitation.
Funding Information:
M.K.: Research funding, honoraria for lectures, and personal fees for consulting from Vifor Pharma. Outside the submitted work: Personal fees and honoraria for consulting and lectures from AstraZeneca, Adrenomed, Amgen, and Sanofi and research funding by the European Research Area Network (ERA‐Net) (PREMED‐CAD) (grant no. FKZ01KL1807).
Publisher Copyright:
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.