Background

Whether iron deficiency contributes to incident heart failure (HF) and cardiac dysfunction has important implications given the prevalence of iron deficiency and the availability of several therapeutics for iron repletion.

Objectives

The aim of this study was to estimate the associations of plasma ferritin level with incident HF overall, HF phenotypes, and cardiac structure and function measures in older adults.

Methods

Participants in the ongoing, longitudinal ARIC (Atherosclerosis Risk In Communities) study who were free of prevalent HF and anemia were studied. The associations of plasma ferritin levels with incident HF overall and heart failure with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) were estimated using Cox proportional hazards regression models. Linear regression models estimated the cross-sectional associations of plasma ferritin with echocardiographic measures of cardiac structure and function.

Results

The cohort included 3,472 individuals with a mean age of 75 ± 5 years (56% women, 14% Black individuals). In fully adjusted models, lower ferritin was associated with higher risk for incident HF overall (HR: 1.20 [95% CI: 1.08-1.34] per 50% lower ferritin level) and higher risk for incident HFpEF (HR: 1.28 [95% CI: 1.09-1.50]). Associations with incident HFrEF were not statistically significant. Lower ferritin levels were associated with higher E/e′ ratio and higher pulmonary artery systolic pressure after adjustment for demographics and HF risk factors but not with measures of left ventricular structure or systolic function.

Conclusions

Among older adults without prevalent HF or anemia, lower plasma ferritin level is associated with a higher risk for incident HF, HFpEF, and higher measures of left ventricular filling pressure.

中文翻译：

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血浆铁蛋白水平、心力衰竭以及心脏结构和功能：ARIC 研究

背景

鉴于缺铁的普遍性以及多种补铁疗法的可用性，缺铁是否会导致心力衰竭（HF）和心功能障碍具有重要意义。

目标

本研究的目的是评估老年人血浆铁蛋白水平与总体心力衰竭、心力衰竭表型以及心脏结构和功能测量的关系。

方法

我们对正在进行的纵向 ARIC（社区动脉粥样硬化风险）研究中没有普遍心衰和贫血的参与者进行了研究。使用 Cox比例风险回归模型估计血浆铁蛋白水平与总体心力衰竭、射血分数保留型心力衰竭(HFpEF) 和射血分数降低型心力衰竭 (HFrEF) 之间的关联。线性回归模型估计了血浆铁蛋白与心脏结构和功能的超声心动图测量的横截面关联。

结果

该队列包括 3,472 名平均年龄为 75 ± 5 岁的人（56% 为女性，14% 为黑人）。在完全调整的模型中，较低的铁蛋白与较高的 HF 总体风险相关（铁蛋白水平每降低 50%，HR：1.20 [95% CI：1.08-1.34]），并且较高的 HFpEF 风险（HR：1.28 [95% CI：1.08-1.34]） ：1.09-1.50]）。与 HFrEF 事件的相关性没有统计学意义。调整人口统计学和心力衰竭危险因素后，较低的铁蛋白水平与较高的 E/e' 比值和较高的肺动脉收缩压相关，但与左心室结构或收缩功能的测量无关。

结论

在没有普遍心衰或贫血的老年人中，较低的血浆铁蛋白水平与较高的心衰、HFpEF 风险和较高的左心室充盈压测量相关。