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Schrage, B.* ; Rübsamen, N.* ; Ojeda, F.M.* ; Thorand, B. ; Peters, A. ; Koenig, W.* ; Söderberg, S.* ; Söderberg, M.* ; Mathiesen, E.B.* ; Njølstad, I.* ; Kee, F.* ; Linneberg, A.* ; Kuulasmaa, K.* ; Tarja, P.* ; Salomaa, V.* ; Blankenberg, S.* ; Zeller, T.* ; Karakas, M.*

Association of iron deficiency with incident cardiovascular diseases and mortality in the general population.

ESC Heart Fail. 8, 4584–4592 (2021)
Publ. Version/Full Text Research data DOI PMC
Open Access Gold
Creative Commons Lizenzvertrag
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.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Cardiovascular ; General Population ; Iron Deficiency ; Mortality ; Risk Factor; Chronic Heart-failure; Ferric Carboxymaltose; Risk; Inflammation; Diagnosis; Morgam; Anemia
ISSN (print) / ISBN 2055-5822
e-ISSN 2055-5822
Journal ESC heart failure
Quellenangaben Volume: 8, Issue: , Pages: 4584–4592 Article Number: , Supplement: ,
Publisher Wiley
Publishing Place One Montgomery St, Suite 1200, San Francisco, Ca 94104 Usa
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology II (EPI2)
Grants European Union Seventh Framework Programme
University of Tromsø
Research Council of Norway
National Screening Services
Northern Norway Regional Health Authority
Norwegian Council on Cardiovascular Diseases
EkstraStiftelsen Helse og Rehabilitering (Stiftelsen Dam)
Helmholtz Zentrum Munchen - German Research Center for Environmental Health
German Federal Ministry of Education and Research (BMBF)
State of Bavaria
Munich Center of Health Sciences (MC-Health), Ludwig-Maximilians-Universität
Umeå University
Swedish Environmental Protection Agency
Swedish Research Council
Norrbotten and Västerbotten County Councils
Finnish Foundation for Cardiovascular research
European Commission Seventh Framework Programme
County Council of Västerbotten