Ferritin levels and risk of heart failure—the Atherosclerosis Risk in Communities Study

Aims Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community‐based cohort. Methods...

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Published inEuropean journal of heart failure Vol. 19; no. 3; pp. 340 - 347
Main Authors Silvestre, Odilson M., Gonçalves, Alexandra, Nadruz Jr, Wilson, Claggett, Brian, Couper, David, Eckfeldt, John H., Pankow, James S., Anker, Stefan D., Solomon, Scott D.
Format Journal Article
LanguageEnglish
Published Oxford, UK John Wiley & Sons, Ltd 01.03.2017
Subjects
Biomarkers - blood
Cohort Studies
Female
Ferritin
Ferritins - blood
Heart failure
Heart Failure - blood
Heart Failure - epidemiology
Humans
Incidence
Iron - blood
Iron deficiency
Iron overload
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
United States - epidemiology
Heart failure
Iron overload
Iron deficiency
Ferritin
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Abstract Aims Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community‐based cohort. Methods and results We examined 1063 participants who were free of heart failure from the Atherosclerosis Risk in Communities (ARIC) Study in whom ferritin serum levels were measured at baseline (1987–1989). The participants (mean age 52.7 ± 5.5 years, 62% women), were categorized in low (<30 ng/mL; n = 153), normal (30–200 ng/mL in women and 30–300 ng/mL in men; n = 663), and high (>200 ng/mL in women and >300 ng/mL in men; n = 247) ferritin levels. Multivariable Cox proportional hazards models were used to evaluate the relationship between ferritin and incident HF. After 21 ± 4.6 years of follow‐up, HF occurred in 144 (13.5%) participants. When compared with participants with normal ferritin levels, participants with low ferritin levels had a higher risk of HF [hazard ratio (HR) = 2.24, 95% confidence interval (CI) 1.15–4.35; P = 0.02] as did those with high ferritin levels (HR = 1.81, 95% CI 1.01–3.25; P = 0.04), after adjusting for potential confounders. Notably, low ferritin levels remained associated with incident HF even after excluding subjects with anaemia (HR = 2.28, 95% CI 1.11–4.68; P = 0.03). Conclusion Derangements in iron metabolism, either low or high ferritin serum levels, were associated with higher risk of incident HF in a general population, even without concurrent anaemia. These findings suggest that iron imbalance might play a role in the development of HF.
AbstractList Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community-based cohort. We examined 1063 participants who were free of heart failure from the Atherosclerosis Risk in Communities (ARIC) Study in whom ferritin serum levels were measured at baseline (1987-1989). The participants (mean age 52.7 ± 5.5 years, 62% women), were categorized in low (<30 ng/mL; n = 153), normal (30-200 ng/mL in women and 30-300 ng/mL in men; n = 663), and high (>200 ng/mL in women and >300 ng/mL in men; n = 247) ferritin levels. Multivariable Cox proportional hazards models were used to evaluate the relationship between ferritin and incident HF. After 21 ± 4.6 years of follow-up, HF occurred in 144 (13.5%) participants. When compared with participants with normal ferritin levels, participants with low ferritin levels had a higher risk of HF [hazard ratio (HR) = 2.24, 95% confidence interval (CI) 1.15-4.35; P = 0.02] as did those with high ferritin levels (HR = 1.81, 95% CI 1.01-3.25; P = 0.04), after adjusting for potential confounders. Notably, low ferritin levels remained associated with incident HF even after excluding subjects with anaemia (HR = 2.28, 95% CI 1.11-4.68; P = 0.03). Derangements in iron metabolism, either low or high ferritin serum levels, were associated with higher risk of incident HF in a general population, even without concurrent anaemia. These findings suggest that iron imbalance might play a role in the development of HF.
Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community-based cohort.AIMSSevere iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community-based cohort.We examined 1063 participants who were free of heart failure from the Atherosclerosis Risk in Communities (ARIC) Study in whom ferritin serum levels were measured at baseline (1987-1989). The participants (mean age 52.7 ± 5.5 years, 62% women), were categorized in low (<30 ng/mL; n = 153), normal (30-200 ng/mL in women and 30-300 ng/mL in men; n = 663), and high (>200 ng/mL in women and >300 ng/mL in men; n = 247) ferritin levels. Multivariable Cox proportional hazards models were used to evaluate the relationship between ferritin and incident HF. After 21 ± 4.6 years of follow-up, HF occurred in 144 (13.5%) participants. When compared with participants with normal ferritin levels, participants with low ferritin levels had a higher risk of HF [hazard ratio (HR) = 2.24, 95% confidence interval (CI) 1.15-4.35; P = 0.02] as did those with high ferritin levels (HR = 1.81, 95% CI 1.01-3.25; P = 0.04), after adjusting for potential confounders. Notably, low ferritin levels remained associated with incident HF even after excluding subjects with anaemia (HR = 2.28, 95% CI 1.11-4.68; P = 0.03).METHODS AND RESULTSWe examined 1063 participants who were free of heart failure from the Atherosclerosis Risk in Communities (ARIC) Study in whom ferritin serum levels were measured at baseline (1987-1989). The participants (mean age 52.7 ± 5.5 years, 62% women), were categorized in low (<30 ng/mL; n = 153), normal (30-200 ng/mL in women and 30-300 ng/mL in men; n = 663), and high (>200 ng/mL in women and >300 ng/mL in men; n = 247) ferritin levels. Multivariable Cox proportional hazards models were used to evaluate the relationship between ferritin and incident HF. After 21 ± 4.6 years of follow-up, HF occurred in 144 (13.5%) participants. When compared with participants with normal ferritin levels, participants with low ferritin levels had a higher risk of HF [hazard ratio (HR) = 2.24, 95% confidence interval (CI) 1.15-4.35; P = 0.02] as did those with high ferritin levels (HR = 1.81, 95% CI 1.01-3.25; P = 0.04), after adjusting for potential confounders. Notably, low ferritin levels remained associated with incident HF even after excluding subjects with anaemia (HR = 2.28, 95% CI 1.11-4.68; P = 0.03).Derangements in iron metabolism, either low or high ferritin serum levels, were associated with higher risk of incident HF in a general population, even without concurrent anaemia. These findings suggest that iron imbalance might play a role in the development of HF.CONCLUSIONDerangements in iron metabolism, either low or high ferritin serum levels, were associated with higher risk of incident HF in a general population, even without concurrent anaemia. These findings suggest that iron imbalance might play a role in the development of HF.
Aims Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community‐based cohort. Methods and results We examined 1063 participants who were free of heart failure from the Atherosclerosis Risk in Communities (ARIC) Study in whom ferritin serum levels were measured at baseline (1987–1989). The participants (mean age 52.7 ± 5.5 years, 62% women), were categorized in low (<30 ng/mL; n = 153), normal (30–200 ng/mL in women and 30–300 ng/mL in men; n = 663), and high (>200 ng/mL in women and >300 ng/mL in men; n = 247) ferritin levels. Multivariable Cox proportional hazards models were used to evaluate the relationship between ferritin and incident HF. After 21 ± 4.6 years of follow‐up, HF occurred in 144 (13.5%) participants. When compared with participants with normal ferritin levels, participants with low ferritin levels had a higher risk of HF [hazard ratio (HR) = 2.24, 95% confidence interval (CI) 1.15–4.35; P = 0.02] as did those with high ferritin levels (HR = 1.81, 95% CI 1.01–3.25; P = 0.04), after adjusting for potential confounders. Notably, low ferritin levels remained associated with incident HF even after excluding subjects with anaemia (HR = 2.28, 95% CI 1.11–4.68; P = 0.03). Conclusion Derangements in iron metabolism, either low or high ferritin serum levels, were associated with higher risk of incident HF in a general population, even without concurrent anaemia. These findings suggest that iron imbalance might play a role in the development of HF.
Author Solomon, Scott D.
Pankow, James S.
Silvestre, Odilson M.
Gonçalves, Alexandra
Eckfeldt, John H.
Couper, David
Claggett, Brian
Nadruz Jr, Wilson
Anker, Stefan D.
AuthorAffiliation Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
University of Porto Medical School, Porto, Portugal
Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
University of Campinas, Campinas, Brazil
University of North Carolina, NC, USA
University of Minnesota, Minneapolis, MN, USA
AuthorAffiliation_xml – name: University of Campinas, Campinas, Brazil
– name: Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
– name: University of Porto Medical School, Porto, Portugal
– name: University of Minnesota, Minneapolis, MN, USA
– name: University of North Carolina, NC, USA
– name: Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
Author_xml – sequence: 1
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  surname: Silvestre
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  organization: Brigham and Women's Hospital, 75 Francis Street
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  givenname: Alexandra
  surname: Gonçalves
  fullname: Gonçalves, Alexandra
  organization: University of Porto Medical School
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  surname: Nadruz Jr
  fullname: Nadruz Jr, Wilson
  organization: University of Campinas
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  surname: Solomon
  fullname: Solomon, Scott D.
  email: ssolomon@rics.bwh.harvard.edu
  organization: Brigham and Women's Hospital, 75 Francis Street
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Keywords Heart failure
Iron overload
Iron deficiency
Ferritin
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Snippet Aims Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This...
Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This...
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SubjectTerms Biomarkers - blood
Cohort Studies
Female
Ferritin
Ferritins - blood
Heart failure
Heart Failure - blood
Heart Failure - epidemiology
Humans
Incidence
Iron - blood
Iron deficiency
Iron overload
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
United States - epidemiology
Title Ferritin levels and risk of heart failure—the Atherosclerosis Risk in Communities Study
URI https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fejhf.701
https://www.ncbi.nlm.nih.gov/pubmed/27976478
https://www.proquest.com/docview/1852682429
https://pubmed.ncbi.nlm.nih.gov/PMC5334451
Volume 19
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