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Ferritin levels and risk of heart failure—the Atherosclerosis Risk in Communities Study
Author(s) -
Silvestre Odilson M.,
Gonçalves Alexandra,
Nadruz Jr Wilson,
Claggett Brian,
Couper David,
Eckfeldt John H.,
Pankow James S.,
Anker Stefan D.,
Solomon Scott D.
Publication year - 2017
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.701
Subject(s) - medicine , hazard ratio , ferritin , heart failure , proportional hazards model , confidence interval , incidence (geometry) , confounding , atherosclerosis risk in communities , cohort study , cohort , gastroenterology , cardiology , physics , optics
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 .