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Abstract: TH-PO678

Iron Deficiency and Incident Heart Failure in Community Dwelling Individuals

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Sharma, Shilpa, University of California Los Angeles, Los Angeles, California, United States
  • Katz, Ronit, University of Washington, Seattle, Washington, United States
  • Chaves, Paulo H. M., Florida International University, Miami, Florida, United States
  • Hoofnagle, Andrew N., University of Washington, Seattle, Washington, United States
  • Kizer, Jorge R., University of California San Francisco, San Francisco, California, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
  • Bansal, Nisha, University of Washington, Seattle, Washington, United States
  • Ganz, Tomas, University of California Los Angeles, Los Angeles, California, United States
  • Ix, Joachim H., University of California San Diego, La Jolla, California, United States
Background

Iron deficiency has been linked to heart failure (HF) admissions in persons with prevalent HF and clinical trials demonstrate IV iron improves outcomes in prevalent HF. We examined the relationship of iron status with incident HF in community dwelling older adults and evaluated separately in those with and without CKD.

Methods

In 980 Cardiovascular Health Study participants aged > 65 years without HF (41% with CKD), we used a case-cohort design and weighted Cox models to evaluate associations of iron status with incident HF. Participants were categorized based on quartiles of transferrin saturation and ferritin as “Iron Replete” (13.9 % of participants; referent group), “Functional Iron Deficiency” (7.7%), “Iron Deficiency” (11.6%), “Mixed Iron Deficiency” (iron indices between the Iron Deficiency and Functional Iron Deficiency groups; 5.6%), “High Iron” (9.7%) and “Non-classified” (51.3%), consistent with prior studies. As c-terminal (but not intact) fibroblast growth factor-23 (FGF23) marks iron deficiency, we explored whether adjustment attenuated associations. We tested for interaction by CKD status (eGFR ≥60 vs. less).

Results

Compared to those deemed iron replete, iron deficiency independently associated with incident HF (HR 1.47; 1.03-2.11) whereas other iron categories did not, in models adjusted for traditional risk factors and kidney function (Table). Further adjustment for C-terminal FGF23 attenuated the association (HR 1.21;0.83-1.76) whereas intact FGF23 did not (HR 1.48; 1.04-2.11). The relationship of iron deficiency with incident HF was similar irrespective of CKD status (P interaction = 0.4).

Conclusion

Among older community-living persons, iron deficiency is independently associated with incident HF, an association that was similar irrespective of CKD status. Our findings support conduct of clinical trials of iron replacement for prevention of HF in older adults with iron deficiency.

Funding

  • NIDDK Support