What's the difference between a heart attack and cardiac arrest?
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A heart attack is a medical emergency whereby the supply of blood to the heart is suddenly blocked, usually by a blood clot. Your risk of having a heart attack is intimately tied to poor lifestyle decisions, but some are more obvious than others. A new study published in the journal of the European Society of Cardiology has shone light on a lesser-known risk factor: iron deficiency.
Iron deficiency was shown to hike the risk of coronary heart disease (CHD) – the leading cause of heart attacks.
“This was an observational study and we cannot conclude that iron deficiency causes heart disease,” said study author doctor Benedikt Schrage of the University Heart and Vasculature Centre Hamburg, Germany.
“However, evidence is growing that there is a link and these findings provide the basis for further research to confirm the results.”
The current study aimed to examine whether the association between iron deficiency and outcomes was also observed in the general population.
The study included 12,164 individuals from three European population-based cohorts. The median age was 59 years and 55 percent were women.
During the baseline study visit, cardiovascular risk factors and comorbidities (one or more underlying conditions) such as smoking, obesity, diabetes and cholesterol were assessed via a thorough clinical assessment including blood samples.
Participants were classified as iron deficient or not according to two definitions: 1) absolute iron deficiency, which only includes stored iron (ferritin); and 2) functional iron deficiency, which includes iron in storage (ferritin) and iron in circulation for use by the body (transferrin).
Doctor Schrage explained: “Absolute iron deficiency is the traditional way of assessing iron status but it misses circulating iron. The functional definition is more accurate as it includes both measures and picks up those with sufficient stores but not enough in circulation for the body to work properly.”
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Participants were followed up for incident coronary heart disease and stroke, death due to cardiovascular disease, and all-cause death.
The researchers analysed the association between iron deficiency and incident coronary heart disease, stroke, cardiovascular mortality, and all-cause mortality after adjustments for age, sex, smoking, cholesterol, blood pressure, diabetes, body mass index, and inflammation.
Participants with a history of coronary heart disease or stroke at baseline were excluded from the incident disease analyses.
At baseline, 60 percent of participants had absolute iron deficiency and 64 percent had functional iron deficiency. During a median follow-up of 13.3 years there were 2,212 (18.2 percent) deaths.
Of these, a total of 573 individuals (4.7 percent) died from a cardiovascular cause. Incidence coronary heart disease and stroke were diagnosed in 1,033 (8.5 percent) and 766 (6.3 percent) participants, respectively.
Functional iron deficiency was associated with a 24 percent higher risk of coronary heart disease, 26 percent raised risk of cardiovascular mortality, and 12 percent increased risk of all-cause mortality compared with no functional iron deficiency.
Absolute iron deficiency was associated with a 20 percent increased risk of coronary heart disease compared with no absolute iron deficiency, but was not linked with mortality.
There were no associations between iron status and incident stroke.
“This analysis suggests that if iron deficiency had been absent at baseline, about five percent of deaths, 12 percent of cardiovascular deaths, and 11 percent of new coronary heart disease diagnoses would not have occurred in the following decade,” said doctor Schrage.
“The study showed that iron deficiency was highly prevalent in this middle-aged population, with nearly two-thirds having functional iron deficiency,” said doctor Schrage.
“These individuals were more likely to develop heart disease and were also more likely to die during the next 13 years.”
Doctor Schrage noted that future studies should examine these associations in younger and non-European cohorts.
He said: “If the relationships are confirmed, the next step would be a randomised trial investigating the effect of treating iron deficiency in the general population.”
“UK dietary surveys indicate that many women are not getting enough iron,” reports the British Dietetic Association (BDA).
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