Treatment of anemia in heart failure: potential risks and benefits of intravenous iron therapy in cardiovascular disease.
Iron-deficiency anemia is common in patients with heart failure (HF), but the optimum diagnostic tests to detect iron deficiency and the treatment options to replete iron have not been fully characterized. Recent studies in patients with HF indicate that intravenous iron can rapidly replenish iron stores in patients having iron-deficiency anemia, with resultant increased hemoglobin levels and improved functional capacity. Preliminary data from a subgroup analysis also suggest that supplemental intravenous iron therapy can improve functional capacity even in those subjects without anemia. The mechanisms responsible for this observation are not fully characterized, but may be related to beneficial effects of iron supplementation on mitochondrial respiration in skeletal muscle. The long-term safety of using intravenous iron supplementation in HF populations is not known. Iron is a known pro-oxidant factor that can inhibit nitric oxide signaling and irreversibly injury cells. Increased iron stores are associated with vascular endothelial dysfunction and increased risk of coronary heart disease events. Additional clinical trials are needed to more fully characterize the therapeutic potential and safety of intravenous iron in HF patients.
Jelani
Qurat-ul-ain
QU
Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, NY 10016, USA.
Katz
Stuart D
SD
D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D019587:Dietary Supplements; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects; D007501:Iron / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D014131:Trace Elements / Q000009:adverse effects / Q000627:therapeutic use*
D014131:Trace Elements; D007501:Iron